Stability of isradipine in an extemporaneously compounded oral liquid

MacDonald, Joanne L.; Johnson, Cary E.; Jacobson, Pamala A.

doi:10.1093/ajhp/51.19.2409

Cited by 18 publications

(23 citation statements)

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“…We typically start with the calcium channel blocker isradipine [121,122] as it can be compounded into a stable 1 mg/mL suspension [123], facilitating dosing in small infants. Amlodipine may also be used, but its slow onset of action and prolonged duration of effect may be problematic in the acute setting.…”

Section: Therapymentioning

confidence: 99%

Hypertension in infancy: diagnosis, management and outcome

2011

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Advances in the ability to identify, evaluate, and care for infants with hypertension, coupled with advances in the practice of Neonatology, have led to an increased awareness of hypertension in modern neonatal intensive care units. This review will present updated data on blood pressure values in neonates, with a focus on the changes that occur over the first days and weeks of life in both term and preterm infants. Optimal blood pressure measurement techniques as well as the differential diagnosis of hypertension in the neonate and older infants will be discussed. Recommendations for the optimal immediate and long-term evaluation and treatment, including potential treatment parameters, will be presented. We will also review additional information on outcome that has become available over the past decade.

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Section: Therapymentioning

confidence: 99%

Hypertension in infancy: diagnosis, management and outcome

2011

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“…Although the short-acting formulation of isradipine is marketed as a twice-daily medication, the rapid metabolism of isradipine, especially in young children, usually necessitates three or even four doses daily. A stable extemporaneous suspension of isradipine can be compounded [50], thereby facilitating precise dosing, even in infants and small children. Several case series of isradipine use in chronic pediatric hypertension have been published [51,52] that demonstrate its efficacy even in children with secondary forms of hypertension.…”

Section: Oral Agents Of Potential Use In Children With Severe Hypertementioning

confidence: 99%

Severe hypertension in children and adolescents: pathophysiology and treatment

2009

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Severe, symptomatic hypertension occurs uncommonly in children, usually only in those with underlying congenital or acquired renal disease. If such hypertension has been long-standing, then rapid blood pressure reduction may be risky due to altered cerebral hemodynamics. While many drugs are available for the treatment of severe hypertension in adults, few have been studied in children. Despite the lack of scientific studies, some agents, particularly continuous intravenous infusions of nicardipine and labetalol, are preferred in many centers. These agents generally provide the ability to control the magnitude and rapidity of blood pressure reduction and should--in conjunction with careful patient monitoring--allow the safe reduction of blood pressure and the avoidance of complications. This review provides a summary of the underlying causes and pathophysiology of acute severe hypertension in childhood as well as a detailed discussion of drug treatment and the optimal clinical approach to managing children and adolescents with acute severe hypertension.

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“…It may also be related to the fact that most of the children received isradipine in suspension form. Although the suspension remains stable after compounding [12], there may be differences in bioavailability of the suspension compared with the commercially available formulations that may reduce the magnitude of the antihypertensive effect of the suspension.…”

Section: Discussionmentioning

confidence: 99%

“…Mott Children's Hospital pharmacy [12]. Occasional patients who were receiving a total daily dose of isradipine of 5 or 10 mg were switched to commercially available extended-release tablets (DynaCirc CR, Novartis Pharmaceuticals) administered once or twice daily.…”

Section: Isradipine Treatmentmentioning

confidence: 99%

“…When used in chronic treatment of hypertension in adults, isradipine is generally well tolerated, with a favorable adverse effect profile compared with the firstgeneration calcium antagonist nifedipine [10,11]. Finally, and perhaps most importantly as far as treatment of children is concerned, isradipine may be easily compounded into a stable extemporaneous suspension [12]. For these reasons, isradipine was applied to the treatment of hypertensive children at the University of Michigan in 1994.…”

Section: Introductionmentioning

confidence: 99%

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Isradipine treatment of hypertension in children: a single-center experience

Flynn

Warnick

2002

Pediatric Nephrology

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Many children with hypertension, particularly those with new-onset hypertension related to glomerulonephritis, organ transplantation, or other forms of secondary hypertension, require treatment with a short-acting antihypertensive in order to quickly achieve blood pressure (BP) control. We administered isradipine, a short-acting, second-generation calcium antagonist, to 72 such children. Retrospective data collection was undertaken to determine the effects of isradipine treatment. The mean age of children treated with isradipine was 74+/-55 months (mean+/-SD). Nearly all of these children had secondary hypertension and were initially treated as hospital inpatients for newly diagnosed hypertension. Mean isradipine dose was 0.36+/-0.17 mg/kg per day, with no significant variation in dose according to patient age. Isradipine was administered three times per day in most instances, but 21% of the time it was administered four times per day. An extemporaneous isradipine suspension was used in 62% of treatment courses. BP control was achieved with isradipine alone in 38 children; the remainder received isradipine in combination with additional antihypertensives. Comparison of pre-treatment BP with BP obtained 8+/-9 days later demonstrated a significant BP reduction with isradipine treatment, with a mean reduction of 14+/-13 mmHg for systolic BP and 13+/-15 mmHg for diastolic BP. There was no effect of isradipine treatment on heart rate. Adverse effects occurred in 9.5% of treatment courses, and included headache, flushing, dizziness, and tachycardia. We conclude that isradipine successfully lowers BP in hypertensive children with secondary forms of hypertension. Use of isradipine suspension allows infants and young children to be treated as readily as older children.

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Stability of isradipine in an extemporaneously compounded oral liquid

Cited by 18 publications

References 0 publications

Hypertension in infancy: diagnosis, management and outcome

Hypertension in infancy: diagnosis, management and outcome

Severe hypertension in children and adolescents: pathophysiology and treatment

Isradipine treatment of hypertension in children: a single-center experience

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