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Adalat

Adalat
Adalat is needed for the prevention of angina attacks (including vasospastic angina pectoris), in some cases - relief of angina attacks; arterial hypertension, hypertensive crises; Raynaud's disease.

Brand: Nifedipine

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: September 2023
Package Price Per pill Save Order
Adalat 30 mg
270 pills - 30 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$228.55 $0.85 $131.36 Add to cart
180 pills - 30 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$157.69 $0.88 $82.25 Add to cart
120 pills - 30 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$109.99 $0.92 $49.97 Add to cart
90 pills - 30 mg $86.77 $0.96 $33.20 Add to cart
60 pills - 30 mg $63.55 $1.06 $16.43 Add to cart
30 pills - 30 mg $39.99 $1.33 No Add to cart
Adalat 20 mg
360 pills - 20 mg
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$117.91 $0.33 $265.97 Add to cart
180 pills - 20 mg $65.75 $0.37 $126.19 Add to cart
120 pills - 20 mg $55.95 $0.47 $72.01 Add to cart
90 pills - 20 mg $48.75 $0.54 $47.22 Add to cart
60 pills - 20 mg $42.95 $0.72 $21.03 Add to cart
30 pills - 20 mg $31.99 $1.07 No Add to cart
Adalat 10 mg
360 pills - 10 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$201.99 $0.56 $157.41 Add to cart
180 pills - 10 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$109.95 $0.61 $69.75 Add to cart
120 pills - 10 mg $79.93 $0.67 $39.87 Add to cart
90 pills - 10 mg $66.55 $0.74 $23.30 Add to cart
60 pills - 10 mg $50.99 $0.85 $8.91 Add to cart
30 pills - 10 mg $29.95 $1.00 No Add to cart

Product description

Adalat Pharmacological action

Buy adalat in Canada

Nifedipine is a selective blocker of "slow" calcium channels, a derivative of 1.4-dihydropyridine. It has antianginal and hypotensive effects. Reduces the flow of calcium ions through "slow" calcium channels into cardiomyocytes, smooth muscle cells of coronary and peripheral arteries, while lowering peripheral vascular resistance and dilating coronary arteries, especially large blood supply vessels, and even intact segments of the walls of partially stenotic vessels.

In addition, nifedipine lowers the tone of the smooth muscles of the coronary arteries, thereby, preventing angiospasm, increases blood flow in the poststenotic parts of the vessels and increases oxygen delivery to the myocardium, decreases myocardial oxygen demand by reducing peripheral vascular resistance (afterload), and with prolonged use it is capable of prevent the development of new atherosclerotic lesions in the coronary arteries.

Adalat for the treatment of heart problems

Nifedipine lowers the smooth muscle tone of the arterioles, thereby reducing the increased peripheral vascular resistance and, consequently, blood pressure. At the beginning of treatment with nifedipine, a temporary reflex increase in heart rate and, as a result, in the value of cardiac output may occur. However, this increase is not significant enough to compensate for the expansion of the blood vessels. In addition, nifedipine, with short-term and long-term use, increases the excretion of sodium ions and fluids from the body. The hypotensive effect of nifedipine is especially pronounced in patients with arterial hypertension. Nifedipine can prevent the development of vasospasm in Raynaud's syndrome.

Pharmacokinetics of Adalat

Absorption

After oral administration, nifedipine is rapidly and almost completely absorbed from the gastrointestinal tract. The bioavailability of uncontrolled release nifedipine is 45-56% due to the "first pass" effect through the liver. Food intake slightly reduces the initial absorption rate, but does not affect the amount of bioavailability. When Adalat is taken at a dose of 20 mg, Cmax in blood plasma is 47-76 mg / l (C47-76 mg /max =l), the time to reach this concentration is 1.6-3.6 h (t max = 1.6 - 3.6 hours).

About 95% of nifedipine binds to blood plasma proteins (albumin).

Metabolism

After oral administration, nifedipine is metabolized in the wall of the small intestine and in the liver to form inactive metabolites.

Withdrawal

Treatment of heart problems with Adalat

The half-life (T 1/2) of Adalat ranges from 3.7 to 4.3 h due to delayed absorption. When taking the drug in usual doses, the accumulation effect is not observed. Nifedipine is excreted from the body in the form of its metabolites through the kidneys and about 5-15% with bile through the intestines. In unchanged form, nifedipine is detected in urine in small amounts (about 0.1%).

