Reactions 743 - 20 Mar 1999

Nifedipine: immediate-release/monotherapy linked to increased

anginaImmediate-release nifedipine and nifedipine

monotherapy increases the risk of cardiovascular eventsin patients with chronic stable angina, and this increasedrisk is mainly due to a greater frequency of episodes ofincreased angina, according to results of a US meta-analysis. However, Dr William Stason and colleagues,who conducted the meta-analysis, say that it is unclearwhether the increased risk is due to an adverse reactionor lack of drug efficacy.

The meta-analysis involved data from 60 publishedrandomised controlled trials of patients (mean age 58.2years) with chronic stable angina; a total of 2635patients were exposed to nifedipine, 2655 to otheractive drugs and 281 to placebo. One or morecardiovascular events were reported in 1.14% ofnifedipine recipients and 0.72% of patients taking otheractive drugs.

Increased risk with nifedipine monotherapyThe risk of all cardiovascular events combined, major

cardiovascular events*, and episodes of increasedangina in the nifedipine group did not differ significantlyfrom the other active drug group. However, forimmediate-release nifedipine, a significantly higher riskof episodes of increased angina and all cardiovascularevents combined was found, compared with otheractive drugs; unadjusted odds ratios (ORs) 4.19 (95% CI1.41–12.49) and 3.09 (1.39–6.88), respectively. Thisincreased risk was not seen with sustained- or extended-release nifedipine formulations. The ORs for increasedangina and all cardiovascular events with nifedipinemonotherapy, compared with combination therapy**,were also significant: unadjusted ORs of 3.9 (95% CI1.45–10.45) and 2.61 (1.3–5.26), respectively.* Major cardiovascular events were defined as deaths, nonfatalmyocardial infarctions, nonfatal strokes and revascularisationprocedures that occurred during the study.** Most nifedipine combination therapy groups used β-blockers.

Stason WB, et al. Safety of nifedipine in angina pectoris: a meta-analysis.Hypertension 33: 24-31, Jan 1999 800744567

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Reactions 20 Mar 1999 No. 7430114-9954/10/0743-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved