1,4-Dihydro-2,6-dimethyl-4-(2-ni-trophenyl)-3,5-pyridindicarbon-säure-dimethylester

EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments, oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop.；SKIN: IMMEDIATELY flood affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly with soap and water. If symptoms such as redness or irritation develop, IMMEDIATELY call a physician and be prepared to transport the victim to a hospital for treatment.；INHALATION: IMMEDIATELY leave the contaminated area; take deep breaths of fresh air. If symptoms (such as wheezing, coughing, shortness of breath, or burning in the mouth, throat, or chest) develop, call a physician and be prepared to transport the victim to a hospital. Provide proper respiratory protection to rescuers entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not available, use a level of protection greater than or equal to that advised under Protective Clothing.；INGESTION: DO NOT INDUCE VOMITING. If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and IMMEDIATELY call a hospital or poison control center. Be prepared to transport the victim to a hospital if advised by a physician. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the head lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY transport the victim to a hospital. (NTP, 1992)

Nifedipine liquid-filled capsules should be protected from light and moisture and stored in tight, light-resistant containers at a temperature of 15-25 °C, and extended-release tablets of the drug should be protected from light and moisture and stored in tight, light-resistant containers at a temperature less than 30 °C.

SMALL SPILLS AND LEAKAGE: If a spill of this chemical occurs, FIRST REMOVE ALL SOURCES OF IGNITION, then you should dampen the solid spill material with acetone and transfer the dampened material to a suitable container. Use absorbent paper dampened with acetone to pick up any remaining material. Seal your contaminated clothing and the absorbent paper in a vapor-tight plastic bag for eventual disposal. Solvent wash all contaminated surfaces with acetone followed by washing with a soap and water solution. Do not reenter the contaminated area until the Safety Officer (or other responsible person) has verified that the area has been properly cleaned.；STORAGE PRECAUTIONS: You should protect this material from exposure to light, and store it under ambient temperatures. (NTP, 1992)

SRP: Expired or waste pharmaceuticals shall carefully take into consideration applicable DEA, EPA, and FDA regulations. It is not appropriate to dispose by flushing the pharmaceutical down the toilet or discarding to trash. If possible return the pharmaceutical to the manufacturer for proper disposal being careful to properly label and securely package the material. Alternatively, the waste pharmaceutical shall be labeled, securely packaged and transported by a state licensed medical waste contractor to dispose by burial in a licensed hazardous or toxic waste landfill or incinerator.

SRP: At the time of review, regulatory criteria for small quantity disposal are subject to significant revision, however, household quantities of waste pharmaceuticals may be managed as follows: Mix with wet cat litter or coffee grounds, double bag in plastic, discard in trash.

RECOMMENDED RESPIRATOR: Where the neat test chemical is weighed and diluted, wear a NIOSH-approved half face respirator equipped with an organic vapor/acid gas cartridge (specific for organic vapors, HCl, acid gas and SO2) with a dust/mist filter. (NTP, 1992)

Quinidine is a substrate of CYP3A and has been shown to inhibit CYP3A in vitro. Co-administration of multiple doses of quinidine sulfate, 200 mg t.i.d., and nifedipine, 20 mg t.i.d., increased Cmax and AUC of nifedipine in healthy volunteers by factors of 2.30 and 1.37, respectively. The heart rate in the initial interval after drug administration was increased by up to 17.9 beats/minute. The exposure to quinidine was not importantly changed in the presence of nifedipine. Monitoring of heart rate and adjustment of the nifedipine dose, if necessary, are recommended when quinidine is added to a treatment with nifedipine.

Pre-treatment of healthy volunteers with 30 mg or 90 mg t.i.d. diltiazem p.o. increased the AUC of nifedipine after a single dose of 20 mg nifedipine by factors of 2.2 and 3.1, respectively. The corresponding Cmax values of nifedipine increased by factors of 2.0 and 1.7, respectively. Caution should be exercised when co-administering diltiazem and nifedipine and a reduction of the dose of nifedipine should be considered.

Verapamil, a CYP3A inhibitor, can inhibit the metabolism of nifedipine and increase the exposure to nifedipine during concomitant therapy. Blood pressure should be monitored and reduction of the dose of nifedipine considered.

In healthy volunteers receiving single dose of 20 mg nifedipine ER and benazepril 10 mg, the plasma concentrations of benazeprilat and nifedipine in the presence and absence of each other were not statistically significantly different. A hypotensive effect was only seen after co-administration of the two drugs. The tachycardic effect of nifedipine was attenuated in the presence of benazepril.

