nitrendipine

Nitrendipin is a calcium channel blocker of dihydropyridine type which is particularly well studied for the treatment of isolated systolic hypertension in older patients. The Syst-Eur study has shown that Nitrendipin can reduce strokes by 42% and dementia by 50%.

Nitrendipin is taken twice a day and is available as a generic and under the brand name Bayotensin®. It has an average half-life and acts predominantly on the vascular muscle.

Nitrendipin blocks L-type calcium channels in vascular muscle:

Active mechanism:

• Blocks calcium inflow into smooth vascular muscle cells
• Arteries and arteries expand
• Peripheral vascular resistance drops
• Blood pressure drops – especially the systolic value

Special features:

• High vascular selectivity
• Low influence of the heart
• Average half-life (8-12 hours)
• Two daily intake

Clinical meaning: The Syst-Eur study showed that Nitrendipin in older patients with isolated systolic hypertension:

• strokes reduced by 42%
• dementia reduced by 50%
• Cardiovascular events reduced by 31%

Initiation of action: After 1-2 hours. Maximum effect after 1-2 weeks of regular intake.

Nitrendipin is suitable for:

• Adults with high blood pressure
• Especially: Isolated systolic hypertension in older patients

Especially recommended at:

• Older patients (over 60 years) with increased systolic blood pressure
• If stroke prevention is at the forefront
• In combination with other blood pressure

Not suitable:

• unstable angina pectoris
• Acute heart attack (first 4 weeks)
• Heavy heart failure
• Heavy aortic stenosis
• Pregnancy and breastfeeding

High blood pressure:

• start dose: 10 mg once or twice a day
• usual dose: 10-20 mg twice a day
• Maximum dose: 20 mg twice a day (40 mg/day)

Older patients:

• start dose: 5-10 mg once a day
• Slow increase

Available starches:

• 10 mg, 20 mg tablets

Intake:

• One to twice a day (morning and evening)
• Independent meals
• With sufficient water
• Avoid grapefruit juice

• Regular blood pressure controls
• Headaches and flush can occur at the beginning – usually improve
• In case of severe facial redness doctor inform
• Do not drop abruptly (medical consultation)

**Nitrendipin must not be taken at:* *

• Sensitivity to Nitrendipin or other dihydropyridines
• unstable angina pectoris
• Acute heart attack (first 4 weeks)
• Heavy heart failure
• Heavy aortic stenosis
• Cardiogenic shock

Preview at:

• Liver insufficiency (reduced degradation)
• Tachycardia (reflective heart rate increase)
• Heavy kidney failure

pregnant: Contraindicated. Not sufficiently studied during pregnancy.

Acid (1-10%):

• Headaches
• Face redness (Flush)
• Squeeze
• Heart palp
• Ankle edema

** Occasionally (0,1-1%):* *

• Gastrointestinal complaints
• fatigue
• Tachycardia
• Skin rash

Selten:

• Gum growth (Gingivahyperplasia)
• liver value increases
• Allergic reactions
• Chest pain
• Paresthesia

** Flush and headaches are common at the beginning of therapy, but usually improve after 1-2 weeks. In case of persistent complaints, consult doctor.

Preview at:

• Grapefruit juice → increased Nitrendipin level (CYP3A4 inhibition)
• CYP3A4 inhibitors (ketoconazole, erythromycin) → enhanced action
• CYP3A4 inductors (Rifampicin, Phenytoin) → reduced effect
• Other blood pressure counter → increased hypotension
• Digoxin → light mirror increase possible
• Cimetidine → increased Nitrendipin levels

Combinable with:

• ACE inhibitors and sartans
• Beta-blockers (prevented reflextachycardia)
• Diuretics

Alcohol: Strengthens blood pressure-lowering effect. Be careful with simultaneous consumption.