Nifedipine 326 INDEX

CANNABIS DILTIAZEM, FELODIPINE, NIFEDIPINE, NIMODIPINE, NISOLDIPINE Unpredictable changes in plasma concentration. Risk of toxicity or therapeutic failure, particularly of drugs with a narrow therapeutic index Induction or inhibition of CYP3A4-mediated metabolism by cannabis. It is not yet known whether the effects are dependent on the degree of cannabis consumption Be aware. Watch for signs of toxicity, especially when cannabis use abruptly changes... 

One of the issues with P450 3A4 is which reaction provides the most appropriate index of activity, both in vitro and in vivo. Historically nifedipine oxidation and testosterone 6p-hydroxy-lation were among the first activities identified and are still used in vitro K Midazolam 1 -hydrox-ylation has also been used , in part because of its acceptance for in vivo assays. 

The UK manufacttners advise caution when cilostazol is given with drugs that are substrates of CYP3A4, especially those with a narrow therapeutic index. They specifically mention cisapride, midazolam, nifedipine and verapamil. Further study is needed to establish these predicted... 

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