ADALAT LA

Main information

  • Trade name:
  • ADALAT LA
  • Dosage:
  • 20 Milligram
  • Pharmaceutical form:
  • Tablet Prolonged Release
  • Medicine domain:
  • Humans
  • Medicine type:
  • Allopathic drug

Documents

Localization

  • Available in:
  • ADALAT LA
    Ireland
  • Language:
  • English

Status

  • Source:
  • HPRA - Health Products Regulatory Authority - Ireland
  • Authorization number:
  • PPA1562/036/001
  • Authorization date:
  • 26-11-2010
  • Last update:
  • 14-10-2016

Summary of Product characteristics: dosage, interactions, side effects

SummaryofProductCharacteristics

1NAMEOFTHEMEDICINALPRODUCT

AdalatLA20mgProlonged-ReleaseTablet

2QUALITATIVEANDQUANTITATIVECOMPOSITION

Onetabletcontains20mgnifedipine.

Excipients:Sodium

Forafulllistofexcipients,seesection6.1.

3PHARMACEUTICALFORM

Prolonged-releasefilm-coatedtablet.

ProductimportedfromtheUK:

Pink,circularconvextabletswithAdalat20markedononeside.

4CLINICALPARTICULARS

4.1TherapeuticIndications

Forthetreatmentofmildtomoderatehypertension.

Forthemanagementofchronicstableanginapectoriseitherasmonotherapyorincombinationwithabeta-blocker.

4.2Posologyandmethodofadministration

Fororaladministration,thetabletsshouldbeswallowedwholewithaglassofwater,independentlyofmeals.The

tabletsshouldbetakenatapproximately24-hourintervals,i.e.atthesametimeeachday,preferablyduringthe

morning.AdalatLAtabletsmustbeswallowedwhole;undernocircumstancesshouldtheybebitten,chewedor

brokenup.

Inmildtomoderatehypertension,therecommendedinitialdoseisone20mgtabletonce-daily.Ifnecessary,the

dosagecanbeincreasedaccordingtoindividualrequirementsuptoamaximumof90mgonce-daily.

Forthemanagementofanginapectoris,therecommendedinitialdoseisone30mgtabletonce-daily.Thedosagecan

beincreasedaccordingtoindividualrequirementsuptoamaximumof90mgonce-daily.

PatientsinwhomhypertensionoranginalsymptomsarecontrolledonAdalatcapsulesorAdalatretardmaybesafely

switchedtoAdalatLA.Prophylacticanti-anginalefficacyismaintainedwhenpatientsareswitchedfromothercalcium

antagonistssuchasdiltiazemorverapamiltoAdalatLA.Patientsswitchedfromothercalciumantagonistsshould

initiatetherapyattherecommendedinitialdoseof30mgAdalatLAonce-daily.Subsequenttitrationtoahigherdose

maybeinitiatedaswarrantedclinically.

Thepharmacokineticsofnifedipinearealteredintheelderlysothatlowermaintenancedosesofnifedipinemaybe

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Co-administrationwithCYP3A4inhibitorsofCYP3A4inducersmayresultintherecommendationtoadaptthe

nifedipinedoseornottousenifedipineatall(seesection4.5).

Patientswithrenalimpairmentshouldnotrequireadjustmentofdosage.

Treatmentmaybecontinuedindefinitely.

Nifedipineisnotrecommendedforuseinchildren.

AdalatLAshouldnotbetakenwithgrapefruitjuice(seeSection4.5).

4.3Contraindications

AdalatLAshouldnotbeadministeredtopatientswithknownhypersensitivitytonifedipineorotherdihydropyridines

becauseofthetheoreticalriskofcross-reactivity.

AdalatLAshouldnotbeadministeredduringpregnancyortonursingmothers.

AdalatLAshouldnotbeusedincardiogenicshock,clinicallysignificantaorticstenosis,unstableanginapectoris,or

duringorwithinonemonthofamyocardialinfarction.

AdalatLAshouldnotbeusedforthetreatmentofacuteattacksofangina.

ThesafetyofAdalatLAinmalignanthypertensionhasnotbeenestablished.

AdalatLAshouldnotbeusedforsecondarypreventionofmyocardialinfarction.

