Nifedipine Alcohol

Qureshi S, Laganiere S, McGilveray IJ, Lacasse Y, CaUe G. Nifedipine-alcohol interaction. JAMA 1990 264(13) 1660-1. 

We describe below the use of halloysite nanotubules for entrapment and the subsequent release of three drugs Nifedipine (anti-anginal), Furosemide (anti-hypertension and diuretic), and Dexamethasone (synthetic corticosteroid). To increase the loading of these poorly soluble drugs in the tubules, we loaded them into a water-alcohol co-solvent solution (0, 10, and 50% ethanol). 

Drugs that may affect metformin include alcohol, cationic drugs, cimetidine, furosemide, iodinated contrast material, and nifedipine. 

Drugs that affect all phosphodiesterase type 5 inhibitors include the following alcohol, amlodipine, angiotensin II receptor blockers, antacids, bendroflumethiazide, beta blockers, cimetidine, diuretics, enalaphl, metoprolol, nifedipine, rifampin, tacrolimus. 

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

Alcohol, antidepressants, hypnotics, sedatives, tranquillizers, fenfluramine, levodopa, vasodilators such as nitrates, nifedipine, verapamil Potentiation. 

Nifedipine conformed to USP XXI Eudragit RS and RL were kindly provided by Roehm Pharma GmbH (Darmstadt, FRG) polyvinyl alcohol (PVA), MW of 14 000, was supplied by BDH Laboratory (Poole, UK). 

Fig. 1—Scanning electron micrograph of nifedipine-loaded microspheres (4.7% w/w) prepared using 1 1 of 0.8% polyvinyl alcohol solution, 25 g Eufragit RS RL mixture. (1 1) in 80 ml methylene chloride stirred at 400 rev/min.

Glyceryl trinitrate overdose should be treated with the patient s head lowered. Other measures include respiration maintenance, use of plasma expanders, and electrolyte balance. Withdrawal of heparin treatment or dose reduction should be performed with the overdose of heparin. Protamine sulfate may be used to reduce severe bleeding. Heparin should be used with caution with glyceryl trinitrate, aprotinine, alcohol, tobacco, and ACE inhibitors. Nifedipine should be used with care when coadministering with immunosuppressants, magnesium salts, tobacco, digoxin, antineoplastics, calcium channel blockers, antihistamines, antifungals, antiepileptics, antiarrhythmics, and alcohol. 

Thoma and Klimek (115) also found that the natural food colorant curcumin as well as Fast Yellow, chrysoine, apocarotinol, and, cochineal Red A photostabi-lized solutions of nifedipine and nitrofurazone. They also found that vanillin and methyl gallate could stabilize solutions of dihydroergotamine. These authors also found that furosemide was stabilized by the addition of vanillin, haloperidol by benzyl alcohol, and vanillin and thiothixene by quinosol and vanillin. 

Suzuki and Sunada " also prepared solid dispersions of nifedipine with other combined carriers using a fusion (melt) method. The combined carriers were nicotinamide and four different water-soluble polymers hydroypropyl methylcellulose (HPMC), polyvinylpyrrolidone (PVP), partially hydrolyzed polyvinyl alcohol (PVA), and pullulan. HPMC, PVP, and PVA dissolved in the melt of nicotinamide and were effective in the amorphous formation of nifedipine in solid dispersions. In dissolution studies, the drug concentration... 

There is a substantial increase in the systemic availability of nifedipine when alcohol is taken at the same time (51). 

Babany G, UzzanF, Larrey D, Degott C, Bourgeois P, Rene E, Vissuzaine C, Erlinger S, Benhamou JP. Alcoholic-like liver lesions induced by nifedipine. J Hepatol 1989 9(2) 252-5. 

Calcium-channel blockers Nifedipine and verapamil can increase alcohol serum levels by about 15-50%. The mechanism is speculated to be via inhibition of hepatic alcohol metabolism. Some data suggest that alcohol might also inhibit the metabolism of nifedipine, thus raising its serum levels with consequent effects. 

Not understood. It seems possible that verapamil inhibits the metabolism of aleohol by the liver, thereby redueing its loss from the body. Aleohol also appears to inhibit the metabolism of nifedipine, and to inerease the bioavailability of felodipine. Red wine may have eaused dose dumping of felodipine from the extended-release preparation whieh altered its phar-maeokinetie profile, but the reason why the felodipine levels remained low until after a meal is unclear. An in vitro study demonstrated that alcohol inhibited the oxidative metabolism of nifedipine by the cytochrome P450 isoenzyme CYP3A. ... 

Blood-alcohol levels can be raised and may remain elevated for a much longer period of time in patients taking verapamil. Alcohol may also increase the bioavailability of felodipine and nifedipine, but amlodipine appears not to interact. An increased incidence of postural hypotension has been reported in patients who took felodipine with alcohol... 

The bioavailability of felodipine and nifedipine appear to be increased by alcohol. The manufacturers of some calcium-channel blockers warn that inter-individual variations in the response to these drugs can occur and some patients ability to drive or operate machinery may be impaired, particularly at the start of treatment and in conjunction with alcohol. " Patients should therefore be advised about these effects. Note that long-term moderate to heavy drinking can impair the efficacy of antihypertensives. See also Alcohol + Antihypertensives , p.48. 

Qureshi S, Laganiere S, Caille G, Gossard D, Lacasse Y, McGilveray I. Effect of an acute dose of alcohol on the pharmacokinetics of oral nifedipine in humans. PharmRes (1992) 9, 683-6. 

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