Intake Of Nifedipine Research Articles

The Effect of Nifedipine used as Tocolytic Agent on Postpartum Blood Loss among Filipino Pregnant Patients in a Tertiary Hospital: a Prospective Cohort Study

Objective. To determine the risk of postpartum hemorrhage among patients who were treated with nifedipine for tocolysis of preterm labor.
 Methods. A prospective cohort study was conducted with 66 pregnant women admitted for preterm labor. One group of women was given nifedipine to give time for the administration of corticosteroids for fetal lung maturity and/or control of preterm labor and another group was not given nifedipine as they were admitted in advanced stage of labor (ie, more than or equal to 4 cm cervical dilatation). Independent/paired sample t-test, Mann-Whitney U/Wilcoxon signed rank test, and Fisher’s exact test were used to determine the difference of mean, median, and frequency between and within groups, respectively. STATA 12.0 was used for data analysis.
 Results. There was more blood loss during delivery, which was statistically significant, among those who received nifedipine compared to those who have not taken the medicine (350 mL versus 250 mL, p = 0.021). Furthermore, the decreases in hemoglobin and hematocrit were also lower among those who did not receive nifedipine compared to those who received nifedipine for tocolysis (8.5 mg/dL versus 16.0 mg/dL, p = 0.014 and 0.03 versus 0.05, p = 0.010), again, statistically significant.
 Conclusion. Nifedipine used as tocolytic appear to increase blood loss during delivery, which was statistically significant. Greater amount of blood loss may be anticipated among those with nifedipine intake thus helping the obstetrician in preparing for active management of postpartum hemorrhage and preventing maternal morbidity and mortality.

HEMODYNAMIC AEROBIC MECHANISMS OF EXERCISE TOLERANCE INCREASE IN STABLE ANGINA PATIENTS ON ANTIANGINAL TREATMENT

Aim. To reveal possible hemodynamic aerobic mechanisms of exercise tolerance improvement in stable angina patients having taken the typical pharmacological antianginal group drugs: nitrates, beta-blockers, calcium channel blockers. Material and methods. Totally, 164 stable angina male patients of II-IV functional class, participated in the study (mean age 55,2±2,1 years), who underwent doubled veloergometry before and after single intake of a mean therapeutical dosage of propranolol (PR) (n=58), isosorbidi dinitras (ID) (n=54), nifedipine (NF) (n=52). At the threshold of exercise intensity, the oxygen consumption (VO 2 ) was measured, cardiac index (CI), arteriovenous gradient by oxygen (АVРО 2 ), peripheral vascular resistance (PVS), and Robinson index (RI). Results. The efficacy of single NF dosage was found in 55,5% of angina patients, ID — in 48%, and PR — in 58%. The increase of threshold intensity was supported by an adequate VO2, which, after the PR intake was realized within analogous to the baseline CI parameters (4,6±1,7 L/min/m 2 and 4,9±1,7 L/min/m 2 ). In this case АVРО 2 was higher than baseline by 43,1% (p<0,001). Increase of exercise tolerance by the same value after the intake of NF was followed by CI increase comparing to the primary values, by 40,5% (p<0,001) and increase of RI from 157,7±39,0 units to 210,0±68,6 units (р<0,001). Value of АVРО 2 did not change. Intake of ID also was followed by significantly higher threshold values of CI and RI, however, less prominent comparing to PR (by 9,6 and 17,6%), which also were followed by 39,8% increased oxygen extraction from blood (p=0,018). Conclusion. Antianginal effect of the drugs is mediated primarily by activation of the various parts of oxygen transporting system than realizes additional oxygen transport to working tissues (muscles). Intensification of oxygen transportation might be followed by the increase of hemodynamic productivity (NF), mostly by activation of extracardiac oxygen consumption factors (PR) and combination of both (ID).