Owingtothedurationofactionoftheformulation,AdalatLAshouldnotbeadministeredtopatientswithhepatic

impairment.

AdalatLAshouldnotbeadministeredtopatientswithahistoryofgastro-intestinalobstruction,oesophageal

obstruction,oranydegreeofdecreasedlumendiameterofthegastro-intestinaltract.

AdalatLAiscontra-indicatedinpatientswithinflammatoryboweldiseaseorCrohn'sdisease.

AdalatLAshouldnotbeadministeredconcomitantlywithrifampicinsinceeffectiveplasmalevelsofnifedipinemay

notbeachievedowingtoenzymeinduction(seeSection4.5).

4.4Specialwarningsandprecautionsforuse

AdalatLAtabletsmustbeswallowedwhole;undernocircumstancesshouldtheybebitten,chewedorbrokenup.

TheoutermembraneoftheAdalatLAtabletisnotdigestedand,therefore,whatappearstobethecompletetabletmay

beseeninthetoiletorassociatedwiththepatient'sstools.

Cautionshouldbeexercisedinpatientswithhypotensionasthereisariskoffurtherreductioninbloodpressure.

AdalatLAmaybeusedincombinationwithbeta-blockingdrugsandotherantihypertensiveagentsbutthepossibility

ofanadditiveeffectresultinginposturalhypotensionshouldbeborneinmind.AdalatLAwillnotpreventpossible

reboundeffectsaftercessationofotherantihypertensivetherapy.

AdalatLAshouldbeusedwithcautioninpatientswhosecardiacreserveispoor.Deteriorationofheartfailurehas

occasionallybeenobservedwithnifedipine.

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Althougha'steal'effecthasnotbeendemonstrated,patientsexperiencingthiseffectshoulddiscontinuenifedipine

therapy.

DiabeticpatientstakingAdalatLAmayrequireadjustmentoftheircontrol.

Indialysispatientswithmalignanthypertensionandhypovolaemia,amarkeddecreaseinbloodpressurecanoccur.

Therearenosafetyandefficacydatafromwell-controlledstudiesinpregnantwomen(seesection4.6).

Animalstudieshaveshownavarietyofembryotoxic,placentotoxicandfetotoxiceffects(seeSection5.3)when

administeredduringandaftertheperiodoforganogenesis.

Whilstnifedipineiscontra-indicatedinpregnancy,particularcaremustbeexercisedwhenadministeringnifedipinein

combinationwithi.v.magnesiumsulphatetopregnantwomen.

Co-administrationofnifedipinewitherythromycin,ketoconazole,itraconazole,fluconazole,fluoxetine,indinavir,

nelfinavir,ritonavir,amprenavirandsaquinavir,maytheoreticallyresultinanincreaseinnifedipineplasma

concentrations.Uponco-administrationwithanyofthesecytochromeP4503A4inhibitors,bloodpressureshouldbe

monitoredand,ifnecessary,areductioninthenifedipinedoseconsidered(seeSection4.5).

AstheoutermembraneoftheAdalatLAtabletisnotdigested,careshouldbeexercisedasobstructivesymptomsmay

occur,particularlyinpatientswithpre-existingseveregastrointestinalnarrowing.Bezoarscanoccurinveryrarecases

andmayrequiresurgicalintervention.

AdalatLAmustnotbeadministeredtopatientswithKockpouch(ileostomyafterproctocolectomy).

Afalsepositiveeffectmaybeexperiencedwhenperformingabariumcontrastx-ray.

4.5Interactionwithothermedicinalproductsandotherformsofinteraction

Drugsthataffectnifedipine

NifedipineismetabolisedviathecytochromeP4503A4system,locatedbothintheintestinalmucosaandintheliver.

Drugsthatareknowntoeitherinhibitortoinducethisenzymesystemmaythereforealterthefirstpass(after

oraladministration)ortheclearanceofnifedipine.

Theextentaswellasthedurationofinteractionsshouldbetakenintoaccountwhenadministeringnifedipinetogether

withthefollowingdrugs:

Rifampicin:RifampicinstronglyinducesthecytochromeP4503A4system.Uponco-administrationwithrifampicin,

thebioavailabilityofnifedipineisdistinctlyreducedandthusitsefficacyweakened.Theuseofnifedipinein

combinationwithrifampicinisthereforecontraindicated(seesection4.3).

