Co-administration Of Nifedipine Research Articles

Exploring the multiple effects of nifedipine and captopril administration in spontaneously hypertensive rats through pharmacokinetic-pharmacodynamic analyses.

This study assessed the pharmacokinetics (PKs) and pharmacodynamics (PDs) of two antihypertensive drugs, nifedipine and captopril, by exploring their main (blood pressure [BP]) and secondary effects (heart rate [HR] and QT interval [QT]) in spontaneously hypertensive rats. This study aimed to assess the relationship between PKs and PDs. Using these PD parameters, BP, HR, and QT during coadministration were estimated. The coadministration of nifedipine and captopril resulted in an increase in nifedipine's total body clearance (CLtot) and a reduction in its mean residence time (MRT) with an increase in the terminal elimination half-life (t1/2) and volume of distribution at steady state (Vdss) of captopril. However, no significant PK interactions were observed. During monotherapy, BP reduced rapidly following nifedipine infusion. Subsequently, despite the increase in nifedipine plasma concentration, BP recovered, likely because of homeostasis. Similar results were observed with coadministration. Subsequently, BP demonstrated a sustained reduction that was greater than or equal to the additive effect estimated from each PK. Captopril exhibited a minimal effect on HR, except for a transient increase observed immediately after starting infusion, consistent with observations during coadministration. Subsequently, the HR reduction was nearly equal to that calculated from the nifedipine PK. QT prolongation was more rapid with captopril than with nifedipine. Although QT prolongation during the initial 60 min of coadministration was approximately the sum of both effects, the recovery period to baseline QT was faster than that in the simulation.

Application of physiologically-based pharmacokinetic/pharmacodynamic models to evaluate the interaction between nifedipine and apatinib.

Aim: It has been found that the co-administration of nifedipine with apatinib could cause exposure changes of nifedipine in vivo. But, whether this pharmacokinetic drug-drug interaction (DDI) between nifedipine and apatinib could enhance the antihypertensive effect of nifedipine, causing sever changes of blood pressure was unknown. Therefore, the aim of the present study was to conduct the pharmacokinetic/pharmacodynamic (PK/PD) modelling to evaluate the effect of pharmacokinetic changes on the antihypertensive effect of nifedipine. Thus, the results could guide the co-administration of these two drugs in clinic. Methods: A physiologically-based pharmacokinetic (PBPK) model was first developed for nifedipine. The pharmacokinetic DDI between nifedipine and apatinib was evaluated. Then the verified PBPK models were linked to a PD model for investigating whether the exposure changes of nifedipine could cause severe changes in blood pressure. Furthermore, the changes in blood pressure caused by combination with apatinib were also assessed in patients with hepatic impairment via the PBPK/PD models. Results: The predicted area under plasma concentration-time profile (AUC), maximum concentration (Cmax), area under effect-time profile (AUE), and maximum reduction in systolic blood pressure (Rmax) are all within 0.5–2.0-fold of the observed data, indicating that the PBPK/PD models for nifedipine are successfully established. The increases of predicted AUC and Cmax of nifedipine in the presence of apatinib are 1.73 and 1.41-fold, respectively. Co-administration of nifedipine with apatinib could cause exposure changes of nifedipine in vivo. However, the predicted AUE and Rmax changes of nifedipine in the presence to the absence of apatinib in cancer patients as well as in patients with hepatic impairment are all within 1.25-fold. The results indicate that the exposure changes of nifedipine caused by combination of apatinib has little effect on the changes of systolic blood pressure both in cancer patients and patients with hepatic impairment. Conclusion: The pharmacokinetic changes of nifedipine caused by co-administration with apatinib has little impact on the antihypertensive effect of nifedipine. Apatinib is unlikely to cause severe pharmacodynamic DDI via inhibition of CYP3A4. It is suggested that nifedipine could be used in combination with apatinib without dose adjustment in clinic.

Extreme bradycardia due to multiple drug–drug interactions in a patient with HIV post‐exposure prophylaxis containing lopinavir–ritonavir

Extreme bradycardia due to multiple drug–drug interactions in a patient with HIV post‐exposure prophylaxis containing lopinavir–ritonavir

Inhibition of Vascular Endothelial Growth Factor-A Signaling Induces Hypertension: Examining the Effect of Cediranib (Recentin; AZD2171) Treatment on Blood Pressure in Rat and the Use of Concomitant Antihypertensive Therapy