Nifedipine Intake Increases the Risk for Periodontal Destruction in Subjects With Type 2 Diabetes Mellitus

This study investigated the possible association of nifedipine (NIF) intake and diabetes mellitus (DM) with periodontal destruction. A group of Chinese subjects (N = 1,083, age: 63 +/- 8.7 years) were screened. Three hundred fifty-eight non-smokers with hypertension were selected for the study and were grouped based on DM status as non-DM and DM groups, DM(-) and DM(+) respectively. NIF(+) and NIF(-) indicated NIF intake or not. The groups were further divided: NIF(-)/DM(-) (n = 135); NIF(+)/DM(-) (n = 108); NIF(-)/DM(+) (n = 64); and NIF(+)/DM(+) (n = 51). The periodontal conditions in anterior teeth were assessed using plaque index, sulcus bleeding index, clinical attachment loss (AL), probing depth (PD), and the number of missing teeth. Using analysis of covariance, NIF intake was associated with mean PD and extent of PD > or =4 mm in the non-DM and DM groups. The subjects in the NIF(+)/DM(+) subgroup showed greater mean AL and percentage of sites with AL > or =5 mm and AL > or =7 mm than those in NIF(-)/DM(+) subgroup, whereas no significant difference existed between subjects in NIF(-)/DM(-) and NIF(+)/DM(-) subgroups. The NIF(+)/DM(+) subgroup exhibited a greater percentage of sites with AL > or =5 mm (35.5%) compared to the other three subgroups (24.7% for NIF[-]/DM[-], P = 0.004; 25.0% for NIF[+]/DM[-], P = 0.007; and 25.2% for NIF[-]/DM[+], P = 0.016). Logistic regression analysis showed that the NIF(+)/DM(+) subgroup had a significantly higher risk for having >10% of sites with AL > or =5 mm compared to the NIF(-)/DM(-) subgroup (odds ratio [OR] = 2.9; 95% confidence interval [CI]: 1.2 to 7.4; P = 0.022), the NIF(+)/DM(-) subgroup (OR = 3.1; 95% CI: 1.2 to 8.1; P = 0.020), and the NIF(-)/DM(+) subgroup (OR = 5.1; CI: 1.8 to 14.3; P = 0.002). NIF intake may increase the risk for periodontal destruction in patients with type 2 DM.

Akutes Nierenversagen im Rahmen einer Grapefruitdiät

Aim: The treatment of overweight is still widespread and an urgent medical problem because of it’s unfavourable effect on general mortality. The most effective prophylaxis for different risk factors of atherosclerosis, of which almost every second German citizen dies, is the fight against obesity. Methods: I am reporting about a female patient who developed an acute kidney failure when following a grapefruit-diet. Results: Because of the simultaneous intake of nifedipine retard to lower her blood pressure, the possible interactions between the bioflavanoids in the grapefruit and nifedipin are discussed, as well as the causes of hyperuricemia during the diet. Conclusion: A diet is, in cases of severe overweight, an effective method but should, due to possible side effects like hyperuricemia only be conducted under medical supervision. The doctor also should be informed which diet the patient follows. This applies particularly to grapefruit-diets, since grapefruit-juice interacts with numerous medications with possible fatal consequences.

Gingival overgrowth in paediatric cardiac transplant patients: a study of 19 patients aged between 2 and 16 years.

It is well established that both cyclosporin and nifedipine are associated with gingival overgrowth. However, there is little information on the prevalence of this undesirable effect in paediatric patients. The present study investigated gingival overgrowth in 19 cardiac transplant patients aged 2 years 8 months to 16 years 3 months (1.5-8.5 years post-transplant) and related such changes to variables of daily cyclosporin dosage, trough blood cyclosporin concentration and daily nifedipine dosage. Ten patients showed clinically significant gingival overgrowth and nine relatively minor overgrowth; there was no significant difference between the two groups with respect to age, length of time post-transplant, cyclosporin dosage, whole blood concentration of cyclosporin or intake of nifedipine. The expression of gingival changes therefore did not relate to any drug variable in this group of subjects.

Prevalence of Nifedipine‐Induced Gingival Hyperplasia

This study investigated the prevalence of gingival hyperplasia in subjects who were undergoing treatment with a calcium channel blocker, nifedipine, in dentate and edentulous subjects. In addition, the relationship between gingival hyperplasia and 5 other variables (duration of nifedipine intake, dose, age, oral hygiene index, and number of teeth) was investigated. Results of statistical analyses showed overwhelming evidence that the percent of nifedipine subjects with gingival hyperplasia was greater than that of the control subjects (P < 0.05) and that, across treatment group, the percent of dentate subjects with hyperplasia was significantly higher than that for edentulous subjects (P < 0.05). The chi2 test showed a strong univariate relationship between gingival hyperplasia and, separately, oral hygiene and number of teeth. For 24% of the subjects with gingival hyperplasia index (GHI) values of 2 or 3, gingivectomy was performed, and the tissues were prepared for histological examination. Microscopic examination of the biopsy material showed findings similar to those from previously reported cases of nifedipine- or phenytoin-induced hyperplasia.