Uponco-administrationofweaktomoderateinhibitorsofthecytochromeP4503A4system(listedimmediately

below),thebloodpressureshouldbemonitoredand,ifnecessary,areductioninthenifedipinedoseconsidered(see

Sections4.2and4.4).Inthemajorityofthesecases,noformalstudiestoassessthepotentialforadruginteraction

betweennifedipineandthedrug(s)listedhavebeenundertaken,thusfar.

Macrolideantibiotics(e.g.,erythromycin):CertainmacrolideantibioticsareknowntoinhibitthecytochromeP450

3A4mediatedmetabolismofotherdrugs.Thereforethepotentialforanincreaseofnifedipineplasmaconcentrations

uponco-administrationofbothdrugscannotbeexcluded(seeSection4.4).

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Anti-HIVproteaseinhibitors(e.g.,ritonavir):Drugsofthisclasshavebeenshowntoinhibitinvitrothecytochrome

P4503A4mediatedmetabolismofnifedipine.Whenadministeredtogetherwithnifedipine,asubstantialincreasein

plasmaconcentrationsofnifedipineduetoadecreasedfirstpassmetabolismandadecreasedeliminationcannotbe

excluded(seeSection4.4).

Azoleanti-mycotics(e.g.,ketoconazole):DrugsofthisclassareknowntoinhibitthecytochromeP4503A4system.

Whenadministeredorallytogetherwithnifedipine,asubstantialincreaseinsystemicbioavailabilityofnifedipinedue

toadecreasedfirstpassmetabolismcannotbeexcluded(seeSection4.4).

Fluoxetine:FluoxetinehasbeenshowntoinhibitinvitrothecytochromeP4503A4mediatedmetabolismofnifedipine.

Thereforeanincreaseofnifedipineplasmaconcentrationsuponco-administrationofbothdrugscannotbe

excluded(seeSection4.4).

Nefazodone:NefazodoneisknowntoinhibitthecytochromeP4503A4mediatedmetabolismofotherdrugs.Therefore

anincreaseinnifedipineplasmaconcentrationsuponco-administrationofbothdrugscannotbeexcluded(seeSection

4.4).

Quinupristin/dalfopristinandcisapride:Simultaneousadministrationofquinupristin/dalfopristinandnifedipine,or

cisaprideandnifedipine,mayleadtoincreasedplasmaconcentrationsofnifedipine(seeSection4.4).

Valproicacid:Asvalproicacidhasbeenshowntoincreasetheplasmaconcentrationsofthestructurallysimilar

calciumchannelblocker,nimodipine,duetoenzymeinhibition,anincreaseinnifedipineplasmaconcentrationsand

henceanincreaseinefficacycannotbeexcluded(seeSection4.4).

Cimetidine:DuetoitsinhibitionofcytochromeP4503A4,cimetidineelevatestheplasmaconcentrationsofnifedipine

andmaypotentiatetheantihypertensiveeffect(seeSection4.4).

Diltiazem:Diltiazemdecreasestheclearanceofnifedipineand,hence,increasesplasmanifedipinelevels.Therefore,

cautionshouldbetakenwhenbothdrugsareusedincombinationandareductionofthenifedipinedosemaybe

necessary.

Furtherstudies

CytochromeP4503A4system-inducinganti-epilepticdrugs,suchasphenytoin,carbamazepineandphenobarbital:

phenytoininducesthecytochromeP4503A4system.Uponco-administrationwithphenytoin,thebioavailabilityof

nifedipineisreducedandthusitsefficacyweakened.Whenbothdrugsareadministeredconcomitantly,theclinical

responsetonifedipineshouldbemonitoredand,ifnecessary,anincreaseofthenifedipinedoseconsidered.Ifthedose

ofnifedipineisincreasedduringco-administrationofbothdrugs,areductionofthenifedipinedoseshouldbe

consideredwhenthetreatmentwithphenytoinisdiscontinued.

Noformalstudieshavebeenperformedtoinvestigatethepotentialinteractionbetweennifedipineandcarbamazepine

orphenobarbital.Asbothdrugshavebeenshowntoreducetheplasmaconcentrationsofthestructurally

similarcalciumchannelblocker,nimodipine,duetoenzymeinduction,adecreaseinnifedipineplasmaconcentrations

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Effectsofnifedipineonotherdrugs

Nifedipinemayincreasethebloodpressureloweringeffectofconcomitantappliedantihypertensives,suchas:

diuretics

beta-blockers

ACE-inhibitors

AT-1antagonists

othercalciumantagonists

alpha-adrenergicblockingagents

PDE5inhibitors

alpha-methyldopa

Whennifedipineisadministeredsimultaneouslywithbeta-receptorblockersthepatientshouldbecarefullymonitored,

sincedeteriorationofheartfailureisalsoknowntodevelopinisolatedcases.

Digoxin:Thesimultaneousadministrationofnifedipineanddigoxinmayleadtoreduceddigoxinclearanceand,hence,

anincreaseintheplasmadigoxinlevel.Thepatientshouldthereforebecheckedforsymptomsofdigoxinoverdosage

asaprecautionand,ifnecessary,theglycosidedoseshouldbereducedtakingaccountoftheplasmaconcentrationof

digoxin.

Quinidine:Whennifedipineandquinidinehavebeenadministeredsimultaneously,loweredquinidinelevels,orafter

discontinuationofnifedipine,adistinctincreaseinplasmaconcentrationsofquinidine,havebeenobserved

inindividualcases.Forthisreason,whennifedipineiseitheradditionallyadministeredordiscontinued,monitoringof

thequinidineplasmaconcentration,andifnecessary,adjustmentofthequinidinedosearerecommended.

Someauthorsreportedincreasedplasmaconcentrationsofnifedipineuponco-administrationofbothdrugs,while

othersdidnotobserveanalterationinthepharmacokineticsofnifedipine.

Thereforethebloodpressureshouldbecarefullymonitored,ifquinidineisaddedtoanexistingtherapywithnifedipine.

Ifnecessary,thedoseofnifedipineshouldbedecreased.

Tacrolimus:TacrolimushasbeenshowntobemetabolisedviathecytochromeP4503A4system.Datarecently

publishedindicatethatthedoseoftacrolimusadministeredsimultaneouslywithnifedipinemaybereducedin

individualcases.Uponco-administrationofbothdrugs,thetacrolimusplasmaconcentrationsshouldbemonitoredand,

ifnecessary,areductioninthetacrolimusdoseconsidered.

Drugfoodinteractions

GrapefruitjuiceinhibitsthecytochromeP4503A4system.Administrationofnifedipinetogetherwithgrapefruitjuice

thusresultsinelevatedplasmaconcentrationsandprolongedactionofnifedipineduetoadecreasedfirst

passmetabolismorreducedclearance.Asaconsequence,thebloodpressureloweringeffectofnifedipinemaybe

increased.Afterregularintakeofgrapefruitjuice,thiseffectmaylastforatleastthreedaysafterthelastingestionof

grapefruitjuice.

Ingestionofgrapefruit/grapefruitjuiceisthereforetobeavoidedwhiletakingnifedipine(seeSection4.2).

Drugsshownnottointeractwithnifedipine

Thefollowingdrugshavebeenshowntohavenoeffectonthepharmacokineticsofnifedipinewhenadministered

concomitantly:ajmaline,aspirin,benazepril,candesartancilexetil,debrisoquine,doxazosin,irbesartan,omeprazole,

orlistat,pantoprazole,ranitidine,rosiglitazone,talinololandtriamterenehydrochlorothiazide.

Otherformsofinteraction

Nifedipinemayincreasethespectrophotometricvaluesofurinaryvanillylmandelicacidfalsely.However,HPLC

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4.6Fertility,pregnancyandlactation

AdalatLAiscontra-indicatedduringpregnancy.

AdalatLAshouldnotbeusedbywomenwhointendtogetpregnantinthenearfuture.

ThesafetyofAdalatLAforuseinhumanpregnancyhasnotbeenestablished.Evaluationofexperimentalanimal

studieshasshownreproductivetoxicityconsistingofembryotoxicityandteratogeniceffectsatmaternallytoxicdoses.