Inhibition of vascular endothelial growth factor-A (VEGF) signaling is a key therapeutic approach in oncology given the role of VEGF in angiogenesis and vascular permeability in solid tumors. Clinical trials examining VEGF signaling inhibitors commonly report hypertension. We examined the effect of cediranib, a highly potent VEGF signaling inhibitor, on the blood pressure of rats and the ability of standard antihypertensive agents to modulate the consequences of VEGF signaling inhibition. The ability of cediranib to induce hypertensive changes and the effect of giving antihypertensive therapy were investigated in conscious, unrestrained telemetered rats. Two antihypertensive agents were studied: captopril, an angiotensin-converting enzyme inhibitor, and nifedipine, a dihydropyridine calcium channel blocker. The antitumor activity of cediranib, alone and in combination with nifedipine, was also evaluated in a LoVo human colorectal tumor xenograft model in nude rats. All treatments were given orally. Administration of 0.1 to 1.5 mg/kg/d of cediranib for 4 consecutive days induced a relatively mild hypertensive effect, elevating diastolic blood pressure by 10 to 14 mmHg. Dosing 3 mg/kg/d cediranib for 4 days induced a marked hypertension of 35 to 50 mmHg. Captopril (30 mg/kg, qd) was effective at lowering a 10 mmHg increase in blood pressure but not a 35 to 50 mmHg increase. However, the latter was rapidly reversed by administration of nifedipine (10 mg/kg, bd). Coadministration of nifedipine did not negatively affect the antitumor activity of cediranib (1.5 mg/kg/d). Hypertension is a direct consequence of inhibiting VEGF signaling but can be controlled with appropriately selected, standard antihypertensive medication.

L-type calcium channel blockade on haloperidol-induced c-Fos expression in the striatum

Haloperidol-induced c-Fos expression in the lateral part of the neostriatum has been correlated with motor side effects while c-Fos induction in the medial part of the neostriatum and the nucleus accumbens is thought to be associated with the therapeutic effects of the drug. Induction of c-Fos in the striatum by haloperidol involves dopamine D 2 (DA D 2) receptor antagonism and is dependent on activation of N-methyl- d-aspartate (NMDA) receptors and L-type Ca 2+ channels. In the current study, pretreatment with L-type Ca 2+ channel blockers suppressed haloperidol-induced c-Fos throughout the neostriatum and the nucleus accumbens at 2 h postinjection. However, elevated c-Fos protein expression was observed only in the lateral part of the neostriatum at 5 h postinjection of haloperidol following pretreatment of L-type Ca 2+ channel blocker compared with rats pretreated with vehicle alone. In addition, pretreatment prolonged the duration of haloperidol-induced catalepsy in rats. Infusions of L-type Ca 2+ channel blockers directly into the neostriatum mimicked similar patterns of changes in haloperidol-induced c-Fos expression. Prolonged expression of c-Fos was not observed following coadministration of nifedipine and a dopamine D 1 (DA D 1) receptor agonist, SKF 81297, but could be mimicked by the DA D 2/3 receptor antagonist raclopride, suggesting that the phenomenon is likely related to DA D 2 receptor antagonism. Moreover, the expression levels of haloperidol-induced zif 268 and haloperidol-induced phosphorylated CREB and phosphorylated Elk-1 were also substantially elevated for a prolonged period of time in the lateral, but not the medial part of the neostriatum, following blockade of L-type Ca 2+ channels. Collectively, the results suggest that coadministration of L-type Ca 2+ channel blockers affects haloperidol signaling in the lateral part of the neostriatum and may exacerbate the development of acute motor side effects.

Angiotensin II suppresses long-term depression in the lateral amygdala of mice via L-type calcium channels

Previously we have shown that angiotensin II (Ang II) suppresses long-term potentiation (LTP) in the lateral nucleus of the amygdala (LA) of horizontal slices. This study examines the effect of Ang II on long-term depression (LTD) in the LA. Low frequency stimulation (1 Hz, 15 min; LFS) applied to fibers running within the LA induced a long-lasting reduction of the amplitudes of field potentials in the LA of mice. We have previously shown that this LTD is sensitive to the NMDA receptor blocker D-AP5 and is dependent on group II mGlu receptors. Ang II blocked dose-dependent LTD. Losartan, an AT 1 receptor antagonist, blocked the Ang II-induced suppression of LTD, whereas PD 123 319, an AT 2 receptor antagonist, had no effect. Co-administration of nifedipine, an L-type calcium channel antagonist, abolished Ang II-induced suppression of LTD. When applied alone nifedipine reduced the magnitude of LA-LTD. According to our previous results, stimulation of external capsule (EC) fibers in rats did not cause LTD in mice. Similarly, Ang II did not induce long-lasting changes of activity when EC stimulation site was used. The results support the view that angiotensins are involved in mechanisms of learning and memory including the plasticity changes in the LA.

