nitrendipine

Nitrendipine is a dihydropyridine calcium channel blocker used in the management of hypertension and, to a lesser extent, angina. It is typically prescribed for long-term blood pressure control and may be used as monotherapy or in combination with other antihypertensive agents. Brand names include Cardene, among others.

The drug acts by selectively inhibiting L-type calcium channels in vascular smooth muscle. By blocking calcium entry, nitrendipine causes vasodilation of peripheral arteries, reducing systemic vascular resistance and blood pressure. Its vasoselective profile tends to have a minimal direct depressant effect on cardiac conduction, though reflex sympathetic activity can occur, which may contribute to symptoms such as tachycardia or palpitations.

Nitrendipine is taken orally and is well absorbed from the gastrointestinal tract. It undergoes hepatic metabolism, primarily via cytochrome P450 3A4, to active and inactive metabolites. It has a relatively long duration of action, which supports once-daily dosing in many regimens. Excretion occurs via urine and feces.

Common adverse effects reflect its vasodilatory action and include peripheral edema, headache, flushing, dizziness, and palpitations. Hypotension can occur, and gingival hyperplasia may develop with prolonged use. Nitrendipine should be used with caution in patients with severe aortic stenosis or uncompensated heart failure and may worsen heart failure symptoms in some individuals.

Drug interactions involve other antihypertensives, potentially additive hypotensive effects, and agents that influence CYP3A4 activity. Inhibitors of CYP3A4 (for example, certain macrolide antibiotics and azole antifungals) can raise nitrendipine levels, while inducers can lower its effectiveness. Grapefruit juice may also increase blood levels of nitrendipine.