Sular

Sular,

trademark for a calcium channel blocker (nisoldipine).

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nisoldipine

Sular, Syscor (UK)

Pharmacologic class: Calcium channel blocker

Therapeutic class: Antihypertensive

Pregnancy risk category C

Action

Suppresses calcium transport into vascular smooth muscle cells. This suppression inhibits vasoconstriction and dilates coronary arteries, improving myocardial oxygen uptake.

Availability

Tablets (extended-release): 10 mg, 20 mg, 30 mg, 40 mg

⊘Indications and dosages

➣ Hypertension

Adults: Initially, 20 mg P.O. daily as a single dose; may increase by 10 mg daily q 7 days, up to 60 mg daily. Usual range is 20 to 40 mg daily.

Contraindications

• Hypersensitivity to drug or dihydropyridine calcium channel blockers

Precautions

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).

Administration

• 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.

Route	Onset	Peak	Duration
P.O.	Unknown	6-12 hr	24 hr

Adverse reactions

CNS: headache, dizziness

CV: peripheral edema, chest pain, vasodilation, hypotension, palpitations

EENT: pharyngitis, sinusitis

GI: nausea

Skin: rash

Interactions

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

Patient monitoring

• Check vital signs and ECG.
• Monitor fluid intake and output. Watch for peripheral edema.

Patient teaching

• 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.

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Sular®

Nisoldipine, see there