니페디핀과 켈세틴의 토끼에서의 약물동태학적 상호작용

The pharmacokinetics of nifedipine was studied after oral coadministration of nifedipine (5 mg/kg) with quercetin (1.5, 7.5, 15 and 30 mg/kg, respectively) and 0.5 h or 3days pretreatment with quercetin (1.5 and 7.5mg/kg) in rabbits. Pretreatment of quercetin significantly (p of nifedipine pretreated with quercetin were increased significantly (p of nifedipine significantly (p. Pretreatment of quercetin significantly (p

Interaction Between Digoxin and Calcium Channel Blockers in Patients Undergoing Hemodialysis

Calcium channel blockers are often co-administered with digoxin because of a high frequency of hypertension and cardiac arrhythmia in patients undergoing hemodialysis. There have been several reports about the interactions between calcium channel blockers and digoxin mediated by P-glycoprotein in subjects with normal renal function, but few reports in patients undergoing hemodialysis. In this report, the interactions between digoxin and calcium channel blockers in patients undergoing hemodialysis were investigated. The serum digoxin concentration/digoxin dosage per week per body weight ratio (C/D ratio) was calculated, and the C/D ratio before and after co-administration of Ca channel blockers (verapamil, nifedipine, amlodipine) was compared. The rate of change in C/D ratio of digoxin was calculated, and the relationship between the rate of change in the C/D ratio of digoxin and the dose of Ca channel blocker per body weight was investigated. The C/D ratio of digoxin was significantly higher after co-administration of verapamil than that without verapamil (P<0.05), but there was no significant difference between co-administration of nifedipine or amlodipine and without co-administration. There was a significant correlation between the rate of change in the C/D ratio of digoxin before and after co-administration of verapamil and the dose of verapamil per body weight (r=0.909, P<0.001). It was suggested that the magnitude of the drug interaction between digoxin and verapamil was dependent on the verapamil dose per body weight.Based on these results, when a high dose of verapamil is co-administered, it appears that adequate precautions are needed regarding digoxin intoxication even in patients undergoing hemodialysis.

The influence of divalent cations on the analgesic effect of opioid and non-opioid drugs

It is generally accepted that divalent cations are involved in the nociceptive pathway. The effect of systemic co-administration of magnesium sulfate and calcium channel blockers (nifedipine, verapamil) on the analgesic effect of opioid (mixed μ / κ: butorphanol) and non-opioid drugs (paracetamol) was investigated. Albino mice and rats were used as experimental animals. Magnesium sulfate and calcium channel blockers were given i.p., 30 min before the administration of butorphanol tartrate and paracetamol. Analgesia was measured using ‘hot-plate’ ( 52.5∘C), ‘tail-flick’ (radiant heat source), ‘writhing’ (acetic acid, 1% , i.p.) and ‘tail-clip’ tests. The pain threshold was evaluated before and after the administration (i.p.) of the different agents. The effect of the combined administration of different agents on behavior, blood pressure and heart rate, was also determined. Nifedipine (5 mg kg−1, i.p.) and verapamil (10 mg kg−1, i.p.) potentiated the analgesic effect of butorphanol tartrate (0.25–2 mg kg−1, i.p.) in all tests (synergism) and enhanced analgesic effect of paracetamol (50–125 mg kg−1, i.p.), only in acetic acid writhing and tail-clip tests. Magensium sulfate (2.5 mg kg−1, i.p.) potentiated the analgesic effect of butorphanol, but not that of paracetamol. Co-administration of nifedipine and verapamil with either of butorphanol (0.25–2 mg kg−1) or paracetamol (50–125 mg kg−1, i.p.) produced no significant effects on motor coordination, motor performance, locomotor activity, long-term memory or on the blood pressure and heart rate of experimental animals. Co-administration of magnesium sulfate, however, significantly induced sedation, inhibition of locomotor activity, motor performance and coordination, as well as impairing of long-term memory, as compared with butorphanol and paracetamol, administered alone. We conclude that the systemic co-administration of calcium channel blockers potentiated the analgesic effect of butorphanol against thermal, mechanical and chemical pain but enhanced that of paracetamol only against mechanical and chemical pain. Magensium sulfate enhanced the analgesic effect of butorphanol, but not that of paracetamol. These findings, merit further studies in animals and humans to evaluate the potential therapeutic benefits of such interactions.

Calcium signaling mechanisms in renal vascular responses to vasopressin in genetic hypertension.

