Adalat: Advanced Calcium Channel Blocker for Hypertension Control
Adalat
| Product dosage: 20mg | |||
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Adalat, with its active ingredient nifedipine, represents a cornerstone in modern cardiovascular pharmacotherapy. As a dihydropyridine calcium channel blocker, it exerts potent vasodilatory effects on arterial smooth muscle, significantly reducing peripheral vascular resistance. This mechanism offers a targeted approach to managing hypertension and angina pectoris, providing predictable blood pressure control while minimizing cardiac workload. Clinicians worldwide rely on Adalat for its well-established efficacy profile and dose-responsive therapeutic effects, making it a first-line choice in numerous treatment guidelines for cardiovascular management.
Features
- Contains nifedipine as the active pharmaceutical ingredient
- Available in extended-release formulations (30mg, 60mg, 90mg)
- Dihydropyridine calcium channel blocker classification
- Once-daily dosing convenience
- Multiple formulation options including tablets and capsules
- Bioavailability of approximately 45-56% with extended-release forms
- Peak plasma concentration within 2.5-5 hours for extended-release formulations
- Plasma protein binding exceeding 95%
- Hepatic metabolism via cytochrome P450 3A4 system
- Elimination half-life of approximately 2-5 hours
Benefits
- Provides sustained 24-hour blood pressure control with single daily dosing
- Reduces myocardial oxygen demand through afterload reduction
- Decreases frequency and severity of angina episodes
- Demonstrates minimal effect on cardiac conduction tissue
- Offers flexible dosing titration for individualized therapy
- Shows proven cardiovascular risk reduction in long-term studies
Common use
Adalat is primarily indicated for the management of essential hypertension, either as monotherapy or in combination with other antihypertensive agents. It is equally effective in the treatment of chronic stable angina pectoris, particularly vasospastic angina. The medication works by selectively inhibiting calcium ion influx across cell membranes in vascular smooth muscle and cardiac muscle, though with greater affinity for vascular tissue. This action results in coronary and peripheral arterial vasodilation, reducing systemic vascular resistance and blood pressure without significantly affecting cardiac contractility. Clinical studies demonstrate consistent blood pressure reduction across diverse patient populations, including those with isolated systolic hypertension.
Dosage and direction
The recommended starting dose for hypertension management is 30 mg once daily, with dosage adjustment based on therapeutic response and tolerability. Dosage may be increased to a maximum of 90 mg daily, though most patients achieve adequate control with 30-60 mg daily. For angina treatment, initiate with 30 mg daily and titrate upward over 7-14 days. Tablets should be swallowed whole with a glass of water, without crushing, chewing, or dividing. Administration with food may help minimize potential gastrointestinal discomfort. Consistent timing of administration is crucial for maintaining stable plasma concentrations. Elderly patients or those with hepatic impairment may require lower initial doses and careful titration.
Precautions
Regular blood pressure monitoring is essential during therapy initiation and dosage adjustments. Patients should avoid grapefruit juice consumption as it may significantly increase nifedipine bioavailability. Caution is advised in patients with heart failure or significant aortic stenosis due to potential negative inotropic effects. Peripheral edema, typically dose-dependent, may occur and usually responds to diuretic therapy or dosage reduction. Abrupt discontinuation should be avoided to prevent rebound hypertension. Dental professionals should be informed of Adalat use due to potential gingival hyperplasia association. Patients should rise slowly from sitting or lying positions to minimize orthostatic effects.
Contraindications
Adalat is contraindicated in patients with known hypersensitivity to nifedipine or other dihydropyridines. It must not be used in cases of cardiogenic shock, clinically significant aortic stenosis, or unstable angina except when confirmed as vasospastic in origin. Concomitant use with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, or ritonavir is contraindicated due to dramatically increased nifedipine exposure. The immediate-release formulation is contraindicated for hypertensive emergencies due to risk of precipitous blood pressure drop and reflex tachycardia.
Possible side effect
Common adverse reactions include peripheral edema (7-29%), headache (10-22%), dizziness (4-12%), and flushing (4-14%). Less frequently, patients may experience palpitations (2-5%), nausea (3-7%), constipation (2-5%), and fatigue (2-6%). Serious but rare side effects include hypotension (1-2%), syncope (0.5-1%), and myocardial infarction (0.5-1%). Gingival hyperplasia occurs in approximately 2-5% of long-term users. Laboratory abnormalities may include transient elevations in liver enzymes (1-3%) and rarely, leukopenia. Most side effects are dose-dependent and often diminish with continued therapy.
Drug interaction
Strong CYP3A4 inhibitors (clarithromycin, indinavir) significantly increase nifedipine exposure, necessitating dosage reduction. Beta-blockers may potentiate heart failure risk while providing complementary antihypertensive effects. Concomitant use with digoxin may increase digoxin levels by 15-20%, requiring monitoring. Quinidine levels may decrease with nifedipine coadministration. Magnesium sulfate infusion with nifedipine may cause profound hypotension and neuromuscular blockade. NSAIDs may attenuate the antihypertensive effect. Phenytoin metabolism may be inhibited, increasing phenytoin levels. Tacrolimus and cyclosporine levels may increase with nifedipine administration.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to make up for a missed dose is not recommended as it may increase the risk of adverse effects. Patients should maintain a consistent dosing routine and consider using pill organizers or reminder systems. If multiple doses are missed, blood pressure should be monitored closely, and healthcare provider consultation is advised before resuming therapy.
Overdose
Nifedipine overdose may manifest as severe hypotension, bradycardia, and reflex tachycardia. In massive overdoses, cardiac conduction abnormalities including AV block may occur. Gastrointestinal symptoms including nausea and vomiting are common. Management involves cardiovascular monitoring and supportive care. Activated charcoal may be administered if presentation is early. Intravenous calcium gluconate (10-20 mL of 10% solution) may reverse hypotension and myocardial depression. Vasopressors such as dopamine or norepinephrine may be required for refractory hypotension. Atropine may be indicated for bradycardia. Due to high protein binding, dialysis is not effective.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in the original container, protected from light and moisture. Keep the bottle tightly closed and away from excessive heat or humidity. Do not store in bathroom cabinets where moisture levels fluctuate. Keep out of reach of children and pets. Do not use if tablets appear discolored or show signs of deterioration. Properly discard expired medication according to local regulations, avoiding flushing down toilets or drainage systems unless specifically instructed.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to Adalat may vary based on clinical circumstances, comorbidities, and concomitant medications. Healthcare providers should exercise clinical judgment when prescribing, considering individual patient factors and current treatment guidelines. Patients should not alter their medication regimen without consulting their healthcare provider. The prescribing information provided here may not include all possible uses, directions, precautions, or interactions.
Reviews
Clinical studies demonstrate that Adalat effectively reduces systolic blood pressure by 12-15 mmHg and diastolic pressure by 8-10 mmHg in hypertensive patients. Angina patients experience approximately 40-50% reduction in attack frequency and nitrate consumption. Long-term extension studies show maintained efficacy over 2-5 years of treatment with consistent safety profile. Patient satisfaction surveys indicate high adherence rates due to once-daily dosing convenience. Meta-analyses confirm cardiovascular risk reduction comparable to other first-line antihypertensive agents. Real-world evidence supports effectiveness in diverse populations including diabetic and elderly patients.