Renal dysfunction

Pharmacokinetics does not change.

Impaired liver function

Reduced clearance of nifedipine, if necessary in severe cases - correction of the dosage regimen.

Indications of the drug Adalat®

  • ischemic heart disease: chronic stable angina pectoris (exertional angina).

  • arterial hypertension.


Contraindications to use Adalat

  • hypersensitivity to nifedipine and other derivatives of 1.4 dihydropyridine;

  • cardiovascular shock;

  • simultaneous use with rifampicin.

With caution: arterial hypotension (systolic blood pressure below 90 mm Hg), acute myocardial infarction, systolic heart failure III - IV f.cl. according to NYHA, severe aortic stenosis, severe hepatic failure, hemodialysis, age up to 18 years (efficacy and safety have not been established).

Application during pregnancy and lactation

Adalat LS is contraindicated in pregnancy.

If necessary, the use of the drug during lactation should decide on the termination of breastfeeding.

Application for violations of liver function

Use with caution in severe liver failure.

Use in children Use with

caution until 18 years of age (efficacy and safety have not been established).

Special instructions

The use of nifedipine in patients with impaired liver function must be monitored; in severe cases, a decrease in the dose of the drug may be required. With the simultaneous use of Adalat and beta-adrenergic receptor blockers, patients require careful monitoring, since a pronounced decrease in blood pressure may develop and the symptoms of heart failure may worsen.

In isolated cases of in-vitro fertilization, a relationship was found between the use of blockers of "slow" calcium channels (BMCC), in particular nifedipine, and reversible biochemical changes in the sperm head, leading to a change in sperm function. Thus, if repeated attempts to in-vitro fertilization are unsuccessful, in the absence of other reasons, the likelihood of the effect of BMCC used by a man, in particular nifedipine, cannot be excluded.

When using BMCC, bradycardia may develop.

Nifedipine causes a false-positive increase in the concentration of vanilla-mandelic acid in urine when determined by the spectrophotometric method. Nifedipine does not affect the indicators obtained by high performance liquid chromatography (HPLC). Nifedipine, the active ingredient in Adalat tablets, is highly sensitive to light. The tablets should not be crushed, so as not to damage the shell, which provides the drug with the necessary protection against this effect.

Influence on the ability to drive a car and moving mechanisms

An individual reaction to the drug can adversely affect the ability to drive a car and complex mechanisms, especially at the beginning of treatment, but the time of changing the dosage regimen and the simultaneous use of alcohol.

Overdose

Symptoms: impaired consciousness up to coma, a sharp drop in blood pressure, heart rhythm disturbances - tachycardia / bradycardia, hyperglycemia, metabolic acidosis, hypoxia.

Cardiogenic shock accompanied by pulmonary edema.

Emergency measures in the first place should be aimed at removing nifedipine from the body and restoring stable hemodynamic parameters.

Recommended gastric lavage in combination with small intestine irrigation to prevent further absorption of the drug. Plasmapheresis is recommended, since nifedipine is characterized by a high degree of binding to blood plasma proteins and a relatively small Vd. Hemodialysis is not advisable because nifedipine is not excreted during dialysis.

With bradycardia, symptomatic treatment with β-sympathomimetics, in the case of life-threatening bradycardia, implantation of a temporary artificial pacemaker is indicated.

With a pronounced decrease in blood pressure - treatment with drugs containing calcium - a slow intravenous injection of 10-20 ml of a 10% solution of calcium gluconate is recommended, if necessary, the administration is repeated. In the absence of effect, the appointment of sympathomimetics dopamine or norepinephrine. Doses of these drugs are selected individually. Inject fluid with caution due to the risk of cardiac overload.

Drug interactions

The hypotensive effect of nifedipine can be enhanced when used simultaneously with drugs that lower blood pressure.

Nifedipine is metabolized by the cytochrome P4503A4 system in the liver and intestinal mucosa. Drugs that inhibit or induce these enzymes can interact with nifedipine when taken orally, disrupting clearance or the "first pass" effect through the liver.

Digoxin:

Nifedipine decreases the clearance of digoxin, which leads to an increase in its concentration in the blood plasma. Therefore, patients require careful monitoring to identify symptoms of digoxin overdose and its dose should be reduced if necessary.