Previous blood flow studies demonstrated that arginine vasopressin (AVP) produces exaggerated renal vasoconstriction in young spontaneously hypertensive rats (SHR) compared with Wistar-Kyoto control rats (WKY). The purpose of the present study was to determine the role of postreceptor calcium signaling pathways in AVP-induced renal vasoconstriction in vivo. Renal blood flow (RBF) was measured by electromagnetic flowmetry in anesthetized, water-loaded, 8-week-old WKY and SHR pretreated with indomethacin to avoid interactions with prostaglandins. AVP was injected into the renal artery to produce a transient 25% to 30% decrease in RBF without affecting arterial pressure. To achieve similar control levels of vasoconstriction, SHR received a lower dose (2 versus 5 ng). Coadministration of nifedipine with AVP produced dose-dependent inhibition of the AVP-induced renal vasoconstriction. Nifedipine exerted maximum inhibition by blocking 30% to 35% of the peak AVP response, indicating the involvement of dihydropyridine-sensitive voltage-dependent calcium channels. To evaluate intracellular calcium mobilization, 8-(N,N-diethylamino)octyl-3,4,5-trimethoxybenzoate (TMB-8) or heparin was coadministered with AVP. Each agent produced a dose-dependent inhibition of up to 65% of the maximum blood flow change produced by AVP. The degrees of inhibition produced by maximum effective doses of nifedipine and TMB-8 were additive; the combination blocked up to 85% of the response to AVP. These observations indicate that about one third of the AVP-induced constriction of renal resistance vessels is mediated by voltage-dependent L-type calcium channels responsive to the dihydropyridine nifedipine. Approximately two thirds of the change in vascular tone is due to inositol 1,4,5-trisphosphate-mediated calcium mobilization from intracellular sources sensitive to TMB-8 and heparin. The results suggest that the exaggerated renal vascular reactivity to AVP challenge in SHR is probably not due to a strain difference in postreceptor calcium signal transduction. After AVP receptor stimulation, calcium mobilization and calcium entry signaling pathways participate to similar degrees in WKY and SHR.

Calcium entry and mobilization signaling pathways in ANG II-induced renal vasoconstriction in vivo.

The purpose of this study was to determine the relative importance of calcium signaling pathways in angiotensin II (ANG II)-induced renal vasoconstriction in vivo. Nifedipine was used to antagonize dihydropyridine-sensitive voltage-dependent calcium channels; BAY K 8644 was employed to activate these calcium channels. Intracellular calcium mobilization was evaluated using TMB-8 or heparin to inhibit calcium release from sarcoplasmic reticulum. Renal blood flow was measured by electromagnetic flowmetry in anesthetized euvolemic Wistar-Kyoto rats. The animals were pretreated with indomethacin to avoid interactions with prostaglandins. ANG II (2 ng) or BAY K 8644 (1 microgram) was injected into the renal artery to produce a transient 30-50% decrease in renal blood flow without affecting arterial pressure. Coadministration of nifedipine with BAY K 8644 produced dose-dependent inhibition of the maximum renal vasoconstriction elicited by BAY K 8644. The calcium-channel antagonist had similar effects on ANG II-induced renal vasoconstriction. Nifedipine exerted maximum inhibition by blocking 50% of the peak ANG II response. To evaluate intracellular calcium mobilization, TMB-8 or heparin was coadministered with ANG II. Each agent produced dose-dependent inhibition of up to 50% of the maximum renal vasoconstriction produced by ANG II. The inhibitory effects of nifedipine and TMB-8 were additive; neither agent had an effect when ANG II AT1 receptors were antagonized with losartan. These observations indicate that one-half of the ANG II-induced constriction of renal resistance vessels is mediated by voltage-dependent L-type calcium channels responsive to the dihydropyridine nifedipine. The remaining 50% of the renal vasoconstriction elicited by ANG II is mediated by inositol 1,4,5-trisphosphate-mediated calcium mobilization from intracellular sources. The additive nature of the inhibitory effects indicates distinct mechanisms involving calcium mobilization and calcium entry signaling pathways that are of equal importance in ANG II activation of AT1 receptors to trigger constriction of renal resistance vessels under basal conditions.

