Nurses Compass
Drug Guide
Nisoldipine
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/ANursing 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.