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Nifecard Xl Tablet

Generic Name(s): Nifedipine

Why it's used

Nifecard Xl Tablet is used to treat high blood pressure. It is a prescription medicine. This medicine works by preventing the transport of calcium ions into the heart and other smooth muscles. This medicine results in the dilation of blood vessels, which decreases the blood pressure. Nifecard Xl is also used to prevent severe stable chest pain.
Nifecard Xl Tablet may also be taken in combination with other medicines to treat certain conditions as recommended by the doctor. Nifecard Xl Tablet is used together with Anti-Hypertensive to treat high blood pressure conditions.
Calcium Channel Blockers
Nifecard Xl belongs to a class of medicines called Calcium Channel Blockers. Calcium channel blockers treat a variety of conditions, such as high blood pressure, chest pain and symptoms of cold hands and feet (Raynaud's disease). These medicines relax blood vessels and thereby increase the supply of blood and oxygen to the heart.

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How to use

Follow directions on the product label, information guide, and provided by your doctor before using Nifecard Xl. Eat this medicine as per your doctor's instructions.
You should track your blood pressure levels regularly. Discuss your results with the doctor, especially if your blood pressure measurements are too high or too low. Your treatment may need changes.
Nifecard Xl is eaten without food. The use of Nifecard Xl in the presence of food may alter the rate of absorption of Nifecard Xl. Nifecard Xl should be swallowed whole on an empty stomach. Do not crush, chew or divide the tablet. Nifecard Xl is eaten usually in the morning.

Typical Dosage

The typical adult dose of Nifecard Xl is 30-60 mg once daily. The maximum dose for adults of Nifecard Xl is 90 mg once daily per day. Nifecard Xl is typically used at the same time every day. There are no known habit-forming tendencies with this medicine.
To decrease the possibility of side-effects, you might be recommended to use the extended-release form of this medicine by your doctor. The extended-release medicine helps in maintaining a steady level of the medicine in your body for a longer period of time. Do not crush or chew the medicine, unless indicated on the package or by your doctor.

Talk to Your Doctor

Tell your doctor if you develop new or worsening symptoms. Talk to your doctor if chest pain, increased breathlessness, and swelling of the ankles. If you have issues with the health of your liver, a low dose of Nifecard Xl is required with careful monitoring. Consult with your doctor before stopping the use of Nifecard Xl Tablet.
You may need to gradually decrease the dose of this medicine before stopping.

Use in Children

The safety and effectiveness of using this medicine in children has not been established. No safety and effectiveness data has been established for the use of Nifecard Xl in children.
Avoid grapefruit and grapefruit juice while using Nifecard Xl. Grapefruit and grapefruit juice increases the amount of Nifecard Xl in the bloodstream.

Storage

Store Nifecard Xl Tablet below 30°C (86°F), away from moisture, and away from light. Keep this medicine away from children and pets.
Medicines may be given for uses other than those listed in the medicine guide. Do not use Nifecard Xl Tablet for symptoms for which it was not prescribed. Do not give Nifecard Xl Tablet to others who may have similar symptoms as you. Self-medication can cause harm.

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How to take Nifecard Xl

The dose and frequency of using Nifecard Xl will depend on the following factors:
  • patient's health
  • the health of the patient's kidneys
  • response to the medicine

Nifecard Xl Dosage

Dosage for high blood pressure

Adult
  • Initial: 20 mg once daily
  • Maximum: 90 mg once daily

Dosage for severe stable chest pain

Adult
  • Initial: 30 mg once daily
  • Maximum: 90 mg once daily

Minimum Age

18 years

Forms

Capsule
Strength: 5 mg, 10 mg, and 20 mg
Liquid Filled Capsule
Strength: 10 mg and 20 mg
Tablet
Strength: 10 mg, 20 mg, and 30 mg
Extended Release Tablet
Strength: 10 mg, 20 mg, 30 mg, 60 mg, and 90 mg
Film-Coated Tablet
Strength: 30 mg, 60 mg, and 90 mg
Film-Coated, Extended Release Tablet
Strength: 30 mg, 60 mg, and 90 mg