For more Interactions (Complete) data for Nifedipine (22 total), please visit the HSDB record page.

Mild and transient elevations in serum aminotransferase levels may occur during nifedipine therapy, but often resolve even with continuation of therapy. Clinically apparent acute liver injury with jaundice due to nifedipine is rare and described only in isolated case reports. The time to onset of injury is typically 1 to 2 months and the pattern of serum enzyme elevations is usually hepatocellular or mixed. Rash, arthralgias, fever and eosinophilia can occur, but are not prominent. Chronic aminotransferase elevations during continued therapy with nifedipine have been described sometimes with histological features of alcoholic liver disease (steatosis and Mallory bodies), but chronic liver injury after withdrawal has not. Nifedipine has not been implicated in cases of vanishing bile duct syndrome or acute liver failure in the published literature.；Likelihood score: B (likely cause of clinically apparent liver injury).

TERRESTRIAL FATE: Based on a classification scheme(1), an estimated Koc value of 370(SRC), determined from a log Kow of 2.20(2) and a regression-derived equation(3), indicates that Nifedipine is expected to have moderate mobility in soil(SRC). Volatilization of Nifedipine from moist soil surfaces is not expected to be an important fate process(SRC) given an estimated Henry's Law constant of 7.3X10-14 atm-cu m/mole(SRC), using a fragment constant estimation method(4). Nifedipine is not expected to volatilize from dry soil surfaces(SRC) based upon an estimated vapor pressure of 2.6X10-8 mm Hg at 25 °C(SRC), determined from a fragment constant method(5). Biodegradation data for Nifedipine were not available(SRC,2009).

AQUATIC FATE: Based on a classification scheme(1), an estimated Koc value of 370(SRC), determined from a log Kow of 2.20(2) and a regression-derived equation(3), indicates that Nifedipine is expected to adsorb to suspended solids and sediment(SRC). Volatilization from water surfaces is not expected(4) based upon an estimated Henry's Law constant of 7.3X10-14 atm-cu m/mole(SRC), developed using a fragment constant estimation method(5). According to a classification scheme(6), an estimated BCF of 13(SRC), from its log Kow(2) and a regression-derived equation(7), suggests the potential for bioconcentration in aquatic organisms is low(SRC). Biodegradation data for Nifedipine were not available(SRC,2009).

ATMOSPHERIC FATE: According to a model of gas/particle partitioning of semivolatile organic compounds in the atmosphere(1), Nifedipine, which has an estimated vapor pressure of 2.6X10-8 mm Hg at 25 °C(SRC), determined from a fragment constant method(2), is expected to exist solely in the particulate phase in the ambient atmosphere. Particulate-phase Nifedipine may be removed from the air by wet or dry deposition(SRC). Nifedipine contains chromophores that absorb at wavelengths >290 nm(3) and therefore may be susceptible to direct photolysis by sunlight(SRC). Nifedipine is photosensitive and decomposes rapidly(4).

