Calcium Channel Blocker

Hypersensitivity to other calcium channel blocking agents; hypotension; advanced aortic stenosis

Reduce dosage in elderly; use with caution in patients with liver insufficiency, digital ischemia, nonobstructive hypertrophic cardiomyopathy, Duchenne muscular dystrophy, or in combination with beta-blocking agents. Blood pressure lowering must be done at a rate appropriate for the patient's clinical condition.

Cardiovascular: Flushing, edema, tachycardia, palpitations, sinus tachycardia, vasodilation

Central nervous system: Headache, dizziness, fatigue

Gastrointestinal: Nausea, gingival hyperplasia

Otic: Tinnitus

The following interactions occur with concomitant use.

Atenolol: Increased hypotensive effect.

Carteolol: Increased hypotensive effect.

Digoxin: At nitrendipine doses exceeding 20 mg daily, increased digoxin levels and toxicity can occur.

Food: Slight increase in bioavailability.

Metoprolol: Increased hypotensive effect.

Ranitidine: Decrease in clearance of nitrendipine probably of little clinical significance.

Dihydropyridine calcium channel blocking agent with actions similar to nifedipine

Distribution: 6 L/kg

Protein binding: 98%

Metabolism: Hepatic to inactive metabolites

Bioavailability: 16% to 23%

Half-life: 8.6 hours

Elimination: Renal (80%), feces (8%)

20 mg/day (in patients with liver disease or in the elderly, an initial dose of 10 mg is recommended); maximum dose: 40 mg/day

Effective antihypertensive therapy, but should be avoided in patients with left ventricular systolic dysfunction because of negative inotropic effects. Nitrendipine alone or in combination with other agents is effective in the management of hypertension, particularly in the elderly, and angina.

Can cause an increase in plasma catecholamine, urinary aldosterone levels, and serum alkaline phosphatase levels; natriuresis and diuresis may also occur on a short-term basis

Philipp T, Anlauf M, Distler A, et al, "Randomised, Double Blind, Multicentre Comparison of Hydrochlorothiazide, Atenolol, Nitrendipine, and Enalapril in Antihypertensive Treatment: Results of the HANE Study. HANE Trial Research Group," BMJ, 1997, 315(7101):154-9.

Staessen JA, Fagard R, Thijs L, et al, "Randomised Double-Blind Comparison of Placebo and Active Treatment for Older Patients With Isolated Systolic Hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trail Investigators," Lancet, 1997, 350(9080):757-64.

"The Sixth Report of the National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure," Arch Intern Med, 1997, 157(21):2413-46.

Tuomilehto J, Rastenyte D, Birkenhager WH, et al, "Effects of Calcium-Channel Blockade in Older Patients With Diabetes and Systolic Hypertension. Systolic Hypertension in Europe Trial Investigators," N Engl J Med, 1999, 340(9):677-84.