An examination of a possible pharmacokinetic interaction between nifedipine and antipyrine

The influence of 2 weeks oral intake of nifedipine (2 x 20 mg) on the oxidative metabolism of antipyrine was investigated in 12 normal volunteers, who had 1050 mg antipyrine solution orally before and after the course of nifedipine. There were no statistically significant differences in the saliva pharmacokinetic parameters of antipyrine on both occassions. However, the metabolite profile of antipyrine in urine showed a significant reduction in the amount of norantipyrine excreted after compared to that before nifedipine administration (16.5 vs 19.6%). This may have implications for drugs that share a similar demethylation pathway with norantipyrine.

Effect of nifedipine on antipyrine and theophylline disposition

On the basis of reports that some calcium channel blockers impair the elimination of some drugs, the effect of nifedipine on the disposition of antipyrine and theophylline was assessed in healthy volunteers. Antipyrine half-life of 10.04 +/- 1.43 h (mean +/- SD) after a week intake of nifedipine (20 mg twice daily) was not significantly different from the control value of 10.64 +/- 2.15 h; nor was that of 10.02 +/- 1.49 h after 2 weeks pretreatment with the calcium channel blocker in eight healthy volunteers. Control antipyrine clearance (ml min-1) of 44.40 +/- 10.58 was not significantly different from that of 45.66 +/- 9.34 and 46.87 +/- 9.63 after nifedipine pretreatment of 1 and 2 weeks, respectively. Similarly volume of distribution was unaltered: 0.601 +/- 0.074, 0.591 +/- 0.078 and 0.602 +/- 0.051 l kg-1, respectively. A week pretreatment with nifedipine did not significantly alter either of theophylline half-life (7.32 +/- 0.81 h (control) to 7.50 +/- 0.80 h) or clearance (42.10 +/- 5.84 ml min-1 (control) to 43.77 +/- 4.00 ml min-1) in six volunteers. However the change in volume of distribution: 0.451 +/- 0.053 l kg-1 (control) to 0.483 +/- 0.062 l kg-1 was significant (p less than 0.025). Generally, theophylline plasma levels were lower after nifedipine pretreatment and the difference was significant at 2 and 4 h post-dosing (p less than 0.05). It is suggested that nifedipine, unlike diltiazem and verapamil, is unlikely to interfere with the functional integrity of the hepatic mixed-function oxygenase enzymes, but might displace theophylline from plasma protein.

Increase in Number of Myocardial Ischemic Episodes Following Nifedipine Administration in Two Patients: Detection of Silent Episodes by Holter Monitoring and Role of Heart Rate

Out of 34 consecutive patients with angina and treated with nifedipine, two subjects (5.8 percent) showed a significant increase of transient myocardial ischemic episodes during the period of treatment, as assessed by continuous Holter ECG monitoring. In both these patients, a large proportion of ischemic episodes happened to be asymptomatic. A relationship between nifedipine intake, heart rate increase, and number of ischemic episodes was observed. This occasional aggravation of myocardial ischemia could be related to an increase in myocardial oxygen demand medicated through a drug-induced reflex tachycardia.