Adverse effects may be present in about 20% to 30% of patients prescribed nifedipine. These effects are primarily due to the vasodilatory properties of nifedipine.；The most common adverse effects include flushing, peripheral edema, dizziness, and headache. Tolerance is better with the extended-release preparations of nifedipine than the immediate-release preparations. Hypersensitivity reactions, such as pruritus, urticaria, and bronchospasms, are rare. Abrupt discontinuance of the drug after prolonged use may lead to rebound hypertension or angina. Nifedipine-induced gingival hyperplasia is a known adverse effect. Nifedipine induces gingival hyperplasia by hindering calcium influx in gingival fibroblasts, promoting extracellular matrix accumulation. This effect is increased by inflammation, genetic susceptibility, and poor oral hygiene. Maintaining good oral hygiene practices is useful for prevention. In cases where gingival hyperplasia continues despite these measures, surgical intervention may be required.[43] Bowel obstruction during treatment with extended-release nifedipine is rare but possible. According to a study, the risk of SJS and TEN is very infrequent.；Drug-Drug Interactions；* Grapefruit juice: Concurrent administration of nifedipine with grapefruit juice results in a doubling of nifedipine exposure and concentration. The increased plasma levels most likely result from inhibition of CYP3A4-related metabolism. Coadministration of grapefruit or grapefruit juice should be avoided during the administration of nifedipine.；* Digoxin: Isolated reports have noted elevated serum digoxin concentrations when used concomitantly with nifedipine. Monitor digoxin levels during initiation, dose adjustments, or discontinuation of nifedipine to minimize the risk of digitalis toxicity or subtherapeutic exposure.；* Coumarin anticoagulants: Rare cases of increased prothrombin time have been observed in patients receiving warfarin with nifedipine. Although a causal relationship remains unconfirmed, clinicians should remain vigilant when co-administering these agents.；* CYP3A4 inducers: Nifedipine is extensively metabolized by CYP3A4. Coadministration with potent inducers such as phenytoin reduces nifedipine plasma concentrations by up to 70%, potentially compromising therapeutic efficacy. Avoid concurrent use or consider dose adjustment with close clinical monitoring.；* CYP3A4 inhibitors: Drugs that inhibit CYP3A4, such as itraconazole, fluconazole, erythromycin, clarithromycin, fluoxetine, nefazodone, indinavir, nelfinavir, and ritonavir, may significantly increase systemic exposure to nifedipine. Initiate nifedipine at the lowest effective dose and monitor for adverse effects or excessive therapeutic response.；* St. John's Wort: Prolonged use (900 mg/day for more than 10 days) induces intestinal and hepatic CYP3A4 through hyperforin (the main compound in St. John's wort plants) mediated activation of the pregnane X receptor (PXR), significantly increasing the clearance of nifedipine and verapamil. This may reduce therapeutic efficacy; therefore, coadministration is not recommended.；* Ginkgo biloba: Coadministration of Ginkgo extract (240 mg/day) with nifedipine (10 mg/day) does not significantly alter pharmacokinetics in most individuals. However, some may experience a twofold increase in concentration and adverse effects such as headache, dizziness, flushing, and increased heart rate. Caution and clinical monitoring are advised during concomitant use.

Signs and Symptoms of Overdose；An overdose of nifedipine can lead to systemic vasodilation, severe hypotension, and reflex tachycardia. Prolonged systemic hypotension can progress to shock and even death. Electrocardiographic results, vital signs, kidney function, urine output, and electrolytes require continuous monitoring. The literature review also suggests the possibility of pharmacobezoar formation, which may require endoscopic intervention. The insolubility of excipients in nifedipine formulations can lead to the formation of pharmacobezoars.；Management of Overdose；Treatment of overdose varies with the amount taken, duration since ingestion, age, and comorbidities of the patient. Initial assessment involves securing airway, breathing, and circulation, as well as appropriate blood work, including testing for coingestants. Early consultation with poison control or toxicology should be a priority. Activated charcoal, administered at a dose of 1 g/kg, is beneficial if the patient presents within 1 to 2 hours of ingestion. Whole bowel irrigation should be considered in cases involving extended-release preparations or large quantities of ingestion. Nasogastric lavage is usually ineffective. Intravenous fluid resuscitation, calcium salts, and vasopressor therapy with dopamine or norepinephrine usually alleviate the hypotension. Administration of high-dose insulin is an option as it has been shown to lower mortality and improve hemodynamics. For intentional ingestion, psychiatric consultation is also necessary. Patients presenting with an overdose of immediate-release preparations need observation for 4 to 7 hours. For extended-release preparations, 24 hours of telemetry observation is ideal. According to the Medical College of Medical Toxicology guidelines, during out-of-hospital care, consider using intravenous calcium, glucagon, and epinephrine for severe hypotension during transport. Intravenous calcium is a vital treatment for calcium channel blocker (CCB) toxicity, improving cardiac contractility and systemic vascular resistance to raise blood pressure.；Calcium chloride contains more elemental calcium than calcium gluconate but poses a higher risk of tissue necrosis; therefore, central line administration is preferred. Calcium gluconate is recommended if central access is unavailable. Typical dosing is 1 to 2 g (10 to 20 mL) of 10% calcium chloride or 3 to 6 g (30 to 60 mL) of 10% calcium gluconate every 10 to 20 minutes, or continuous infusions at 0.2 to 0.4 mL/kg/hr and 0.6 to 1.2 mL/kg/hr, respectively. The American College of Medical Toxicology recommends IV calcium, glucagon, and epinephrine during prehospital transport for severe hypotension due to CCB toxicity (Grade D). The 2023 AHA ACLS guidelines also endorse IV calcium for CCB-induced cardiac arrest, but stress the need to combine it with vasopressors, high-dose insulin, and mechanical support. Targeting ionized calcium levels up to twice normal may enhance efficacy.

