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Sular

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Sular

Side Effects
Interactions

SIDE EFFECTS

More than 6000 patients world-wide have received nisoldipine in clinical trials for the treatment of hypertension, either as the immediate release or the SULAR (nisoldipine) extended release formulation. Of about 1,500 patients who received SULAR (nisoldipine) in hypertension studies, about 55% were exposed for at least 2 months and about one third were exposed for over 6 months, the great majority at doses of 20 to 60 mg daily.

SULAR (nisoldipine) is generally well-tolerated. In the U.S. clinical trials of SULAR (nisoldipine) in hypertension, 10.9% of the 921 SULAR (nisoldipine) patients discontinued treatment due to adverse events compared with 2.9% of 280 placebo patients. The frequency of discontinuations due to adverse experiences was related to dose, with a 5.4% discontinuation rate at 10 mg daily and a 10.9% discontinuation rate at 60 mg daily.

The most frequently occurring adverse experiences with SULAR (nisoldipine) are those related to its vasodilator properties; these are generally mild and only occasionally lead to patient withdrawal from treatment. The table below, from U.S. placebo-controlled parallel dose response trials of SULAR (nisoldipine) using doses from 10 - 60 mg once daily in patients with hypertension, lists all of the adverse events, regardless of the causal relationship to SULAR (nisoldipine) , for which the overall incidence on SULAR (nisoldipine) was both > 1% and greater with SULAR (nisoldipine) than with placebo.

Adverse Event Nisoldipine (%)
(n=663)
Placebo (%)
(n=280)
Peripheral Edema 22 10
Headache 22 15
Dizziness 5 4
Pharyngitis 5 4
Vasodilation 4 2
Sinusitis 3 2
Palpitation 3 1
Chest Pain 2 1
Nausea 2 1
Rash 2 1

Only peripheral edema and possibly dizziness appear to be dose related.

Adverse Event SULAR
Placebo 10mg 20mg 30mg 40mg 60mg
(Rates in %) N=280 N=30 N=170 N=105 N=139 N=137
Peripheral Edema 10 7 15 20 27 29
Dizziness 4 7 3 3 4 10

The common adverse events occurred at about the same rate in men as in women, and at a similar rate in patients over age 65 as in those under that age, except that headache was much less common in older patients. Except for peripheral edema and vasodilation, which were more common in whites, adverse event rates were similar in blacks and whites.

The following adverse events occurred in ≤ 1% of all patients treated for hypertension in U.S. and foreign clinical trials, or with unspecified incidence in other studies. Although a causal relationship of SULAR (nisoldipine) to these events cannot be established, they are listed to alert the physician to a possible relationship with SULAR (nisoldipine) treatment.

Body As A Whole: cellulitis, chills, facial edema, fever, flu syndrome, malaise

Cardiovascular: atrial fibrillation, cerebrovascular accident, congestive heart failure, first degree AV block, hypertension, hypotension, jugular venous distension, migraine, myocardial infarction, postural hypotension, ventricular extrasystoles, supraventricular tachycardia, syncope, systolic ejection murmur, T wave abnormalities on ECG (flattening, inversion, nonspecific changes), venous insufficiency

Digestive: abnormal liver function tests, anorexia, colitis, diarrhea, dry mouth, dyspepsia, dysphagia, flatulence, gastritis, gastrointestinal hemorrhage, gingival hyperplasia, glossitis, hepatomegaly, increased appetite, melena, mouth ulceration

Endocrine: diabetes mellitus, thyroiditis

Hemic and Lymphatic: anemia, ecchymoses, leukopenia, petechiae

Metabolic and Nutritional: gout, hypokalemia, increased serum creatine kinase, increased nonprotein nitrogen, weight gain, weight loss

Musculoskeletal: arthralgia, arthritis, leg cramps, myalgia, myasthenia, myositis, tenosynovitis

Nervous: abnormal dreams, abnormal thinking and confusion, amnesia, anxiety, ataxia, cerebral ischemia, decreased libido, depression, hypesthesia, hypertonia, insomnia, nervousness, paresthesia, somnolence, tremor, vertigo

Respiratory: asthma, dyspnea, end inspiratory wheeze and fine rales, epistaxis, increased cough, laryngitis, pharyngitis, pleural effusion, rhinitis, sinusitis

Skin and Appendages: acne, alopecia, dry skin, exfoliative dermatitis, fungal dermatitis, herpes simplex, herpes zoster, maculopapular rash, pruritus, pustular rash, skin discoloration, skin ulcer, sweating, urticaria

Special Senses: abnormal vision, amblyopia, blepharitis, conjunctivitis, ear pain, glaucoma, itchy eyes, keratoconjunctivitis, otitis media, retinal detachment, tinnitus, watery eyes, taste disturbance, temporary unilateral loss of vision, vitreous floater

Urogenital: dysuria, hematuria, impotence, nocturia, urinary frequency, increased BUN and serum creatinine, vaginal hemorrhage, vaginitis.

The following postmarketing event has been reported very rarely in patients receiving SULAR (nisoldipine) : systemic hypersensitivity reaction which may include one or more of the following; angioedema, shortness of breath, tachycardia, chest tightness, hypotension, and rash. A definite causal relationship with SULAR (nisoldipine) has not been established. An unusual event observed with immediate release nisoldipine but not observed with SULAR (nisoldipine) was one case of photosensitivity. Gynecomastia has been associated with the use of calcium channel blockers.

Read the Sular (nisoldipine) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

A 30 to 45% increase in AUC and C max of nisoldipine was observed with concomitant administration of cimetidine 400 mg twice daily. Ranitidine 150 mg twice daily did not interact significantly with nisoldipine (AUC was decreased by 15 - 20 %). No pharmacodynamic effects of either histamine H2 receptor antagonist were observed.

Coadministration of phenytoin with 40 mg SULAR tablets in epileptic patients lowered the nisoldipine plasma concentrations to undetectable levels. Coadministration of SULAR (nisoldipine) with phenytoin or any known CYP3A4 inducer should be avoided and alternative antihypertensive therapy should be considered. Pharmacokinetic interactions between nisoldipine and beta-blockers (atenolol, propranolol) were variable and not significant. Propranolol attenuated the heart rate increase following administration of immediate release nisoldipine. The blood pressure effect of SULAR (nisoldipine) tended to be greater in patients on atenolol than in patients on no other antihypertensive therapy. Quinidine at 648 mg bid decreased the bioavailability (AUC) of nisoldipine by 26%, but not the peak concentration. The immedi- ate release, but not the coat-core formulation of nisoldipine increased plasma quinidine concentrations by about 20%. This interaction was not accompanied by ECG changes and its clinical significance is not known. No significant inter- actions were found between nisoldipine and warfarin or digoxin.

Read the Sular Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 2/7/2008
This monograph has been modified to include the generic and brand name in many instances.

Side Effects
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