AdalatLAiscontra-indicatedinbreastfeeding.Nifedipinepassesintothebreastmilk.Asthereisnoexperienceof

possibleeffectsoninfants,breastfeedingshouldfirstbestoppedifnifedipinetreatmentbecomesnecessaryduringthe

breastfeedingperiod.

Insinglecasesofinvitrofertilisationcalciumantagonistslikenifedipinehavebeenassociatedwithreversible

biochemicalchangesinthespermatozoa’sheadsectionthatmayresultinimpairedspermfunction.Inthosemenwho

arerepeatedlyunsuccessfulinfatheringachildbyinvitrofertilisation,andwherenootherexplanationcanbefound,

calciumantagonistslikenifedipineshouldbeconsideredaspossiblecauses.

4.7Effectsonabilitytodriveandusemachines

Reactionstothedrug,whichvaryinintensityfromindividualtoindividual,mayimpairtheabilitytodriveorto

operatemachinery.Thisappliesparticularlyatthestartoftreatment,onchangingthemedicationandincombination

withalcohol.

4.8Undesirableeffects

Adversedrugreactions(ADRs)basedonplacebo-controlledstudieswithnifedipinesortedbyCIOMSIIIcategoriesof

frequency(clinicaltrialdatabase:nifedipinen=2,661;placebon=1,486;status:22Feb2006andtheACTIONstudy:

nifedipinen=3,825;placebon=3,840)arelistedbelow:

ADRslistedunder"common"wereobservedwithafrequencybelow3%withtheexceptionofoedema(9.9%)and

headache(3.9%).ADRsderivedfrompostmarketingreports(status:15Feb2006)areprintedinbolditalic.

Clinical

Description Common

≥1%to<10% Uncommon

>0.1%to<1% Rare

>0.01%to<0.1% VeryRare

<0.01%

ImmuneSystemDisorder

Acute

hypersensitivity

reactions Allergicreaction

Allergic

oedema/angioedema Pruritus

Urticaria

Rash Anaphylactic/

anaphylactoid

reaction

PsychiatricDisorders

Behavioural

disturbancesand

sleepdisorders Anxietyreactions

Sleepdisorders

NervousSystemDisorders

Unspecific

cerebrovascular

symptoms Headache Vertigo

Migraine

Unspecific

neurological

symptoms Dizziness

Tremor

Unspecificaltered

peripheral

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Indialysispatientswithmalignanthypertensionandhypovolaemiaadistinctfallinbloodpressurecanoccurasaresult

ofvasodilation.

4.9Overdose

Symptoms

Thefollowingsymptomsareobservedincasesofseverenifedipineintoxication:

Disturbancesofconsciousnesstothepointofcoma,adropinbloodpressure,tachycardiac/bradycardiacheartrhythm

EyeDisorders

Unspecificeye

disorders Visualdisturbances

CardiacDisorders

Unspecific

arrhythmias Tachycardia

Palpitations

VascularDisorders

Unspecific

vascular

symptoms Oedema

Vasodilatation Hypotension

Syncope

RespiratoryDisorders

Upperrespiratory

tractsymptoms Nosebleed

Nasalcongestion Dyspnoea

GastrointestinalDisorders

Gastro-intestinal

symptoms Constipation Gastrointestinal and

abdominalpain

Nausea

Dyspepsia

Flatulence

Drymouth Gingival

hyperplasia Bezoar

Dysphagia

Intestinal

obstruction

Intestinalulcer

Vomiting

HepatobiliaryDisorders

Mildtomoderate

hepaticreactions Transientincreasein

liverenzymes

SkinandSubcutaneousTissueDisorders

Unspecificskin

reactions Erythema

MusculoskeletalandConnectiveTissueDisorders

Unspecific

jointandmuscular

disorders Musclecramps

Jointswelling

RenalandUrinaryDisorders

Urinarydisorders Polyuria

Dysuria

ReproductiveSystemDisorders

Sexual

dysfunction Erectiledysfunction

GeneralDisordersandAdministrationSiteConditions

Generalfeelingof

illness Feelingunwell Unspecificpain

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Treatment

Asfarastreatmentisconcerned,eliminationoftheactivesubstanceandtherestorationofstablecardiovascular

conditionshavepriority.

