felodipine
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felodipine
[fĕ-lo´dĭ-pēn]felodipine
Pharmacologic class: Calcium channel blocker
Therapeutic class: Antihypertensive, antianginal
Pregnancy risk category C
Action
Impedes extracellular calcium ion movement across membranes of myocardial muscle cells, depressing myocardial contractility and impulse formation; slows impulse conduction velocity and dilates coronary arteries and peripheral arterioles. Net effect is reduced cardiac workload and lower blood pressure.
Availability
Tablets (extended-release): 2.5 mg, 5 mg, 10 mg
Indications and dosages
➣ Hypertension
Adults: Initially, 5 mg P.O. daily. Depending on response, may decrease to 2.5 mg or increase to a maximum of 10 mg P.O. daily at 2-week intervals.
Dosage adjustment
• Hepatic impairment
• Elderly patients
Off-label uses
• Heart failure
• Angina pectoris or vasospastic (Prinzmetal's) angina
Contraindications
• Hypersensitivity to drug
Precautions
Use cautiously in:
• cardiac disease, arrhythmias, severe hepatic or renal impairment
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).
Administration
• Give without regard to meals.
• Make sure patient swallows tablet whole without crushing or chewing.
Adverse reactions
CNS: headache, drowsiness, dizziness, syncope, nervousness, anxiety, psychiatric disturbances, paresthesia, insomnia, asthenia, confusion, irritability
CV: chest pain, peripheral edema, hypotension, palpitations, tachycardia, angina, arrhythmias, myocardial infarction, atrioventricular block
EENT: rhinorrhea, sneezing, pharyngitis
GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, dyspepsia, abdominal cramps, flatulence, dry mouth
Hematologic: anemia
Musculoskeletal: back pain
Respiratory: bronchitis
Skin: dermatitis, rash, pruritus, urticaria, erythema
Other: dysgeusia, gingival hyperplasia, facial edema, thirst, warm sensation
Interactions
Drug-drug. Antifungals, cimetidine, erythromycin, propranolol, ranitidine: increased felodipine blood level, increased risk of toxicity
Barbiturates, hydantoins: decreased felodipine blood level
Beta-adrenergic blockers, digoxin, disopyramide, phenytoin: bradycardia, conduction defects, heart failure
Fentanyl, nitrates, other antihypertensives, quinidine: additive hypotension
Nonsteroidal anti-inflammatory drugs: decreased antihypertensive effects
Drug-food. Grapefruit juice: increased felodipine blood level and effects
Drug-behaviors. Acute alcohol ingestion: additive hypotension
Patient monitoring
☞ Don't give to patient with heart block unless he has a pacemaker.
☞ Use extreme caution when administering to patients with pulmonary hypertension, renal insufficiency, heart failure, or compromised ventricular function (especially those receiving beta-adrenergic blockers concurrently).
• Monitor fluid intake and output, and weigh patient daily.
• Monitor ECG and vital signs. Assess for signs and symptoms of heart block.
• Assess for reflex tachycardia, angina, and sustained hypotension.
• Check hepatic profile and alkaline phosphatase level in patients with hepatic impairment.
Patient teaching
• Tell patient drug controls but doesn't cure high blood pressure, so he should keep taking it even if he feels well.
• Instruct patient to move slowly when rising, to avoid light-headedness or dizziness from sudden blood pressure decrease.
• Explain that exercise and hot weather may increase drug's hypotensive effects.
• Tell patient to report peripheral edema, persistent headache, or flushing.
• Advise patient to use hard candy or gum if dry mouth or thirst occurs.
• Tell female patient to inform prescriber if she is pregnant or breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above.