Missed Dose

Take the missed dose as soon as you remember and continue the regular dosing schedule after waiting for 12 hours before consuming the next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Nifecard Xl?
In case of overdose, close supervision of heart and respiratory function is recommended. Also, provide supportive care for low blood pressure such as placing legs in elevated position, use of calcium infusion, fluids and pressor agents. Stomach emptying should be performed by cleaning out the contents of the stomach or by using charcoal, a substance that absorbs poisons from the stomach. If the sufficient increase in blood pressure with calcium treatment is not achieved than provide treatment with noradrenaline or dopamine. The dose of these medicines should be adjusted based on the patient's response. Atropine is used to treat a slow heart rate. The Nifecard Xl should be removed from the body by blood purifying technique (called as, plasmapheresis).
Symptoms of an overdose of Nifecard Xl
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • accumulation of fluid in the lungs
  • cardiogenic shock
  • excessive acid in the blood (metabolic acidosis)
  • heart rhythm disturbances
  • high blood sugar levels
  • loss of consciousness
  • low blood pressure
  • low oxygen level in the tissue (hypoxia)
If you think you have overdosed on Nifecard Xl Tablet, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Nifecard Xl

Before you use Nifecard Xl, tell your doctor of your medical and health history including the following:
  • allergic to Nifecard Xl or other dihydropyridines
  • heart problems (cardiogenic shock)
  • high blood pressure
  • inflammation of the bowel or intestine (Crohn’s disease)
  • Liver disease
  • narrowing of an intestine
  • narrowing of the aortic heart valves
  • obstruction in the food pipe
  • patients with an artificial pouch (Kock pouch) constructed after surgical removal of a part of small intestine, rectum, or anus
  • patients with occurrence of heart attack in the last month
  • sudden episodes of an angina attack
  • use of Rifampicin
Before you use Nifecard Xl Tablet, discuss with your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic any of the following substances: dihydropyridine.
Before having surgery during the use of Nifecard Xl, discuss with your doctor and dentist about the medicinal products you use including prescription/non-prescription/herbal medicines.
The use of this medicine may change creatinine levels in the blood. In patients with existing kidney disease, a reversible increase in the creatinine level may be seen while using this medicine.
The use of Nifecard Xl Tablet may change blood urea nitrogen. In patients with existing kidney disease, a reversible increase in the blood urea nitrogen may be seen while using this medicine.
The use of this medicine may change liver enzymes level. A temporary elevation in the liver enzymes such as alkaline phosphatase, creatine kinase, lactate dehydrogenase, aspartate aminotransferase (SGOT) and alanine transaminase (SGPT) has been seen in patients using this medicine.

Seizures

Nifecard Xl Tablet can make you feel sleepy. Be careful when using any machinery, driving a vehicle, or doing any other activity that needs you to be fully alert. The consumption of alcohol with Nifecard Xl Tablet can worsen the sleepiness. Nifecard Xl Tablet may cause rarely seizures in some people. If you perform any activities where a loss of consciousness may cause harm to you (or others), you should discuss with your doctor.

Use in Pregnancy

The use of Nifecard Xl during pregnancy should only be when required. There are no well-controlled studies on the use of Nifecard Xl is available for pregnant women. There are few reports of poor growth of fetus (intrauterine growth retardation), lack of oxygen at birth (perinatal asphyxia), surgical delivery of the baby (cesarean delivery) and preterm birth (prematurity) while using this medicine.

Use while Breastfeeding

The use of Nifecard Xl Tablet is not safe for use in women who are breastfeeding. If you are breastfeeding a baby, discuss with your doctor if you should either discontinue breastfeeding or stop using this medicine while breastfeeding. This medicine passes into the breastmilk. The mothers should not breastfeed their babies while consuming Nifecard Xl. After the consumption of immediate release formulations of Nifecard Xl, do not breastfeed the baby for 3 to 4 hours to reduce the risk of exposure of this medicine to the infant.

Use while Conceiving

Nifecard Xl may impact fertility in women. If you are trying to conceive, discuss with your doctor on the use of this medicine. The use of Nifecard Xl may cause a reversible change in the sperm's head section and decreases the ability of sperm to bind and fertilize an egg.

Alcohol

Limit drinking alcohol with Nifecard Xl. Drinking alcohol may cause dizziness, fainting, tiredness, and visual disturbance.

