8/15/2023 0 Comments Nifedipine er![]() Nifedipine should be used cautiously in patients with severe bradycardia. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.Īcute myocardial infarction, bradycardia, cardiogenic shock, coronary artery disease, heart failure, hypotension, ventricular dysfunction Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. Nifedipine has been used to treat Raynaud's phenomenon of the nipple to decrease the pain associated with breast-feeding. Previous recommendations from The American Academy of Pediatrics (AAP) listed nifedipine as usually compatible with breast-feeding. ![]() ![]() The authors further concluded that delaying breast-feeding or expressing milk for 3 to 4 hours after a dose would significantly reduce the amount of drug ingested by a nursing infant. However, neonatal myocardium is very sensitive to changes in calcium status, and the therapeutic dose for a neonate is unknown. Based off of data from a single mother-infant pair, it has been estimated that the amount of drug that would appear in the breast-milk is less than 5% of the maternal therapeutic dose. Store at controlled room temperature (between 68 and 77 degrees F)īecause nifedipine is excreted in human milk, the manufacturer does not recommend breast-feeding during nifedipine therapy. Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F Magnesium sulfate therapy should not be given concurrently because of additive effects on maternal cardiac function. Additionally, some studies have used maintenance dosing with slow-release nifedipine (doses of 60 to 160 mg/day PO). ![]() Although maintenance use of tocolytics after acute suppression of contractions has not been shown to prolong pregnancy, doses of 10 to 20 mg PO every 4 to 6 hours have been used. When compared to ritodrine or magnesium sulfate, nifedipine has generally demonstrated similar efficacy with similar or fewer maternal side effects. Although not definitive, typical duration of tocolysis for acute inhibition of premature labor is 24 to 72 hours. Typical regimens for the loading dose include 10 mg SL with 20 mg PO, 30 mg PO, or 10 to 20 mg SL or PO every 15 to 20 minutes until contractions stop, up to a maximum of 30 to 40 mg over 1 hour. NOTE: A route of administration is not provided, although typically PO and/or SL is used for the loading dose and PO is used for subsequent dosing. The recommended dose by the American College of Obstetrics and Gynecology (ACOG) is a 30-mg loading dose, followed by 10 to 20 mg every 4 to 6 hours. Although the use of immediate-release nifedipine for the treatment acute hypertensive episodes is still relatively common practice in pediatric patients, considerable controversy exists and caution should be used. The immediate-release nifedipine formulation has been associated with serious side effects when used to treat adult patients with hypertension, hypertensive urgency, hypertensive emergency, or coexisting myocardial infarction. NOTE: Per the FDA and manufacturers, immediate-release nifedipine dosage forms should not be used to treat hypertension and should only be used to treat patients with chronic stable angina or vasospastic angina. Mean doses of 0.22 to 0.23 mg/kg (range: 0.04 to 0.69 mg/kg) have been reported in retrospective studies (n = 299 pediatric patients 0.1 to 18.9 years). To avoid a precipitous and unexpected drop in blood pressure, some authors recommend initial doses less than 0.2 mg/kg and avoiding use in patients with CNS injury. 0.2 to 0.5 mg/kg/dose (Max: 10 mg/dose) PO every 4 to 6 hours as needed. ![]()
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