It has anti-anginal and anti-hypertensive action. Reduces current extracellular calcium into cardiomyocytes and smooth muscle cells of the coronary and peripheral arteries; at high doses inhibits the release of calcium ions from intracellular stores. Reduces nandrolone phenylpropionate side effects the number of operating channels, without affecting the time of activation, inactivation and recovery.
Dissociative processes of excitation and contraction in the myocardium mediated by tropomyosin and troponin, in vascular smooth muscle, mediated by calmodulin. At therapeutic doses, it normalizes the transmembrane current of calcium ions, disrupted in a number of pathological conditions, especially in arterial hypertension. No effect on venous tone. It increases coronary blood flow, and improves blood flow to the ischemic myocardium areas without development “steal” phenomenon, activates functioning collaterals.
It improves myocardial function, reduces the force of heart rate and myocardial oxygen demand. Expanding the peripheral arteries, lowers blood pressure (BP) and reduce total peripheral resistance and afterload on the heart. Almost no effect on the sinoatrial and atrioventricular nodes. It increases renal blood flow, causing a mild natriuresis.
Inhibits platelet aggregation, has anti-atherogenic properties (especially long-term use). Lowers blood pressure in the pulmonary artery, has a positive impact on the blood supply to the brain vessels. Plasma concentration reaches a plateau after approximately 6 hours and is supported with slight fluctuations during the 24 hours. The half-life is approximately 2 hours. It is metabolized in the liver. Active metabolites have been identified. Displays in the form of inactive metabolites, mainly kidneys (80%) and bile (20%). Nifedipine penetrates the blood-brain and placental barrier, excreted in breast milk. The cumulative effect is not. Chronic renal failure, hemodialysis and peritoneal dialysis have no effect on the pharmacokinetics. If abnormal liver function clearance of nifedipine reduced. In severe hepatic dysfunction may require dose adjustment. Elderly patients with intravenous nandrolone phenylpropionate side effects use of nifedipine clearance was reduced by 33% as compared to young healthy volunteers. With prolonged use can be observed the development of tolerance to the nifedipine.
• coronary heart disease (CHD): stable angina, vasospastic angina (Prinzmetal angina).
• Hypersensitivity to nifedipine or components of the drug and other derivatives of 1,4-dihydropyridine;
• severe hypotension (systolic blood pressure blood pressure below 90 mmHg);
• severe aortic valve stenosis with clinically significant hemodynamic impairment;
• unstable angina;
• chronic heart failure decompensation, cardiogenic shock (risk of myocardial infarction), acute phase of myocardial infarction (within the first 4 weeks);
• concurrent use of rifampicin;
• a rare hereditary form of lactose intolerance, lactase or malabsorption deficiency of glucose / galactose (as in the composition contains lactose);
• pregnancy up to 20 weeks, the period of breast-feeding;
• the age of 18 years (effectiveness and safety have been established).
Stenosis of the aortic or mitral valve; hypertrophic obstructive cardiomyopathy; marked tachycardia; sick sinus syndrome; malignant hypertension; myocardial infarction with left ventricular failure;cerebrovascular diseases; of the liver and / or kidney problems; hemodialysis (risk of arterial hypotension); diabetes; bowel obstruction; pregnancy after 20 weeks; the simultaneous use of beta-blockers or cardiac glycosides, inducers or inhibitors of CYP3A4.
Application of pregnancy and during breastfeeding
Some studies blockers “slow” calcium channel blockers such as nifedipine, resulted in reversible sperm heads biochemical changes that may disrupt their function. In men, repeatedly experiencing problems in conceiving a child in vitro fertilization, as one of the possible causes should be considered the use of nifedipine, if no other explanation can be found. Pregnancy is controlled by the use of nifedipine studies in pregnant women have been conducted. Studies in animals have shown teratogenicity and embryo / fetotokichnost nifedipine. Use of the drug Nifecard ® CL to 20 weeks is contraindicated. Use of the drug Nifecard ® CL after the 20th week of pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus and the drug should be used only in a hospital with a corresponding control status of the mother and fruit (control of blood pressure of the mother; a regular ultrasound monitoring of fetal growth and survival). In the event of anomalies should stop using the drug.Breastfeeding Period Nifedipine passes into breast milk, therefore the application of lactation, it is necessary to resolve the issue of termination of breastfeeding.