Increased Risks

This medicine may increase your sensitivity to sunlight. If this happens, use a sunscreen and cover your skin when you are outdoors. Limit your time in the sun. If you get a sunburn on your skin, consult with your doctor.

What precautions should be taken during Pregnancy and Nursing, and administering Nifecard Xl to Children or the Older Adults?

Pregnant Women

Only When Necessary
Warning: As no well-controlled studies are available with the use of Nifecard Xl in pregnant women. So this medicine can only be used when required after consultation with the doctor.

Breastfeeding

Contraindicated or Not Recommended
Warning: This medicine may pass into the breastmilk. So the mothers should not breastfeed their babies while consuming Nifecard Xl. After the consumption of immediate release formulations of Nifecard Xl, do not breastfeed the baby for 3 to 4 hours to reduce the risk of exposure of this medicine to the infant.

Younger Adults Population

Contraindicated or Not Recommended
Warning: The safety and efficacy of Nifecard Xl have not been established in children below 18 years.

Older Adults Population

Precaution
Warning: The dose for an elderly patient should be selected with caution. The starting dose of Nifecard Xl should be low in these patients due to reduced liver, kidney, heart function and any disease or other drug therapy.

Nifecard Xl Side-effects

The following side-effects may commonly occur when using Nifecard Xl Tablet. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
Rarely, the use of Nifecard Xl Tablet may cause the following side-effects:
The following severe side-effects may also occur when using Nifecard Xl Tablet:
  • Symptoms: a severe reduction in the number of white blood cells enlarged lymph nodes
  • central nervous system disorders
  • stomach and intestinal disorders
    Symptoms: diarrhea, difficulty swallowing, inflammation of the oesophagus (esophagitis), stomach and intestinal bleeding, increased levels of the enzyme gamma-glutamyl transferase (GGT increased), gum bleeding, vomiting, intestinal obstruction intestinal ulcer
  • Symptoms: shortness of breath (dyspnea), abnormal lung sounds (rales), inflammation of the pharynx (pharyngitis), high pitched breathing sound (stridor) presence of excess fluid in the lungs
  • heart and blood vessel disorders
    Symptoms: rapid or irregular heartbeat, low heart rate, heart attack (cardiac arrest), abnormal heart beat (extrasystole), low blood pressure, low blood pressure when suddenly standing from a sitting position cutaneous angiectases
  • Symptoms: high levels of uric acid in the blood (gout) high blood sugar (hyperglycaemia)
  • liver disorder
    Symptoms: yellow discoloration of the skin (jaundice)
  • kidney disorder
    Symptoms: kidney stone
  • severe skin reactions
    Symptoms: swelling of the lower layer of the skin, rash, drug induced severe allergic reaction increased skin sensitivity to the sunlight
  • eye disorder
    Symptoms: pink eye (conjunctivitis), eye bleeding (eye hemorrhage) blurred vision
Your doctor has prescribed this medicine because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious cases of side-effects. This page does not contain a complete list of all possible side-effects.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Side-effects and Allergic Reactions of Nifecard Xl by Severity and Frequency

Common Side-effects

Following are the common side-effects of this medicine:

Infrequent and Rare Side-effects

Following are the infrequent and rare side-effects of this medicine:

Severe Side-effects

Following are the severe side-effects of this medicine:

Mild Allergic Reactions

Following are the symptoms of mild allergic reactions to this medicine:

Serious Allergic Reactions

Following are the symptoms of serious allergic reactions to this medicine:
If this happens, stop using this medicine and contact your doctor immediately.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Use with antihypertensive agents

The patients using Nifecard Xl with beta-blocking drugs and other antihypertensive agents are at increased risk. The use of Nifecard Xl with beta-blocking drugs and other antihypertensive agents may cause an additive effect resulting in a sudden fall in the blood pressure. The possibility of occurrence of such events must be borne in mind before using these medicines together.

Patients with heart disorders

The patients with heart disorders such as reduced heart's ability to pump blood according to the need of the body. Such patients may suffer from worsening of heart failure. Nifecard Xl should be used with caution in such patients.

Patients suffering from diabetes

The patients suffering from diabetes are at increased risk while using this medicine. Such patients may require some adjustments for the control of diabetes while using Nifecard Xl.

