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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by tecknohed on November 4, 2005, at 14:48:42
Can someone please tell me the brand/other name for sublingual Nifedipine? I can find lots of Nifedipine around but no sublingual type.
(Dr. Bob - I'm not asking for a source, just the name)
Thanks,
teck
Posted by ed_uk on November 5, 2005, at 9:50:24
In reply to Sublingual Nifedipine?, posted by tecknohed on November 4, 2005, at 14:48:42
Hi Kev
Nifedipine is not well absorbed sublingually, it is more active when it's swallowed. There are no approved nifedipine preparations for sublingual use in the UK, although immediate release nifedipine capsules have been administered in this way.
In the treatment of an MAOI/tyramine-induced hypertensive crisis, nifedipine is given as an oral capsule. The capsule should be swallowed (not held under the tongue) - you can bite the capsule first if you want to.
Nifedipine is available both as slow release capsules/tablets and as standard/immediate release capsules. The immediate release capsules have been used to treat MAOI-induced hypertensive crises. In the UK, these capsules are available as a generic. They are also available as Adalat capsules (not Adalat tablets - which are 'slow release').
In the US, immediate release nifedipine capsules are available under the brand name Procardia capsules (not Procardia XL tablets - which are slow release).
Adalat (UK) capsules are available as 5mg and 10mg capsules. Procardia (US) capsules are available as 10mg and 20mg capsules.
Nifedipine is an inappropriate treatment for most forms of hypertensive crisis eg. due to kidney disease. It's safety is uncertain and it can cause significant side effects. The rapid BP drop induced by nifedipine is dangerous for many hypertensive patients with chronic hypertension, a more gradual reducation in BP is desirable. Nevertheless, an MAOI-induced hypertensive crisis is characterised by a very rapid BP rise in a previously normotensive patient. Under these cirumstances, it is possible that nifedipine might be an acceptable treatment. Ideally, an MAOI hypertensive crisis should always be treated in hospital. Phentolamine (if available) can be given intravenously. Many emergency departments may not stock phentolamine. Sodium nitroprusside IV infusion could be used as an alternative.
There is no ideal drug for the treatment of MAOI-induced hypertensive crisis. Nifedipine (5 or 10mg) may be suitable as a pre-hospital treatment but this is controversial. Chlorpromazine (Largactil, Thorazine) has been used in a similar manner.
A hypertensive crisis can cause considerable pain and anxiety, which might theoretically aggravate the hypertension. Diazepam (Valium) 10mg can be given for anxiety. Paracetamol 1000mg can be given for pain.
Kind regards
Ed
Posted by tecknohed on November 6, 2005, at 7:27:42
In reply to Re: Sublingual Nifedipine? » tecknohed, posted by ed_uk on November 5, 2005, at 9:50:24
Thanks Ed!
It is indeed for MAOI crisis. I did look into Thorazine but after weighing up, decided for Nifedipine. I took Largactil (same med?) once and was 'knocked out cold'. Because of my diabetes this isn't ideal.
I've had 2 hypertensive crisis on Nardil. One from food - Lambs Liver, and the other from a 'Herbal High' - Sida Cordifolia which I now know cantains ephedrine & pseudoephedrine! Both times I was in excruciating pain and agony (first time was worst) and was scared I might die and both times I ended up in A&E. They did nothing to help at all! Said there was nothing they could do! Appaling!
My pdoc wont give me anything (I'm changing pdocs soon - tell you about it another time). So seems I must take things into my own hands YET AGAIN.
Anyway, I had the impression that nifedipine was sublingual as people often say ther 'bite' into them. Thanks for putting that straight for me.
I have also read the conflicting advise about it, but my plan would be to take it and then visit A&E, just in case.Regrds
Kev.
Posted by ed_uk on November 6, 2005, at 15:40:44
In reply to Re: Sublingual Nifedipine? » ed_uk, posted by tecknohed on November 6, 2005, at 7:27:42
Hi Kev
I got your email :-) Sorry for not responding yet, I'm often so tired when I get home from work. I will reply soon :-)
>I took Largactil (same med?)
Yes! Largactil is the brand name for chlorpromazine.
>Both times I was in excruciating pain and agony (first time was worst) and was scared I might die and both times I ended up in A&E. They did nothing to help at all! Said there was nothing they could do! Appaling!