Afteroralingestion,thoroughgastriclavageisindicated,ifnecessaryincombinationwithirrigationofthesmall

intestine.

Particularlyincasesofintoxicationwithslow-releaseproductslikeAdalatLA,eliminationmustbeascompleteas

possible,includingthesmallintestine,topreventtheotherwiseinevitablesubsequentabsorptionoftheactive

substance.

Haemodialysisservesnopurpose,asnifedipineisnotdialysable,butplasmapheresisisadvisable(highplasmaprotein

binding,relativelylowvolumeofdistribution).

Hypotensionasaresultofcardiogenicshockandarterialvasodilatationcanbetreatedwithcalcium(10-20mlofa10

%calciumgluconatesolutionadministeredslowlyI.V.andrepeatedifnecessary).Asaresulttheserumcalciumcan

reachtheuppernormalrangetoslightlyelevatedlevels.Ifaninsufficientincreaseinbloodpressureisachievedwith

calcium,vasoconstrictingsympathomimeticssuchasdopamineornoradrenalineshouldbeadministered.Thedosage

ofthesedrugsshouldbedeterminedsolelybythepatient'sresponse.

Symptomaticbradycardiamaybetreatedwithbeta-sympathomimetics,andinlife-threateningbradycardiac

disturbancesofheartrhythm,temporarycardiacpacemakertherapycanbeadvisable.

Additionalliquidorvolumemustbeadministeredwithcautionbecauseofthedangerofoverloadingtheheart.

5PHARMACOLOGICALPROPERTIES

5.1Pharmacodynamicproperties

ATCcode:C08CA05

Nifedipineisacalciumantagonistofthe1,4-dihydropyridinetype.Calciumantagonistsreducethetransmembranal

influxofcalciumionsthroughtheslowcalciumchannelintothecell.Asaspecificandpotentcalcium

antagonist,nifedipineactsparticularlyonthecellsofthemyocardiumandthesmoothmusclecellsofthecoronary

arteriesandtheperipheralresistancevessels.Themainactionofnifedipineistorelaxarterialsmoothmuscle,bothin

thecoronaryandperipheralcirculation.TheAdalatLAtabletisformulatedtoachievecontrolleddeliveryofnifedipine

inareleaseprofilesufficienttoenableonce-dailyadministrationtobeeffectiveinclinicaluse.

Inhypertension,themainactionofnifedipineistocauseperipheralvasodilatationandthusreduceperipheral

resistance.Nifedipineadministeredonce-dailyprovides24-hourcontrolofraisedbloodpressure.Nifedipinecauses

reductioninbloodpressuresuchthatthepercentageloweringisproportionaltoitsinitiallevel.Innormotensive

individuals,nifedipinehaslittleornoeffectonbloodpressure.

Inangina,AdalatLAreducesperipheralandcoronaryvascularresistance,leadingtoanincreaseincoronaryblood

flow,cardiacoutputandstrokevolume,whilstdecreasingafter-load.Additionally,nifedipinedilatessubmaximally

bothclearandatheroscleroticcoronaryarteries,thusprotectingtheheartagainstcoronaryarteryspasmandimproving

perfusiontotheischaemicmyocardium.NifedipinereducesthefrequencyofpainfulattacksandtheischaemicECG

changesirrespectiveoftherelativecontributionfromcoronaryarteryspasmoratherosclerosis.

Inamulti-national,randomised,double-blind,prospectivestudyinvolving6321hypertensivepatientswithatleastone

additionalriskfactorfollowedover3to4.8years,AdalatLA30and60(nifedipineGITS)wereshowntoreduce

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Inthemulticentre,randomized,placebo-controlled,double-blindACTIONtrialwithafollow-upof5yearsinvolving

7665patientswithstableanginapectorisonbestpracticestandardtreatment.Theeffectsonclinicaloutcomesof

nifedipineLAvsplacebowereinvestigated.

Theprimaryendpointforefficacy(combinedrateofdeathfromanycause,acutemyocardialinfarction,refractory

angina,newovertheartfailure,debilitatingstroke,andperipheralrevascularization)didnotdifferbetweenpatients

assignednifedipineLA(n=3825)andpatientsallocatedplacebo(n=3840)(P=0.54).

