Other drugs that affect the metabolism of nifedipine cisapride simultaneous use of cisapride and nifedipine may lead to increased plasma concentrations of nifedipine. Diltiazem nandrolone phenylpropionate decreases nifedipine clearance and thus increases the plasma concentrations of nifedipine . Therefore, caution should be exercised when using drugs in combination and, if necessary, reduce the dose of nifedipine. Cyclosporine Concomitant use may lead to increased plasma concentrations of nifedipine. Nifedipine effects on other drugs Gipotezivnye drugs may enhance the antihypertensive effect of diuretics, beta-blockers, angiotensin converting enzyme inhibitors , angiotensin II receptor antagonists, other blockers “slow” calcium channel blockers, alpha-blockers, inhibitors, alpha-methyldopa. In the application of nifedipine in conjunction with beta-blockers should be closely monitored for the patient as possible worsening of symptoms a heart failure (described sporadic cases). digoxin simultaneous use of nifedipine and digoxin may cause increased plasma digoxin concentrations, should therefore monitor the concentration of digoxin in serum, and the dose of digoxin needs to be adjusted when necessary. quinidine in an application of nifedipine and quinidine a decrease in plasma quinidine concentration, and in some cases the cancellation of nifedipine showed an increase of its plasma concentrations. It is therefore recommended dose quinidine correction if necessary. Some authors reported increased plasma concentrations of nifedipine, while the use of both drugs. Thus, it should be carefully monitored blood pressure and, if necessary nifedipine dose should be reduced. Tacrolimus has been shown that cyclosporin metabolized via isoenzyme.
Published data indicate that there may be a need to reduce the tacrolimus dose while the use of nifedipine. Vincristine In an application with nifedipine decreases the excretion of vincristine, may need to reduce the dose. magnesium sulfate is necessary to carefully monitor blood pressure with intravenous magnesium sulfate in patients receiving nifedipine, because perhaps marked reduction in blood pressure. Cephalosporins While the use of nifedipine increased plasma concentrations of cephalosporins. Phenytoin Nifedipine may slow the metabolism of phenytoin and increase its toxicity. Patients taking phenytoin, at the beginning of treatment with nifedipine is recommended to monitor the plasma concentration of phenytoin. Nitrates synergistic effects should be taken into account when concomitant use of nifedipine and nitrates. theophylline nifedipine increases the concentration of theophylline in the blood plasma, while the application. fentanylConcomitant use of nifedipine and fentanyl can lead to severe hypotension, so it is advisable to abolish the use of nifedipine (if possible) at least 36 hours prior to anesthesia the use of fentanyl.anticoagulants of indirect action are registered rare reports of increased prothrombin time, while the use of nifedipine with indirect anticoagulants (eg, warfarin).
The relationship to therapy with nifedipine is not installed, the clinical significance of this effect is unknown. Other forms of interaction When spectrophotometric determination vanillylmandelic acid in the urine of nifedipine may be the cause of false-positive results. It is recommended to perform other measurements. Grapefruit juice Grapefruit juice inhibits the isoenzyme of nandrolone phenylpropionate At the same time taking grapefruit juice increases the concentration of nifedipine in blood plasma due to decreased first-pass metabolism. In view of enhancing the bioavailability of nifedipine in patients with severe hypertension or stable angina may develop ischemic complications (heart attack, unstable angina). Drinking grapefruit juice during treatment with nifedipine is not recommended. With the simultaneous application of nifedipine and acetylsalicylic acid, benazepril, candesartan, debrisokvina, doxazosin, irbesartan, omeprazole, orlistat, pantoprazole, ranitidine, rosiglitazone and triamterene / hydrochlorothiazide had any impact on the pharmacokinetics of nifedipine is absent.
To stop treatment is recommended gradually.
It should be borne in mind that in the beginning of treatment may be angina, especially after the recent abrupt withdrawal of beta-blockers (the latter should be lifted gradually).
Concomitant use of beta-blockers should be carried out under careful medical supervision, as this may lead to an excessive fall in blood pressure, and in some cases -. symptoms worsen current heart failure
if the drug expressed cardiac insufficiency dosed with great caution.
Occasionally patients with severe stenosis of the coronary arteries at the beginning of treatment or when increasing the dose of nifedipine may increase the frequency and severity of . anginal pain, until the development of myocardial infarction
diagnostic criteria of drugs in vasospastic angina are: classical clinical picture is accompanied by an increase in the ST segment, the occurrence of ergonovine-induced angina or coronary artery spasm, identify coronary spasm during angiography or detection angiospastic component without confirmation ( . for example, at different threshold voltage or unstable angina, when the electrocardiogram data indicate transient vasoconstriction)
For patients with severe hypertrophic obstructive cardiomyopathy, there is a risk to increase the frequency, severity and duration of symptoms of angina attacks after nifedipine; in this case the necessary removal of the drug.
In patients with diabetes mellitus when using the drug nandrolone phenylpropionatemay be required to control plasma glucose concentration.
In patients on hemodialysis, high blood pressure, and irreversible renal impairment, reduced capacity of the drug circulating blood should used with caution, a sharp drop in blood pressure. can occur
for patients with hepatic impairment feature set closely monitored and, if necessary, reduce the dose and / or use other formulations of nifedipine.
In patients with severe stenosis of any gastrointestinal tract can develop ileus. In very rare cases can develop bezoars, to which may require surgical intervention. In rare cases, symptoms of intestinal obstruction can occur in patients who have no pathology of the gastrointestinal tract. The risk of bezoar elevated in patients with reduced intestinal motility patients (constipation, gastroesophageal reflux disease, obesity, hypothyroidism, diabetes mellitus), colon tumors, diverticulitis, intestinal inflammatory changes vertical gastroplasty, gastric bypass surgery, resection of the small intestine, colostomy, as well as Together with the application blocker of H2-histamine receptors, opioids, non-steroidal anti-inflammatory drugs, anticholinergic drugs, neuromuscular blockers (muscle relaxants), laksativami (laxatives).
There are few reports “sticking” tablets to the intestinal wall with the formation of ulcers, which required hospitalization and surgery.
it should be borne in mind that during radiographic bowel studies with barium can identify false positive symptoms polyp ( “filling” defect).
If during the treatment the patient is required to conduct surgery under general anesthesia, you must inform the anesthesiologist about the nature of the therapy.
Nifedipine, blockers like other “slow” calcium channel blockers, inhibit platelet aggregation in vitro. a small number of reports confirm the data statistically significant decrease in platelet aggregation and increase in bleeding time. The clinical significance of this is unknown.
During treatment possible positive during the direct Coombs reaction and increasing titer of antinuclear antibodies. buy anabolic steroids online bruce lee’s workout anabolic steroids online uk