Should a Moratorium Be Placed on Sublingual Nifedipine Capsules Given for Hypertensive Emergencies and Pseudoemergencies?

Grossman, Ehud; Messerli, Franz H.; Grodzicki, Tomasz; Kowey, Peter R.

doi:10.1001/jama.1996.03540160050032

Cited by 376 publications

(79 citation statements)

References 53 publications

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“…[7][8][9][10][11] The``Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure'' recognize that parenteral drugs for treatment of hypertensive emergencies are vasodilators, such as sodium nitroprusside and nitroglycerin. 12) Grossman et al 2) reported that sublingual nifedipine capsule given for hypertensive emergencies might produce severe adverse eŠects such as cerebrovascular ischemia, stroke, hypotension, acute myocardial infarction and death. However, nifedipine is still widely used for treatment of emergency, especially pseudoemergency hypertension, because it has been said that it has rarely induced excessive hypotension and has had no serious side eŠects.…”

Section: Discussionmentioning

confidence: 99%

“…It is administered by various methods especially for pseudoemergency control of sudden and temporal increases in the blood pressure in Japan and European countries 1) although Grossman et al 2) reported that sublingual administration of nifedipine might produce serious adverse eŠects. Although a method for administration of nifedipine for pseudoemergency antihypertensive treatment is described in the package insert of nifedipine products in Japan or some countries, it is actually administered by various techniques according to the custom of the ward or the judgment of the nurses while their eŠec-tiveness or safety remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the Method for Nifedipine Administration for a Rapid Onset of Clinical Effect: A Clinical Study in Normal Volunteers.

2001

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Nifedipine is frequently used for patients who require an immediate reduction of blood pressure elevated temporarily by various administration techniques including sublingual route without administrating intravenous infusion of vasodilator. A cross-over clinical study was conducted to investigate the optimal administration metho of nifedipine for rapid management of hypertension. Four method of administering 10 mg nifedipine (the capsule was bitten and swallowed, sublingually with a hole in it or the contents administered orally or intranasally with a syringe) were evaluated with regarded e‹cacy, safety, and usefulness in 6 normal volunteers. Systolic and diastolic blood pressures were correlated with the nifedipine serum concentration in each method. Nifedipine pharmacokinetic parameters diŠered among the 4 administration methods. Nifedipine was absorbed rapidly by not only intestinal mucosa but also the nasal or oral mucosa. The pharmacological eŠect of intranasal or sublingual administration was superior. However, mint oil which is present in nifedipine capsules stimulates nasal mucosa when administered intranasally. For clinical usage, nifedipine capsules in which a hole is made with a needle, administered sublingually, can be eŠectively and safely used for rapid management of systemic hypertension.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the Method for Nifedipine Administration for a Rapid Onset of Clinical Effect: A Clinical Study in Normal Volunteers.

2001

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“…Sublingual use of a calcium channel antagonist, such as nifedipine, should be avoided because of rapid absorption and a secondary precipitous decline in blood pressure. [4] …”

Section: The Role Of Medications In General Supportive Carementioning

confidence: 99%

Drug Treatment of Acute Ischemic Stroke

Bansal

Sangha

Khatri

2013

Am J Cardiovasc Drugs

107

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Acute ischemic stroke (AIS) is the fourth leading cause of death and the leading cause of adult disability in the USA. AIS most commonly occurs when a blood vessel is obstructed leading to irreversible brain injury and subsequent focal neurologic deficits. Drug treatment of AIS involves intravenous thrombolysis with alteplase (recombinant tissue plasminogen activator [rtPA]). Intravenous alteplase promotes thrombolysis by hydrolyzing plasminogen to form the proteolytic enzyme plasmin. Plasmin targets the blood clot with limited systemic thrombolytic effects. Alteplase must be administered within a short time window to appropriate patients to optimize its therapeutic efficacy. Recent trials have shown this time window may be extended from 3 to 4.5 hours in select patients. Other acute supportive interventions for AIS include maintaining normoglycemia, euthermia and treating severe hypertension. Urgent anticoagulation for AIS has generally not shown benefits that exceed the hemorrhage risks in the acute setting. Urgent antiplatelet use for AIS has limited benefits and should only promptly be initiated if alteplase was not administered, or after 24 hours if alteplase was administered. The majority of AIS patients do not receive thrombolytic therapy due to late arrival to emergency departments and currently there is a paucity of acute interventions for them. Ongoing clinical trials may lead to further medical breakthroughs to limit the damage inflicted by this devastating disease.

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“…Rapid acting nifedipine should not be used for treating hypertension or hypertensive emergencies especially in pregnancy because it has been associated with fatal and nonfatal untoward cardiovascular events as well as compromised placental perfusion. [1415] The rapid fall in blood pressure can be detrimental to the fetus. The rampant use of sublingual nifedipine as in our study is considered irrational.…”

Section: Discussionmentioning

confidence: 99%

Assessment of clinical outcomes and prescribing behavior among inpatients with severe preeclampsia and eclampsia: An Indian experience

et al. 2014

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Objectives:The study aims to evaluate the management, maternal-fetal outcomes, and prescription behavior among inpatients with severe preeclampsia and eclampsia.Materials and Methods:This prospective cohort study in a tertiary referral center was conducted in 164 inpatient pregnant women who fulfilled the inclusion criteria. The study was conducted between November 2005 and February 2007. The patients were followed-up till delivery. Antepartum and intrapartum care and maternal and perinatal outcome were noted. Chief outcome measures were maternal and perinatal mortality and drug use indicators.Results:Median age at delivery of the women was 25 (22-28) years. Majority were suffering from antepartum eclampsia (52.5%), followed by preeclampsia (31%) and postpartum eclampsia (16.5%). Nulliparity (61.6%) was more common in eclampsia, while multiparity in preclamptic group. A total of 48% had preterm delivery. Most presented with headache (50%) and hyperreflexia (29%). Only 15% presented with all three prodromal symptoms and 86% had hypertension. There was increased morbidity, operative intervention, and admission to intensive care unit. Most babies (67%) weighed <2.5 kg and had poor outcome. The maternal mortality was 0.4/1000. Average number of drugs prescribed in patients of preeclampsia, antepartum eclampsia, and postpartum eclampsia were 13.2, 14.9, and 14.2, respectively. Antibiotics (24.6%) were the most common class of the drugs prescribed in all the groups, followed by vitamin and calcium supplements (22.7%) and antihypertensives (13.5%). Most common antihypertensive used were calcium channel blockers and anticonvulsant magnesium sulphate.Conclusions:There was increased maternal and perinatal morbidity. Protocols for the management of eclampsia, including antihypertensive and anticonvulsant therapies, should be available and reviewed regularly to improve the standard of care and reduce the prevalence of this dangerous condition.

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Should a Moratorium Be Placed on Sublingual Nifedipine Capsules Given for Hypertensive Emergencies and Pseudoemergencies?

Cited by 376 publications

References 53 publications

Evaluation of the Method for Nifedipine Administration for a Rapid Onset of Clinical Effect: A Clinical Study in Normal Volunteers.

Evaluation of the Method for Nifedipine Administration for a Rapid Onset of Clinical Effect: A Clinical Study in Normal Volunteers.

Drug Treatment of Acute Ischemic Stroke

Assessment of clinical outcomes and prescribing behavior among inpatients with severe preeclampsia and eclampsia: An Indian experience

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