Inapredefinedsubgroupanalysiswhichincluded3997anginapatientswithhypertensionatbaselinenifedipineLAled

toasignificant13%reductionoftheprimaryendpointforefficacy.

NifedipineLAhasbeendemonstratedtobesafeastheprimaryendpointforsafety(combinedrateofdeathfromany

cause,acutemyocardialinfarction,anddebilitatingstroke)wassimilarinbothtreatmentgroups(P=0.86).

NifedipineLAhadapositiveeffectontwoofthethreepredefinedsecondaryendpoints.Thecombinedrateofdeath,

majorcardiovascularevents,revascularization,andcoronaryangiography(CAG)wasreducedby11%(P=0.0012),the

mainreasonbeingthepronouncedreductionintheneedforcoronaryangiography.Therewere150fewerCAGsasthe

firsteventinthenifedipinegroupwhencomparedtoplacebo.Anyvasculareventwasreducedby9%(P=0.027),the

mainreasonbeingthereducedneedforpercutaneouscoronaryinterventionsandbypasssurgery.Intotal,therewere89

fewerproceduresasfirsteventsinthenifedipinegroupcomparedtoplacebo.Theoutcomeofthethirdsecondary

endpoint'majorcardiovascularevent'didnotshowdifferencesbetweenthetwotreatmentgroups(P=0.26).

5.2Pharmacokineticproperties

Generalcharacteristics:

AdalatLAtabletsareformulatedtoprovidenifedipineatanapproximatelyconstantrateover24hours.Nifedipineis

releasedfromthetabletatazero-orderratebyamembrance-controlled,osmoticpush-pullprocess.The

pharmacokineticprofileofthisformulationischaracterizedbylowpeak-troughfluctuation.0-24hourplasma

concentrationversustimeprofilesatsteady-stateareplateau-like,renderingtheAdalatLAtabletappropriateforonce-

a-dayadministration.

ThedeliveryrateisindependentofgastrointestinalpHormotility.Uponswallowing,thebiologicallyinertcomponents

ofthetabletremainintactduringgastrointestinaltransitandareeliminatedinthefaecesasaninsolubleshell.

Orallyadministerednifedipineisalmostcompletelyabsorbedinthegastro-intestinaltract.Thesystemicavailability

oforallyadministerednifedipineimmediatereleaseformulations(nifedipinecapsules)is45-56%owingtoafirstpass

effect.Atsteady-state,thebioavailabilityofAdalatLAtabletsrangesfrom68-86%relativetoAdalatcapsules.

Administrationinthepresenceoffoodslightlyalterstheearlyrateofabsorptionbutdoesnotinfluencetheextentof

drugavailability.

Nifedipineisabout95%boundtoplasmaprotein(albumin).Thedistributionhalf-lifeafterintravenousadministration

hasbeendeterminedtobe5to6minutes.

Afteroraladministrationnifedipineismetabolisedinthegutwallandintheliverprimarilybyoxidativeprocesses.

Thesemetabolitesshownopharmacodynamicactivity.Nifedipineiseliminatedintheformofitsmetabolites,

predominantlyviathekidneys,withapproximately5-15%beingexcretedviathebileinthefaeces.Non-metabolised

nifedipinecanbedetectedonlyintraces(below1.0%)intheurine.

Theterminaleliminationhalf-lifeis1.7to3.4hinconventionalformulations(nifedipinecapsules).Theterminalhalf-

lifefollowingAdalatLAadministrationdoesnotrepresentameaningfulparameterasaplateau-likeplasma

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Characteristicsinpatients:

Therearenosignificantdifferencesinthepharmacokineticsofnifedipinebetweenhealthysubjectsandsubjectswith

renalimpairment.Therefore,dosageadjustmentisnotneededinthesepatients.

Inpatientswithhepaticimpairment,theeliminationhalf-lifeisdistinctlyprolongedandthetotalclearanceisreduced.

Owingtothedurationofactionoftheformulation,AdalatLAshouldnotbeadministeredinthesepatients.

5.3Preclinicalsafetydata

Preclinicaldatarevealnospecialhazardforhumansbasedonconventionalstudiesofsingleandrepeateddose

toxicity,genotoxicityandcarcinogenicpotential.