Phenytoin:

Induces enzymes of the cytochrome P4503A4 system, reduces the bioavailability of nifedipine, which may require an increase in its dose. When phenytoin is discontinued, the dose of nifedipine is reduced.

Quinidine:

Nifedipine reduces the concentration of quinidine in the blood plasma, however, if it is withdrawn, the quinidine content can increase significantly, which requires an adjustment of its dose. In some cases, the concentration of nifedipine in the blood plasma may increase, therefore, if indicated, its dose should be reduced. During the period of combined therapy, it is necessary to control the concentration of quinidine in the blood plasma and the level of blood pressure.

Cimetidine:

Increases plasma concentrations of nifedipine and may potentiate the hypotensive effect.

Rifampicin:

Due to the fact that rifampicin induces enzymes of the cytochrome P450 ZA4 system, Adalat should not be used in conjunction with rifampicin. Since, due to a decrease in the bioavailability of nifedipine, the level of its therapeutic concentration in blood plasma decreases.

Diltiazem:

Reduces the clearance of nifedipine. With this combination, a dose reduction of nifedipine may be required.

Grapefruit juice: inhibits enzymes of the cytochrome P450 ZA4 system. As a result, the simultaneous intake of grapefruit juice inhibits the metabolism of nifedipine, which leads to an increase in its concentration in the blood plasma and may cause a decrease in the therapeutic effect of the drug in hypertension.

Cisapride:

The simultaneous administration of cisapride and nifedipine may lead to an increase in the concentration of the latter in the blood plasma. Therefore, blood pressure should be monitored and, if necessary, the dose of nifedipine can be reduced.

Possible interactions:

Erythromycin, Fluoxetine, Amprenavir, Indinavir, Nelfinavir, Ritonavir, Saquinavir, Ketoconazole, Iraconazole, Fluconazole, Nefazodone: They inhibit the

action of drugs whose metabolism is associated with the cytochrome P4503A4 system. Although, in studies, the interaction between the above agents and nifedipine was not noted, a potential increase in the concentration of nifedipine in blood plasma is not excluded. With the simultaneous administration of these funds and nifedipine, the level of blood pressure should be monitored, and, if necessary, the dose of nifedipine should be reduced.

Tacrolimus:

Metabolized by the cytochrome P4503A4 system. Plasma tacrolimus concentration should be monitored and, if necessary, the tacrolimus dose may be reduced.

Carbamazepine, Phenobarbital, Valproic acid:

Although the interaction between these agents and nifedipine has not been studied, it is known that they can reduce the plasma concentration of another blocker of "slow" calcium channels - nimodipine. Therefore, a decrease in the concentration of nifedipine in blood plasma is not excluded.


Side effect

Frequency of development> 1% <0%

General: asthenia (fatigue), edema of the lower extremities.

Cardiovascular system: vasodilation (facial flushing, feeling hot), heart palpitations, peripheral edema.

Digestive system: nausea.

Nervous system: dizziness, headache.

Frequency of development> 0.1% <1.0%

General: pain in the abdomen, chest, feeling unwell.

Cardiovascular system: angina attacks, postural hypotension, tachycardia, syncope.

Digestive system: constipation, diarrhea, dry mouth, dyspepsia, vomiting.

Musculoskeletal system: myalgia, arthralgia.

Nervous system: insomnia, irritability, paresthesia, drowsiness, tremors, dizziness.

Respiratory system: dyspnea.

Skin: sweating, itching, rash, skin redness.

Urinary system: polyuria, nocturia.

Frequency of development> 0.01% <0.1%

General: an increase in the volume of the abdomen due to subcutaneous fat, allergic reactions, photosensitivity reactions.

Cardiovascular system: marked decrease in blood pressure.

Digestive system: gastrointestinal disorders, flatulence, changes in transaminase parameters, increased content of gamma-glutamyl transpeptidase.

Nervous system: hypersthesia.

Skin: urticaria.

Blood and hematopoietic system: purpura (thrombocytopenia).

Sense organs: visual impairment, ambilopia.

Urinary system: increased urination.

The incidence of <0.01%

Digestive system: gingival hyperplasia.

Blood and hematopoietic system: agranulocytosis.

Skin: erythromelalgia, exfoliative dermatitis.

Others: allergic reactions (anaphylactic reaction), gynecomastia.

In patients on hemodialysis with severe hypertension and hypovolemia due to the vasodilating effect of nifedipine, a significant decrease in blood pressure is possible.