DRUG REACTIONS Nifedipine used indiscriminately for severe hypertension

The indiscriminate use of oral or sublingual nifedipine for the treatment of severe hypertension 'is poor medical practice and can lead to potentially serious side effects, ' in the opinion of Dr Faiz Rehman and colleagues from Connecticut, US.

The investigators report disturbing practices of nifedipine capsule administration amongst both resident and attending physicians at 3 hospitals in Connecticut.

Lack of clinical evaluation Over a 2-month period, 152 doses of nifedipine

were administered to 83 patients based on arbitrary and wide ranges of BPs. The nifedipine dosage was IOmg in 96% of cases; however, 65% of patients received multiple doses of nifedipine. Of concern, the majority (63%) of nifedipine orders were given over the phone, and 98% of orders lacked any evidence of clinical bedside evaluation. Furthermore, in 25% of cases, there was no documentation of follow-up BP recording until 2-6 hours after nifedipine administration.

Large asymptomatic BP reductions were common, and 1 patient experienced severe hypotension and an anterior wall myocardial infarction 1 hour after the administration of nifedipine 2Omg.

Dr Rehman and colleagues stress that the risks associated with rapid and excessive reduction of BP with nifedipine may outweigh the benefits in patients with severe hypertension. It seems more logical in such cases to use a long-acting antihypertensive agent and follow the response closely, they say.

Rebman F, Mansoor GA, White WB. Inappropriate physician habits in prescribing oral nifedipine capsules in hospital patients. American Joumal of Hypertension 9: 1035-1039, Part I, Oct 1996 .... '96711

0156-270319611063-000211$01.00"' Adlalm.rnatJonal Limited 1886. All rlghta ..-wd

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Inpharma-18 Nov 1886 No. 1083