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Suppresses calcium transport into vascular smooth muscle cells. This suppression inhibits vasoconstriction and dilates coronary arteries, improving myocardial oxygen uptake.
Tablets (extended-release): 8.5 mg, 17 mg, 22.5 mg, 34 mg
Indications and dosages
Adults: Initially, 17 mg P.O. daily; may increase by 8.5 mg per week or longer intervals to attain adequate blood pressure control. Usual maintenance dosage is 17 to 34 mg daily.
• Hypersensitivity to drug or dihydropyridine calcium channel blockers
Use cautiously in:
• heart failure and left ventricular dysfunction, hepatic impairment, renal disease, coronary artery disease, hypotension
• concurrent phenytoin use
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).
• Give with meals, but not with high-fat meals, grapefruit, or grapefruit juice.
• Don't crush or break extended-release tablets. Make sure patient swallows them whole.
• Know that drug may be given alone or with other antihypertensives.
CNS: headache, dizziness
CV: peripheral edema, chest pain, vasodilation, hypotension, palpitations
EENT: pharyngitis, sinusitis
Drug-drug. Cimetidine: increased nisoldipine blood level
Phenytoin, other CYP3A4 inducers: decreased nisoldipine blood level and efficacy
Drug-food. Grapefruit juice: significantly increased drug blood level and effects
High-fat meal: decreased drug blood level
Drug-herbs. Ephedra (ma huang), yohimbine: antagonism of nimodipine effects
St. John's wort: decreased nimodipine blood level
Drug-behaviors. Alcohol use: increased hypotensive effects
• Check vital signs and ECG.
• Monitor fluid intake and output. Watch for peripheral edema.
• Tell patient to swallow extended-release tablets whole and not to crush or break them.
• Advise patient to take with food, but not high-fat food. Recommend small, frequent meals.
• Instruct patient to avoid high-fat meals, alcohol, grapefruit, and grapefruit juice.
• Tell patient to immediately report irregular heart beat, shortness of breath, swelling, pronounced dizziness, rash, or chest pain.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.