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Adalat CR

Brand name: Adalat CR
Generic name: Nifedipine
Manufacturer: Bayer

How does Adalat work?
Adalat capsules contain the active ingredient nifedipine, which is a type of medicine called a calcium channel blocker. This type of medicine acts on the heart and blood vessels. (NB. Nifedipine is also available without a brand name, ie as the generic medicine.)

Nifedipine works by slowing the movement of calcium through the muscle cells that are found in the walls of blood vessels. It does this by blocking 'calcium channels' in these muscle cells. Calcium is needed by muscle cells in order for them to contract, so by depriving them of calcium, nifedipine causes the muscle cells to relax.

Nifedipine acts specifically on the muscle cells in the walls of arteries, causing them to relax. This allows the arteries in the body to widen, an effect that has two main uses.

The relaxing and widening of the small arteries in the body decreases the resistance that the heart has to push against in order to pump the blood around the body. This reduces the pressure within the blood vessels. Nifedipine can therefore be used to lower high blood pressure.

The widening effect on the small arteries and the arteries in the heart also improves the blood and therefore oxygen supply to the heart. This feature means nifedipine can be used in the management of angina. The chest pain of angina is caused by insufficient oxygen supply to the heart. As nifedipine improves this oxygen supply, and also reduces the effort the heart has to make to pump blood, can be used to prevent angina attacks.

Nifedipine is also used to treat a circulatory disorder called Raynaud's phenomenon. In this condition the blood vessels in the hands go into spasm and contract excessively when the hands are cold. This causes the hands to go white, numb and painful. Nifedipine relaxes the peripheral arteries in the hands, causing them to widen and the blood circulation to the fingers to improve.

Nifedipine may be given in a form that has an effect as soon as the medicine is taken and then tapers off (described as immediate-release or short-acting), or in a form that releases the medicine slowly over the day (which may be described as controlled/slow/prolonged/extended/modified/sustained-release or long-acting). Adalat capsules are a short-acting form of nifedipine.

Short-acting forms of nifedipine such as Adalat capsules are usually only used to relieve the symptoms of Raynaud's. They may also be given in single doses to control high blood pressure, but are not recommended for the long-term treatment of high blood pressure or angina. This is because short-acting nifedipine can cause large variations in blood pressure and a reflex increase in heart rate. Long-acting forms of nifedipine are preferred for these conditions, because the steady release of the medicine doesn't cause this problem.

What is Adalat used for?
• Condition called Raynaud's phenomenon, in which the blood vessels in the hands go into spasm when the hands are cold, causing white, numb and painful hands and fingers.
• High blood pressure (hypertension) (but see above).
• Prevention of angina attacks (but see above).

• Blood pressure lowering medicines can occasionally make you feel dizzy or weary. If you are affected, you should take care when driving or operating machinery.
• You should not drink grapefruit juice while you are taking this medicine, as it can increase the level of the medicine in your blood and thus increase its effect on your blood pressure. This could make you feel dizzy. If you have been regularly drinking grapefruit juice, this effect can last for at least three days after your last drink.
• If you experience any chest pain after taking this medicine you should not take a further dose until you have consulted your doctor.
• This medicine must not be used to treat an attack of angina.

Use with caution in
• Elderly people.
• Decreased liver function.
• People having kidney dialysis.
• Heart failure.
• Poor functioning of one chamber of the heart (left ventricular dysfunction).
• Very low blood pressure (hypotension).
• Diabetes.

Not to be used in
• Allergy to related calcium channel blockers (dihydropyridines), eg amlodipine, felodipine, nicardipine.
• Angina not well controlled by medical treatment (unstable angina).
• Narrowing of the main artery coming from the heart (aortic stenosis).
• Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
• People who have had a heart attack in the last month.
• Hereditary blood disorders called porphyrias.
• This medicine is not recommended for children.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• This medicine should not normally be used during pregnancy as its safety has not been established. However, it is occasionally used to control high blood pressure in pregnant women, in which case any possible risk to the foetus from the medicine needs to be weighed against the possible risk of uncontrolled high blood pressure in the mother. Seek medical advice from your doctor.
• This medicine passes into breast milk in amounts that are probably too small to be harmful to the nursing infant. However, since the medicine does pass into breast milk, the manufacturer recommends that it should not used by breastfeeding mothers. Seek medical advice from your doctor.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