Changes in the blood pressure

The patients with excessively high blood pressure causing organ damage and decreased blood volume (hypovolaemia) are at increased risk while using this medicine. Such patients may suffer from low blood pressure.

Patients undergoing barium contrast x-ray

The patients undergoing barium contrast x-ray are at increased risk while using this medicine. Such patients are at risk of giving a false -positive reaction to test which is used for examination of the stomach and intestinal tract (barium contrast x-ray test). Tell the doctor before undergoing this test while using Nifecard Xl.

Low blood pressure

The patients who underwent bypass surgery (coronary artery bypass surgery) using a high dose of fentanyl anesthesia or other narcotics are at increased risk while using this medicine. Also, the patients using beta-blockers in combination with Nifecard Xl are at increased risk. Such patients may suffer from severely low blood pressure. Before using Nifecard Xl with fentanyl anesthesia, the doctor should remain aware of the occurrence of such adverse event. In such case, sufficient time (minimum 36 hours) should be given to the patient to wash out the Nifecard Xl before the surgery.

Chest pain (angina) or heart attack

The patients who are facing the severe condition of reduced blood flow to the heart (obstructive coronary artery disease) are at increased risk while using this medicine. Such patients may suffer from increased severity, frequency and duration of chest pain (angina) or heart attack by starting the use of Nifecard Xl or while increasing its dose.

Withdrawal of beta-blockers

The patients who suddenly discontinue the use of beta-blockers before using this medicine are at increased risk. Such patients may get a withdrawal syndrome such as enhanced chest pain (angina) which may be related to sensitivity to catecholamines. Do not discontinue the use of a beta-blocker suddenly. A reduction in the dose is recommended to prevent the occurrence of withdrawal syndrome.

Heart failure

The patients suffering from narrowing of the heart valve (aortic stenosis) are at increased risk while using this medicine. These patients may suffer from heart failure.The use of Nifecard Xl will be not beneficial in such patients due to reduced blood flow across the aortic valve.

Stomach and intestinal obstruction

The patients using Nifecard Xl tablet are at increased risk. The outer membrane of Nifecard Xl is not digested and appears as a complete tablet in the patient's stool. It is advised to take care of the patient while using this medicine, due to the increased chances of the occurrence of obstructive symptoms or accumulation of undigested material (bezoars). Surgical treatment may be needed to treat bezoars.

Interactions with Nifecard Xl

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Nifecard Xl Tablet. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

CYP3A inhibitors

Nifecard Xl Tablet may interact with CYP3A inhibitors (ketoconazole, itraconazole, and fluconazole), which are used to treat fungal infections. When these drugs are used in combination with Nifecard Xl, the exposure to Nifecard Xl gets increased. In this case, dose adjustment and careful monitoring of blood pressure may be required. When using Nifecard Xl with these medicines, a low starting dose of Nifecard Xl should be used. A patient should avoid using grapefruit while using Nifecard Xl.

Strong CYP3A inducers

There may be an interaction of Nifecard Xl with strong CYP3A inducers (phenobarbital, carbamazepine, and phenytoin), which are used to treat seizures. When Nifecard Xl is used with these drugs, the effectiveness of Nifecard Xl has been found to be decreased. It is advised that Nifecard Xl should not be used in combination with these medicines.

Antiarrhythmic drugs

Nifecard Xl Tablet interacts with quinidine, which is used to treat irregular heartbeat. Use of Nifecard Xl with quinidine may lead to a decrease in the level of quinidine and an increase in the level of Nifecard Xl in the blood. The dose adjustment of Nifecard Xl and appropriate monitoring of heart rate or blood pressure is recommended while using quinidine with Nifecard Xl.

Calcium channel blockers

Special instructions need to be followed while taking this medicine along with diltiazem and verapamil, which are used to treat high blood pressure and chest pain. When Nifecard Xl is used in combination with these drugs, it may increase the level of Nifecard Xl in the blood. In this case, the dose of Nifecard Xl should be reduced. Caution must be followed, and blood pressure should also be monitored.

Beta-blockers

Your doctor's guidelines may need to be followed while taking this medicine along with timolol, which is used to treat glaucoma. When using Nifecard Xl with beta-blockers, patients with heart diseases may see an increased risk of congestive heart failure, severe low blood pressure or exacerbation of angina. Careful monitoring and proper dose adjustment of Nifecard Xl is advised in these patients.