Followingacuteoralandintravenousadministrationofnifedipineinvariousanimalspecies,thefollowingLD

(mg/kg)valueswereobtained:

Insubacuteandsubchronictoxicitystudiesinratsanddogs,nifedipinewastoleratedwithoutdamageatdosesofupto

50mg/kg(rats)and100mg/kg(dogs)p.o.overperiodsofthirteenandfourweeks,respectively.Following

intravenousadministration,dogstoleratedupto0.1mg/kgnifedipineforsixdayswithoutdamage.Ratstolerateddaily

intravenousadministrationof2.5mg/kgnifedipineoveraperiodofthreeweekswithoutdamage.

Inchronictoxicitystudiesindogswithtreatmentlastinguptooneyear,nifedipinewastoleratedwithoutdamageat

dosesuptoandincluding100mg/kgp.o.Inrats,toxiceffectsoccurredatconcentrationsabove100ppminthefeed

(approximately5-7mg/kgbodyweight).

Inacarcinogenicitystudyinrats(twoyears),therewasnoevidenceofacarcinogeniceffectofnifedipine.

Nifedipinehasbeenshowntoproduceteratogenicfindingsinrats,miceandrabbits,includingdigitalanomalies,

malformationoftheextremities,cleftpalates,cleftsternum,andmalformationoftheribs.

Digitalanomaliesandmalformationoftheextremitiesarepossiblyaresultofcompromiseduterinebloodflow,but

havealsobeenobservedinanimalstreatedwithnifedipinesolelyaftertheendoftheorganogenesisperiod.

Nifedipineadministrationwasassociatedwithavarietyofembryotoxic,placentotoxicandfetotoxiceffects,including

stuntedfetuses(rats,mice,rabbits),smallplacentasandunderdevelopedchorionicvilli(monkeys),embryonicandfetal

deaths(rats,mice,rabbits)andprolongedpregnancy/decreasedneonatalsurvival(rats;notevaluatedinotherspecies).

Allofthedosesassociatedwiththeteratogenic,embryotoxicorfetotoxiceffectsinanimalswerematernallytoxicand

severaltimestherecommendedmaximumdoseforhumans.

Mouse: Oral:494(421-572)*; i.v.:4.2(3.8-4.6)*.

Rat: Oral:1022(950-1087)*; i.v.:15.5(13.7-17.5)*.

Rabbit: Oral:250-500; i.v.:2-3.

Cat: Oral:~100; i.v.:0.5-8.

Dog: Oral:>250; i.v.:2-3.

Irish Medicines Board

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Date Printed 01/12/2010 CRN 2088946 page number: 10

6PHARMACEUTICALPARTICULARS

6.1Listofexcipients

Propyleneglycol

Celluloseacetate

Hypromellose

Hydroxypropylcellulose

Polyethyleneoxide

Macrogol

Magnesiumstearate

Shellac

Titaniumdioxide(E171)

Ironoxide(E172)

Sodiumchloride(salt)

6.2Incompatibilities

Notapplicable.

6.3ShelfLife

Theshelflifeexpirydateforthisproductshallbethedateshownontheblisterandouterpackageoftheproductonthe

marketinthecountryoforigin.

6.4Specialprecautionsforstorage

Protectfromlight,Storeintheoriginalcontainer

6.5Natureandcontentsofcontainer

Blisterstripsof2x14tablets.BlisterpackscomposedofPPbackedwithaluminiumfoil.

Packsize:28tablets.

6.6Specialprecautionsfordisposalofausedmedicinalproductorwastematerialsderivedfrom

suchmedicinalproductandotherhandlingoftheproduct

Nospecialrequirements.

7PARALLELPRODUCTAUTHORISATIONHOLDER

LTTPharmaLimited

Unit18

OxleasowRoad

EastMoonsMoat

Redditch

WorcestershireB980RE

Irish Medicines Board

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Date Printed 01/12/2010 CRN 2088946 page number: 11

8PARALLELPRODUCTAUTHORISATIONNUMBER

PPA1562/36/1

9DATEOFFIRSTAUTHORISATION/RENEWALOFTHEAUTHORISATION

Dateoffirstauthorisation:26 th

November2010

Irish Medicines Board

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Date Printed 01/12/2010 CRN 2088946 page number: 12