My experiences of A&E have been disturbing. I think it would be useful to prepare some information to take to the A&E department in the event of suffering a hypertensive crisis. You may be treated by doctors who have not even heard of Nardil! They should, however, be familiar with the treatment of other types of acute severe hypertension. Phentolamine (injection) is the traditional drug of choice for the treatment of an MAOI-induced hypertensive crisis. It's quite possible that the hospital will not have any supplies of phentolamine though. As such, sodium nitroprusside infusion could be used to control the hypertension. Sodium nitroprusside is a potent vasodilator which can be precisely titrated in order to control hypertensive emergencies safely.
>Anyway, I had the impression that nifedipine was sublingual as people often say ther 'bite' into them.
If you do decide to use nifedipine, I'd suggest taking a single 5mg capsule initially followed by a further 5mg capsule after 60 minutes if your BP is still very high - although you should already be in hospital at this point! Avoid the temptation to take a high dose, 5mg may be sufficient! The capsule should be swallowed whole or bitten then swallowed. There is no reason to hold it under the tongue - it tastes horrible and little is absorbed until it reaches the intestine.
Here is some information RE the risks of nifedipine IR.......
http://www.ptcommunity.com/ptjournal/fulltext/27/7/PTJ2707362.pdf
Do you have a BP monitor? You'd need a monitor to use nifedipine. Don't try to normalise your BP using nifedipine, the aim should be to reduce your BP until it's no longer critical.
Kind regards
Ed
Posted by ed_uk on November 7, 2005, at 14:38:29
In reply to Re: Sublingual Nifedipine? » ed_uk, posted by tecknohed on November 6, 2005, at 7:27:42
Hi Kevin
So what do you think? Will you buy some nifedipine?
Ed
Posted by tecknohed on November 7, 2005, at 15:17:51
In reply to Re: Sublingual Nifedipine? » tecknohed, posted by ed_uk on November 7, 2005, at 14:38:29
> Hi Kevin
>
> So what do you think? Will you buy some nifedipine?
>
> EdYes Ed. I dont see what else I can use. I must admit that the report you pointed me to did seem a bit worrying, even though I didn't know what half the conditions were (the side effects/warnings). I've been too lazy to look them up. I will do though.
Like I said, I wont touch Thorazine. Anyway, sounds like it takes too long to work.
I will take your advice and only use one to start with. They're VERY cheap so I might aswell buy them. More importantly, lets hope I'll never need to use them! lolAwe, that reminds me - check you're email in about 1/2hr.
Cheers,
kev
Posted by ed_uk on November 7, 2005, at 15:29:22
In reply to Re: Sublingual Nifedipine? » ed_uk, posted by tecknohed on November 7, 2005, at 15:17:51
Hi Kev
>Yes Ed.
I've gotta say, I'd buy them if I were you. It would make me feel safer. I'd definitely get the 5mg caps though - more room for titration.
>More importantly, lets hope I'll never need to use them! lol
I hope so too :-)
Kind regards
Ed
Posted by ger man on October 4, 2011, at 16:11:59
In reply to Re: Sublingual Nifedipine? » tecknohed, posted by ed_uk on November 5, 2005, at 9:50:24
As im a new member in the MAOi-community and my pdoc prescribed some nifepidine i wanted to ask some details. First of all the med i have benn prescribed is called Adalat 5 mg. I think those are capsules. I wanted to ask other MAOi-users how they use this emergency med? My doc told me only to use it when there is no adequate emergency care around. If there is a chance to get high quality emergency attention i should prefer to use it over self treatment.
1. Would you use 5 or 10 mg for treating hypertensive crisis? My pdoc told me to use 5 mg but i read that other use 10 mg!
2. What is a high blood pressure for you?
3. How are the caps ingested when it comes to the case of need?
4. Should one try to reach a normal BP or is it sufficient to reach for example a BP of 150/95? I mean is it essential to reach optimal BP (120/80) by nifedipine treatment?
5. How do you, first of all those who already experienced BP-Crisis, feel a real hypertensive crisis?
thx for your reply....
Posted by Chairman_MAO on October 5, 2011, at 22:54:35
In reply to Sublingual Nifedipine?, posted by tecknohed on November 4, 2005, at 14:48:42
None of my doctors ever wanted to touch this one. As another poster said, IV phentolamine is the treatment of choice.
I have had Thorazine to carry around (never touched it) and also clonidine (not even sure if that one is a good idea).
I've only had one hypertensive crisis on ~120mg/day tranylcypromine when I ate some esoteric thai dish that must have had some obscene amount of tyramine in it. Well, I wouldn't even call it a "crisis", as I did not have to call 911, but it was painful. Clonidine made it go away.
This is the end of the thread.
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