This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. Which is more effective, nifedipine controlled-release tablets or amlodipine tablets?How do I take nifedipine controlled-release tablets or amlodipine tablets?What to look out for?
Nifedipine controlled-release tablets and amlodipine tablets are both commonly used first-line antihypertensive drugs in clinical practice, which belong to calcium channel blockers, mainly by inhibiting the influx of calcium ions, so that the total amount of calcium ions entering the cells is reduced, thereby relaxing the smooth muscle of arterioles, reducing peripheral vascular resistance, mild diuresis, and achieving the purpose of lowering blood pressure. In addition, they can also dilate coronary arteries, reduce coronary smooth muscle tone, inhibit coronary spasm, increase blood perfusion and oxygen supply to coronary arteries, improve angina, long-term use can delay the occurrence and development of atherosclerosis, significantly reduce the incidence and mortality of cardiovascular and cerebrovascular events such as myocardial infarction and stroke, and can be used clinically for various types of hypertension and coronary heart disease angina.
Nifedipine controlled-release tablets are controlled-release dosage forms, through the unique gastrointestinal membrane regulation technology, the drug is released uniformly within 24 hours, and the antihypertensive effect is stable and long-lasting, and amlodipine also has the characteristics of "membrane control", with long tissue half-life, mild, stable and long-lasting antihypertensive effect, and small blood pressure fluctuations, both drugs are taken once a day, with good medication compliance, which can effectively control night blood pressure and morning peak blood pressure, and prevent cardiovascular and cerebrovascular complications.
On the one hand, the antihypertensive effect of amlodipine tablets 5mg-10mg is comparable to that of nifedipine controlled-release tablets 30mg-60mg, on the other hand, the half-life of nifedipine is only 4-5 hours, by making a controlled-release dosage form, the release rate of the drug in the gastrointestinal tract is slowed down, and the maximum antihypertensive effect is achieved 6-12 hours after oral administration, and stable blood pressure can be lowered after 3 days of continuous medication, and the half-life of amlodipine tablets is as long as 35-50 hours, with slow onset and long-lasting effect, and it can be taken continuously for 1-2 weeks to stabilize blood pressure. Nifedipine controlled-release tablets have a short half-life, and once they are missed, their antihypertensive efficacy decreases significantly or even fails, while amlodipine tablets have a long half-life and no significant effect on the antihypertensive efficacy if they miss a dose, especially for elderly hypertensive patients with poor medication compliance. In summary, the antihypertensive strength and action time of amlodipine are better than those of nifedipine controlled-release tablets, and the antihypertensive effect is better.
The blood pressure of the human body has a diurnal pattern, which is manifested as "two peaks and one valley", generally from 9 a.m. to 11 a.m. and from 4 p.m. to 6 p.m., and drops to the lowest trough from 2 a.m. to 3 a.m. the next day. Nitrandipine tablets, etc., generally take effect half an hour after taking the drug, 2-3 hours to reach the peak blood concentration, taken at 7 o'clock in the morning and 2 o'clock in the afternoon, just to cover the two peaks of blood pressure, and nifedipine controlled-release tablets are long-acting antihypertensive drugs, taken once a day, can effectively cover 24 hours of blood pressure, it is recommended to take it on an empty stomach at 7 in the morning, the starting dose is 30mg, once a day, if the effect is not good, it can be increased to 60mg, once a day, 60mg per day is the maximum dose.
If it is found that the missed dose is less than 6 hours away from the regular medication time, it should be taken immediately, and the next time it is still taken according to the original time, which will not cause large blood pressure fluctuations, if it is more than 6 hours away from the conventional medication time, it is recommended to measure blood pressure in time, if it exceeds the target blood pressure of 20mmHg, it should be taken immediately, if the target blood pressure is less than 20mmHg, and there are no uncomfortable symptoms, it is generally not necessary to make up the dose, and the two doses must not be taken together when taking the supplement, so as not to cause a sudden drop in blood pressure, induce ischemic events such as myocardial infarction or stroke。 In addition, nifedipine controlled-release tablets should be swallowed whole, and the tablets must not be polished or cut open with a sharp blade, so as to avoid the sudden release of the drug when taking it, and the rapid increase in blood concentration, resulting in hypotension, tachycardia, and even impaired consciousness and coma.
Amlodipine tablets are long-acting antihypertensive drugs, taken once a day, can effectively control blood pressure for 24 hours, so it is recommended to take it at 7 o'clock in the morning, its antihypertensive effect is not affected by diet, and it can be taken before or after meals. For patients with hypertension and angina, amlodipine tablets 5-10 mg once a day, once a day, and for the elderly and frail people with liver impairment, the initial dose of amlodipine tablets** hypertension is 2 at a time5 mg once a day, ** angina, 5 mg once a day.
Commonly used nifedipine controlled-release tablets should be noted:
1.The half-life of nifedipine controlled-release tablets in the elderly may be prolonged, and attention should be paid to the application to be vigilant for hypotension.
2.Patients with hypotension, heart failure, tachyarrhythmia, aortic stenosis, liver and kidney impairment should be used with caution.
3.Blood pressure and ECG changes should be monitored regularly while taking the drug.
4.Hypotension can occur with overdose, and the drug should be discontinued for observation.
5.Occasionally, liver function is abnormal but asymptomatic when taking nifedipine controlled-release tablets, which can cause a decrease in platelet aggregation rate and prolonged bleeding time.
Amlodipine tablets are commonly used, what should I pay attention to?
1.Amlodipine tablets are rare in gingival hyperplasia, which generally occurs at **1-9 months, but symptoms and hyperplasia can improve 1-21 weeks after discontinuation of the drug.
2.An overdose of amlodipine tablets can cause hypotension and, rarely, bradycardia.
Second- and third-degree atrioventricular block, a small number of patients may have cardiac arrest.
3.Use with caution in patients with hypotension, severe aortic valve stenosis (increasing the risk of hypotension), severe hepatic insufficiency, and congestive heart failure.
4.In patients with severe coronary artery stenosis, the frequency, duration, and/or severity of angina pectoris may increase at the beginning of application or dose, or acute myocardial infarction may develop, and the mechanism is unknown.
5.It is safe to use in patients with obstructive pulmonary disease (e.g., COPD), well-metabolized heart failure, and dyslipid disorders.