• Headache.
• Flushing.
• Dizziness.
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting, indigestion or abdominal pain.
• Swollen ankles caused by fluid retention (peripheral oedema).
• Tiredness.
• Awareness of your heart beat (heart palpitations).
• Increased heart rate (tachycardia).
• Shaking, usually of the hands (tremor).
• Skin reactions such as rash, sweating or itching.
• Visual disturbances.
• Increased need to pass urine.
• Impotence.
• Depression.
• Pain in the muscles (myalgia).
• Pins and needles sensations (paraesthesia).
• Abnormal enlargement of breasts in men (gynaecomastia).
• Enlargement of the gums (gingival hyperplasia).

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Likewise, always ask your doctor or pharmacist before taking any new medicines during treatment with this one, to check that the combination is safe.

The antibiotic rifampicin should not be used with this medicine, as it decreases the blood level of nifedipine and could make it less effective.

If nifedipine is used in combination with other medicines that lower blood pressure, either to treat high blood pressure (antihypertensives), or as a side effect, the combination might lower your blood pressure too much. This could make you feel dizzy or faint, particularly when moving from a lying or sitting position to sitting or standing. This is more likely when you first start taking nifedipine with one of these medicines. If this happens to you, you should sit or lie down until the symptoms pass. Tell your doctor if any dizziness persists, as your medicine doses may need adjusting. Other medicines that decrease blood pressure include the following:

• ACE inhibitors such as enalapril
• alpha-blockers such as prazosin
• angiotensin II receptor antagonists such as losartan
• beta-blockers such as propranolol
• other calcium-channel blockers such as verapamil, diltiazem
• clonidine
• nitrates, eg glyceryl trinitrate
• certain antidepressants
• certain antipsychotics
• alprostadil
• baclofen
• benzodiazepines, eg diazepam, temazepam.

The blood level of nifedipine may be increased by the following medicines:
• cimetidine
• fluconazole
• fluoxetine
• itraconazole.

If you take any of these with nifedipine, you should tell your doctor if you feel dizzy or experience any other side effects, as the dose of your nifedipine may need to be reduced.

The blood level of nifedipine may be reduced by the antiepileptic medicines carbamazepine, phenytoin and phenobarbital.

If nifedipine is taken in combination with diltiazem, the blood level of both medicines may increase and their doses may need to be adjusted.

If nifedipine is taken in combination with quinidine, the blood level of quinidine may increase or decrease, and the blood level of nifedipine may increase. Your doctor may need to alter the dose of either medicine.

Nifedipine may increase blood levels of the following medicines:
• digoxin
• phenytoin
• tacrolimus
• theophylline.

Your doctor may want to monitor the level of these medicines in your blood if you take them with nifedipine.

Adalat may also be known under some of these names:
Adapine, Adapress, Alat, Aldipin, Alfadal, Alonix, Angipec, Anifed, Anpine, Apo-Nifed Aprical, Bonacid, Calcibloc, Calcigard, Calcilat, Camont, Cardifen, Cardilate, Cardionorm, Chronadalate, Citilat, Coracten, Coral, Cordafen, Cordaflex, Cordalat, Cordicant, Cordilan, Cordipin, Corinfar, Corotrend, Corynphar, Depin, Dignokonstant, Dilafed, Dilcor, Dipinkor, Duranifin, Ecodipi, Fedcor, Fenamon, Fenihidin, Glopir, Hadipin, Hexadilat, Introcar, Kordafen, Macorel, Megalat, Myogard, Nedipin, Nicardia, Nifangin, Nifar, Nifdemin, Nifebene, Nifecard, Nifecor, Nifedepat, Nifedicor, Nifedin, Nifedipres, Nifelan, Nifelat, Nifipen, Niphedipine, Orix, Oxcord, Pidilat, Procardia, Sepamit, Tibricol, Zenusin

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