Dosing and Administration
Tablets should be taken at the same time of day, not liquid, they can not be split up or divide. Dosage is determined individually. Tablets can not drink grapefruit juice.
Sclearance of nifedipine is possible in elderly patients, therefore, may require lower maintenance doses than younger patients. In patients with impaired liver function the use of nifedipine should be under close surveillance and reduction in dose may be required, if necessary. In patients with impaired renal function dose adjustment is required. patients with severe cerebrovascular disease need to treat a low dose. if necessary, discontinuation nandrolone phenylpropionate side effects, the dose should be reduced gradually.
According to the World Health Organization (WHO) adverse reactions are classified according to their rate of development as follows: very common (≥1 / 10), commonly (≥1 / 100, <1/10), uncommon (≥1 / 1000, < 1/100), rare (≥1 / 10,000, <1/1000) and very rare (<1/10000); the frequency is unknown – according to available data to set the frequency of occurrence is not possible. On the part of the blood and lymphatic system frequency is not known: agranulocytosis, leukopenia, anemia, thrombocytopenia. Immune system rare: allergic reactions, allergic edema / angioedema rarely: itching, skin rash, hives, the frequency is unknown: anaphylactic / anaphylactoid reactions, toxic epidermal necrolysis, exfoliative dermatitis, fotodermatit, autoimmune hepatitis, thrombocytopenic purpura. On the part of metabolism and supply frequency is not known: hyperglycemia. From the nervous system common: headache; uncommon: dizziness, headache, fatigue, tremor, rarely: paresthesia / dysesthesia limbs; the frequency is unknown: long-term use at high doses – depression, anxiety, extrapyramidal (parkinsonian) disorders (ataxia, “mask-like” face, “shuffling” gait, stiffness movements of arms and legs, tremors of the hands and fingers, difficulty swallowing, gipostezii, drowsiness), irritability, sleep disturbances (including insomnia), night “nightmares”, decreased libido. From a sight organ rare: visual disturbances (transient); the frequency is unknown: in the eye pain. On the part of the organ of hearing and labyrinth disorders uncommon: “ringing” in the ears, dysgeusia (taste disturbance .) On the part of the cardiovascular systemoften: peripheral edema, increased vasodilation symptoms (asymptomatic decrease in blood pressure, “tides” of blood to the skin of the face, facial flushing, hot flashes); rare: tachycardia, palpitations, arrhythmia, excessive reduction of blood pressure ( particularly in patients on dialysis with malignant hypertension and a reduced volume of circulating blood), syncope, syncope; very rarely in some patients, especially at the beginning of treatment, angina pectoris attacks may occur, which requires discontinuation of the drug. Described isolated cases of myocardial infarction; Frequency not known: chest pain, worsening of the symptoms of a heart failure. The respiratory system Uncommon: epistaxis, nasal congestion, cough, sinusitis, shortness of breath, upper respiratory tract infection, the frequency is unknown: dyspnea, bronchospasm, pulmonary edema. On the part of the digestive system common: constipation; rare: dryness of the oral mucosa, loss of appetite, dyspepsia (nausea, diarrhea), abdominal pain, rarely: gingival hyperplasia (bleeding, pain, swelling); the frequency is unknown: dysphagia, erosive and ulcerative intestinal mucosa damage , vomiting, lack of gastro-esophageal sphincter, long-term use – the liver (intrahepatic cholestasis, increased activity of “liver” transaminases, jaundice), bezoars (lumps in the stomach from undigested food residues). On the part of the musculoskeletal system and connective tissue rare: convulsions upper and lower extremities, swelling of the joints, back pain, gout, frequency is not known: arthritis, arthralgia, myalgia. With the genitourinary system rare: increase / decrease in the daily urine, erectile dysfunction, rarely gynaecomastia (in older patients, fully disappears after discontinuation of the drug); the frequency is unknown: galactorrhea, worsening of renal function (patients with renal insufficiency). skin and subcutaneous tissue disorders uncommon: alopecia, increased sweating, purpura. General disorders and injection site common: asthenia, fatigue ; rare: nonspecific pain, chills, face edema, periorbital edema, fever, weight gain. prohormonen