Home Drug Guide Nisoldipine

Drug Guide

Generic Name

Nisoldipine

Brand Names Sular

Classification

Therapeutic: Antihypertensive, Antianginal

Pharmacological: Calcium Channel Blocker (Dihydropyridine)

FDA Approved Indications

  • Hypertension
  • Chronic Stable Angina

Mechanism of Action

Nisoldipine inhibits calcium ion influx across cardiac and smooth muscle cell membranes, resulting in vasodilation and decreased vascular resistance, which lowers blood pressure and reduces myocardial oxygen demand.

Dosage and Administration

Adult: Start at 10-20 mg once daily; titrate up to 40 mg once daily as needed, based on response and tolerability.

Pediatric: Not established for pediatric use.

Geriatric: Use with caution; may require dose adjustments due to increased sensitivity and comorbidities.

Renal Impairment: Use cautiously; no specific dose adjustment provided.

Hepatic Impairment: Use cautiously; start with lower doses due to decreased metabolism.

Pharmacokinetics

Absorption: Well absorbed orally, bioavailability approximately 45-70%.

Distribution: Vast volume of distribution; extensively bound to plasma proteins.

Metabolism: Extensively metabolized in the liver via CYP3A4 enzymes.

Excretion: Primarily excreted in feces; minimal renal excretion.

Half Life: Approximately 8-12 hours.

Contraindications

  • Allergy to nisoldipine or other dihydropyridines.
  • Concurrent use of grapefruit or grapefruit juice.

Precautions

  • Use cautiously in patients with severe aortic stenosis, unstable angina, heart failure, or hepatic impairment.
  • Monitor blood pressure regularly.

Adverse Reactions - Common

  • Dizziness (Common)
  • Headache (Common)
  • Flushing (Common)
  • Peripheral edema (Common)

Adverse Reactions - Serious

  • Hypotension (Serious)
  • Bradycardia or tachycardia (Serious)
  • Cardiac arrhythmias (Serious)

Drug-Drug Interactions

  • Other antihypertensives, especially beta-blockers, diuretics, or other calcium channel blockers.
  • Grapefruit juice can increase plasma concentration.

Drug-Food Interactions

  • Grapefruit and grapefruit juice can increase absorption and plasma levels.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure and heart rate before and during therapy. Assess for signs of hypotension or edema.

Diagnoses:

  • Risk for hypotension
  • Risk for falls due to dizziness.

Implementation: Administer with or without food, consistently at the same time daily. Educate patients to avoid grapefruit products.

Evaluation: Evaluate effectiveness by measuring blood pressure and symptom relief.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not consume grapefruit or grapefruit juice.
  • Rise slowly from sitting or lying positions to minimize dizziness.
  • Report signs of swelling, dizziness, or irregular heartbeat.

Special Considerations

Black Box Warnings:

  • None specifically for nisoldipine.

Genetic Factors: Pharmacogenetic variations may affect drug metabolism via CYP3A4.

Lab Test Interference: May affect liver function tests.

Overdose Management

Signs/Symptoms: Severe hypotension, dizziness, tachycardia, or bradycardia.

Treatment: Supportive care: Monitor vital signs, administer intravenous vasopressors for hypotension, and provide other symptomatic treatments as needed.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.