The Koc of Nifedipine is estimated as 370(SRC), using a log Kow of 2.20(1) and a regression-derived equation(2). According to a classification scheme(3), this estimated Koc value suggests that Nifedipine is expected to have moderate mobility in soil.

/SIGNS AND SYMPTOMS/ Generally, overdosage with the drug would be expected to produce toxic effects that are extensions of the usual adverse effects of the drug, including pronounced hypotension. ... Other symptoms associated with severe nifedipine overdosage include loss of consciousness, heart rhythm disturbances, metabolic acidosis, hypoxia, and cardiogenic shock with pulmonary edema.

/SIGNS AND SYMPTOMS/ The use of the selective serotonin reuptake inhibitor fluoxetine is associated with only minor cardiovascular effects. However, due to a possible inhibitory effect on the metabolism of calcium channel blockers it may potentiate the activity of nifedipine, causing profound adverse cardiovascular effects. This report describes the appearance of profound weakness, orthostatic hypotension and tachycardia following the initiation of fluoxetine treatment in a nifedipine-treated 80-year-old patient.

/SIGNS AND SYMPTOMS/ Several cases of profound hypotension, cerebrovascular ischemia or stroke, myocardial ischemia or infarction, and/or death have been reported when conventional short-acting preparations of nifedipine were used for the management of hypertensive crises, and therefore, the manufacturers currently warn that short-acting preparations should not be used for acute reduction in blood pressure. However, profound hypotension, myocardial ischemia or infarction, and/or death also have been reported occasionally in patients receiving conventional short-acting preparations of the drug for other uses (e.g., angina, pulmonary hypertension). The manufacturers also warn that short-acting preparations of nifedipine should not be used for the chronic management of hypertension.

/CASE REPORTS/ In one lactating woman who received 10, 20, and 30 mg of the drug every 8 hours as conventional capsules, peak milk concentrations of nifedipine occurred within 1 hour after a dose and ranged from about 13-53 ng/mL; the drug generally was not detectable during the hour prior to a dose.

For more Human Toxicity Excerpts (Complete) data for Nifedipine (30 total), please visit the HSDB record page.

Drug Induced Liver Injury Rank (DILIrank 2.0)

Nifedipine

vLess-DILI-concern

3

Warnings & precautions

DOI:10.1016/j.drudis.2016.02.015

An estimated BCF of 13 was calculated for Nifedipine(SRC), using a log Kow of 2.20(1) and a regression-derived equation(2). According to a classification scheme(3), this BCF suggests the potential for bioconcentration in aquatic organisms is low(SRC).

The Henry's Law constant for Nifedipine is estimated as 7.3X10-14 atm-cu m/mole(SRC) using a fragment constant estimation method(1). This Henry's Law constant indicates that Nifedipine is expected to be essentially nonvolatile from water surfaces(2). Nifedipine's Henry's Law constant indicates that volatilization from moist soil surfaces is not expected to occur(SRC). Nifedipine is not expected to volatilize from dry soil surfaces(SRC) based upon an estimated vapor pressure of 2.6X10-8 mm Hg(SRC), determined from a fragment constant method(3).

Hazard Traits - Developmental Toxicity; Reproductive Toxicity；Authoritative List - Prop 65；Report - regardless of intended function of ingredient in the product

Nifedipine: Does not have an individual approval but may be used under an appropriate group standard

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl nifedipine, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.

Therapeutic Category: Antianginal; antihypertensive.

Use (kg; approx.) in Germany (2009): >2500；Use (kg) in USA (2002): 13200；Consumption (g per capita; approx.) in Germany (2009): 0.0305；Consumption (g per capita) in the USA (2002): 0.0468；Excretion rate: 0.001；Calculated removal (%): 23.4

Dimethyl 2,6-dimethyl-4-(2-nitrophenyl)pyridine-3,5-dicarboxylate

Dimethyl 2,6-dimethyl-4-(2_nitrosophenyl)pyridine-3,5-dicarboxylate

Methyl 2-(2-nitrobenzylidene)-3-oxobutanoate

Methyl 3-aminobut-2-enoate

Heating 2-nitrobenzaldehyde with an excess of methyl acetoacetate and ammonia in methanol for several hours affords nifedipine as light-sensitive yellow crystals in high yield.

Preparation: Bossert, Vater, ZA 6801482; eidem, US 3485847 (1968, 1969 both to Bayer)

Adalat

Bay 1040

Bay A 1040

Citilat

For more Formulations/Preparations (Complete) data for Nifedipine (9 total), please visit the HSDB record page.