Hypoxic pulmonary vasoconstriction and pulmonary gas exchange in normal man

Blood gases, hemodynamics and ventilation were measured in 7 healthy volunteers at baseline while breathing room air (F i O 2 0.21), during hypoxia (F i O 2 0.125, 15 min) and after nifedipine 20 mg sublingually at F i O 2 0.21 (45 min) and at F i O 2 (15 min). Distributions of ventilation-perfusion ratios (V̇ a/Q̇) were determined, using the multiple inert gas elimination technique, at baseline, during hypoxia, and again during hypoxia after nifedipine intake. Hypoxia was associated with an average increase in pulmonary vascular resistances by 104%, which was partialaly inhibited by nifedipine. The inert gas data showed a mild deterioration in the distribution of V̇ a/Q̇ ratios during hypoxia. However, when blood flow and ventilation were constrained to the baseline normoxic values in the distributions recovered during hypoxia (‘normalization procedure’) a slight improvement in V̇ a/Q̇ matching could be evidenced, which was blunted during hypoxia after nifedipine. This was interpreted as the functional of hypoxic pulmonary vasoconstriction (HPV). Using the ‘normalized’ distributions, we computed the relationship between the decrease in compartmental blood flow that occurred during hypoxia and the corresponding alveolar P O 2 , and calculated the gain due to HPV feedback using equations of the control theory. The contribution of HPV to the stability of compartmental V̇ a/Q̇ was greatest for alveolar P O 2 values around 60 mm Hg, but at best the feedback had only a moderate efficiency.

Gingival hyperplasia by nifedipine. Report of a case

We describe a case of gingival hyperplasia in a 36-year-old renal transplantation recipient treated with nifedipine for severe arterial hypertension. The appearance of the gingival disorder was probably related to nifedipine intake. Histologically, in addition to the findings of acanthosis, papillomatosis and connective tissue hyperplasia, there was also an important plasma cell inflammatory infiltrate.

Adverse drug reaction monitoring in Kuwait (1981-1984).

The methodologic, operational, and medical aspects of general population spontaneous adverse drug reaction (ADR) monitoring system organized in the State of Kuwait between June 1981 to June 1984 are described. The objectives of the study were to outline the procedures required for the establishment of a national ADR center in addition to studying the pattern of ADRs. Ethnic and sociocultural variables were factors influencing the frequency of adverse effects. A computer data base was created to handle incoming reports. A total of 704 reports were received from 26 hospitals and health clinics; the majority (90.5%) were classified as having a possible positive causal relationship. Anti-infectives were the most commonly reported drugs (32.2%), and cutaneous reactions were encountered most often (48.6%). Serious drug-induced reactions have been identified. Intake of nifedipine adversely affected glucose tolerance among diabetic and nondiabetic subjects. Bromocriptine causal sexual dysfunction was reported among women. Cimetidine and ethambutol were associated with optic neuritis and blindness. Metoclopramide and prochlorperazine resulted in dystonic reactions in children. Based on this study, the health authorities in Kuwait indicated their intention to establish a national ADR center.

Effects of nifedipine in women with unstable bladders.

A study of the effect of the calcium antagonist nifedipine on the detrusor contractions of 10 women with an unstable bladder is reported. An inhibiting effect was observed in all patients after intake of nifedipine. The number of contractions and the contraction amplitudes decreased, and the bladder capacity increased. Resting intraurethral and intravesical pressures were not affected. Subjective improvement was reported by all patients during a week of continuous nifedipine treatment. Side effects were few and tolerable. It is suggested that nifedipine can be of value in the treatment of unstable bladder.

Effects of nifedipine on the smooth muscle of the human urinary tract in vitro and in vivo.

Smooth muscle preparations of the urethra, bladder, and ureter were obtained from patients undergoing operations for various urological disorders. The urethral preparations were contracted by noradrenaline (0.1-3 microgram . ml-1), prostaglandin F2alpha (1-10 microgram . ml-1), and potassium (127 mM), the bladder preparations by carbacholine (0.004-1 microgram . ml-1), prostaglandin F2alpha (1-10 microgram . ml-1), potassium (127 mM), and barium chloride (3 mM), and the ureter preparations by potassium (127 mM), and barium chloride (3 mM). Irrespective of the mode of activation, pretreatment with nifedipine (0.1 microgram . ml-1) for 10 min. reduced the responses. Nifedipine also relaxed preparations contracted by the contractile agents used. In 19 female patients, aged 20 to 73 years, undergoing investigation because of urgency and/or urge incontinence, simultaneous urethrocystometry at rest was performed before and after oral administration of 20 to 40 mg nifedipine. Bladder capacity and residual urine were also determined. Nifedipine did not affect the pressures within the bladder and urethra, nor did it increase the bladder capacity. However, after nifedipine intake there was a statistically significant increase in residual urine. The results suggest that nifedipine can inhibit contractile activity induced by drugs with different modes of action; the drug does not affect the tone in bladder and urethra.