Digitalis

Nifecard Xl Tablet may interact with digoxin, which is used to treat irregular heartbeat and heart failure. If the Nifecard Xl and digoxin are used together, the level of digoxin gets increased in the blood. It is advised to monitor the digoxin levels when starting, adjusting and discontinuing Nifecard Xl. If required, the dose of glycoside should be reduced.

Antibacterial drugs

There may be an interaction of Nifecard Xl with quinupristin/dalfopristin, which are used to treat bacterial infection. When Nifecard Xl is used in combination with these drugs, it may lead to an increase in the level of Nifecard Xl in the blood. In such cases, proper monitoring of blood pressure and the dose reduction of Nifecard Xl should be considered.

Immunosuppressive drugs

Nifecard Xl Tablet interacts with tacrolimus, which is used to treat a skin condition called eczema. Use of Nifecard Xl with tacrolimus may lead to an increase in the level of tacrolimus in the blood. In this case, the amount of tacrolimus in the blood should be monitored, and the dose of tacrolimus must be reduced.

Glucose-lowering drugs

Special instructions need to be followed while taking this medicine along with metformin and acarbose, which are used to control high blood sugar level. The use of Nifecard Xl with glucose-lowering drugs may enhance the absorption, excretion and amount of metformin in the blood. Nifecard Xl produces high blood sugar level. While using acarbose with Nifecard Xl, the monitoring of blood glucose level and dose adjustment of Nifecard Xl is recommended.

Alpha-adrenergic blocker

Your doctor's guidelines may need to be followed while taking this medicine along with doxazosin, which is used to treat high blood pressure. The use of Nifecard Xl with doxazosin may increase the level of Nifecard Xl in the blood and lower the blood pressure. Appropriate monitoring of blood pressure and dose adjustment of Nifecard Xl is recommended in such patients.

Anticoagulants

Nifecard Xl Tablet may interact with coumarin, which is used to prevent blood clotting. Patients taking Nifecard Xl with coumarin may experience an increase in the blood clotting time.

Antihypertensive drugs

There may be an interaction of Nifecard Xl with diuretics, PDE5 inhibitors, alpha-methyldopa, these drugs are used to treat high blood pressure. When these drugs are used in combination with Nifecard Xl may increase the blood lowering effect of diuretics, PDE5 inhibitors, alpha-methyldopa.

Interactions of Nifecard Xl by Severity

Severe

The following medicines are usually not to be taken together without consulting with your doctor or pharmacist.

Serious

The following medicines may interact when taken together and can cause harmful effects in the body. Please consult with your doctor or pharmacist before taking these medicines together.

Moderate

The following medicines may interact when taken together and can increase your risk of harmful effects. Please consult with your doctor or pharmacist before taking these medicines together.

When should Nifecard Xl be not used?

Allergic to Nifecard Xl and other dihydropyridines

This medicine is not recommended for use in patients having a severe allergy to this medicine or other dihydropyridines. Such patients may suffer from an increased risk of cross-reactivity. These patients may have the following symptoms if they use this medicine:

Patients suffering from heart disease

This medicine is not recommended in patients having an inability of the heart to pump enough blood to the body (shock), narrowing of the heart valve (aortic stenosis), unstable chest pain (angina), or during or within one month of having a heart attack. This medicine should not be used to treat attacks of chest pain or to prevent heart attacks.

Patients using P450 inducers

This medicine is not recommended in patients using P450 inducers such as rifampin as the effectiveness of Nifecard Xl may reduce due to enzyme induction.

Stomach and intestinal diseases

This medicine is not recommended in patients having inflammation of the intestine (Crohn's disease), stomach and intestinal obstruction, obstruction of food pipe or narrowing of the stomach and intestinal tract.

Abnormal functioning of the liver

This medicine should not be used in patients with abnormal functioning of the kidney due to its reduced clearance from the body.

High blood pressure

This medicine is not recommended in patients suffering from an extremely high blood pressure condition which leads to organ damage.

Patients with kock pouch

This medicine is not recommended in patients with an artificial pouch (Kock pouch) constructed after surgical removal of a part of small intestine, rectum, or anus.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Nifecard Xl is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Nifecard Xl Tablet .

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