Differences between haloperidol- and pimozide-induced withdrawal syndrome: a role for Ca 2+ channels

We investigated the behavioral and biochemical events appearing in rats after withdrawal for 24 h or 8–12 days from two classical neuroleptics, haloperidol and pimozide. The neuroleptics were given for 14 days alone or shortly after injection of the Ca 2+ channel blocker nifedipine. We have found that withdrawal effects after haloperidol and pimozide were different. After haloperidol treatment we observed an increase in cortical Ca 2+ channel and limbic dopamine D 1 receptor density and an increase in spontaneous motor activity and apomorphine-induced hyperactivity and stereotypy. In contrast no biochemical changes were observed during pimozide withdrawal, and locomotor activity and responses to apomorphine were depressed. Co-administration of nifedipine with haloperidol prevented the observed biochemical and behavioral symptoms of withdrawal. Nifedipine administration did not change the depressant effects of pimozide. Our results suggest that the voltage-dependent Ca 2+ channel is involved in the observed withdrawal syndrome of neuroleptics, and that the absence of this syndrome after pimozide may be related to its considerable Ca 2+ channel-blocking properties.

Effects of nifedipine on physical dependence on barbital or diazepam in rats.

The effects of nifedipine on the development of physical dependence on barbital and diazepam in rats were examined using the drug-admixed food method. Rats were chronically treated with either barbital- or barbital in combination with nifedipine-admixed food for 28 days, and with either diazepam- or diazepam in combination with nifedipine-admixed food for 26 days, on schedules of gradually increasing doses of barbital or diazepam. Withdrawal was conducted by substituting normal food for drug-admixed food on the last day of the treatment. Co-administration of nifedipine with barbital potentiated weight loss and withdrawal scores after the termination of barbital treatment. However, the withdrawal signs after the termination of diazepam treatment were not affected by co-administration of nifedipine with diazepam. These results suggest that nifedipine potentiates the development of physical dependence on barbital but not diazepam. It is known that co-administration of dihydropyridine derivative nitrendipine suppresses the development of physical dependence on ethanol. Basing on the differences in sensitivity of central depressants, barbiturates, benzodiazepines and ethanol, to three types of voltage-dependent Ca2+ channels, such as L-, N- and T-types studied so far, the development of physical dependence on central depressants may be modified differently by L-type Ca2+ channel blockers, corresponding to respective depressants.

Evaluation of the Pharmacokinetic and Pharmacodynamic Interaction Between Quinidine and Nifedipine

Quinidine and nifedipine appear to be subject to metabolism by the same isozyme of cytochrome P-450. In addition, both drugs have been reported to alter the pharmacokinetics of other compounds. To investigate a potential interaction, 10 healthy subjects (five male, five female) received quinidine sulfate (200 mg orally), nifedipine (20 mg orally), or the combination of both drugs every 8 hours for 4 doses using a randomized, cross-over study design with a 2-week washout period between treatments. Drug concentration, heart rate, and mean arterial pressure were measured at frequent intervals after the final dose. Quinidine concentrations were unchanged by the co-administration of nifedipine. Nifedipine area under the curve (AUC0-8) increased 36.6% from 333 to 455 micrograms.hr/L (P < .05) after quinidine administration. Heart rate was significantly higher in the nifedipine-quinidine treatment at 0.5, 1.0, 1.5, and 2.0 hours when compared with either drug alone. The maximum increase in heart rate (17.9 beats/minute) occurred at 0.5 hours after nifedipine administration and was significantly correlated with serum concentrations at that time (r = .78). These results suggest that quinidine inhibits nifedipine metabolism, and this pharmacokinetic interaction results in enhanced pharmacologic response.

Reduction of morphine dependence and potentiation of analgesia by chronic co-administration of nifedipine.

Nifedipine, 5 mg/kg IP, potentiated the morphine-induced analgesia measured in the hot-plate, but not in the tail-flick test. Further experiments were carried out using the hot-plate test only. Pretreatment with nifedipine partially restores the analgesic action of morphine in morphine-tolerant rats. Co-administration of nifedipine with morphine in a chronic experiment did not prevent the loss of morphine efficiency (an increase in latency of 44% was not significant) and did not prevent the debilitating effect of chronic morphine administration reflected by an inhibition of the body weight gain, but prevented naloxone-induced withdrawal syndrome (quantified by counting head shakes) in the test carried out 24 h after the injection of nifedipine, when the drug did not affect morphine analgesia. Chronic treatment with either morphine or nifedipine did not produce a significant increase in the density of [3H] naloxone or [3H]prazosin binding sites in the cortex and in the rest of the brain (measured 24 h after the last dose), but the combined treatment resulted in a significant increase in the cortical [3H]prazosin binding site density. The present results suggest that opiate tolerance and physical dependence may be separated by co-administration of nifedipine and suggest that the combined chronic treatment with morphine and nifedipine may increase the efficacy of morphine during chronic treatment and prevent development of abstinence.