Crushed nifedipine XL pharmacodynamics

PLEASE NOTE:   Posts made to this forum should not be considered as the expressed opinions of, nor should be considered endorsed by, the Medication Safety Officer’s Society (MSOS) or the Institute for Safe Medication Practices (ISMP). 

Make sure your email is up-to-date
In order to continue to receive updates from MSOS, as well as forum posts and other valuable information as a member of MSOS, please be sure to update your email address with us, whenever it changes. If you need assistance doing so, please send an email to jgold@ismp.org

1 post / 0 new
Erin Gavin
Erin Gavin's picture
Offline
Last seen: 1 week 4 days ago
Joined: 08/02/2021 - 13:41
Crushed nifedipine XL pharmacodynamics

Hi everyone,
I'm wondering if any of you have done/are aware of a detailed review on the PD of crushed nifedipine XL.

Many of us are very familiar with the horror stories of immediate BP drop, but have also seen cases where there is minimal or delayed impact to the patient. Those latter cases give some individuals a false sense of security or cause them to question the true hazard of crushing. I've done some research but my med chem is too rusty to formulate a confident explanation for why some patients have bad outcomes and some don't, or why multiple doses can be given before an adverse event occurs.

I'm especially open to thoughts on the impact of the delivery system. Many nifedipine XL tabs use an osmotic push-pull system, in which a layer of a drug is packaged with a layer of osmotic polymer; a small opening is on the side with the drug. Both layers absorb water, and as the osmotic layer expands it pushes drug out of the opening. Would incomplete destruction during the crushing process cause some of the variability in patient response?

I'm grateful for any insights you can provide! If you have links, attachments or theories you'd like to send directly, my email is erin.gavin@amitahealth.org.

Thank you!
Erin

Tags: