Nifedipine with Ma Huang Interaction Details
Brand Names Associated with Nifedipine
- Adalat®
- Adalat® CC
- Afeditab® CR
- Nifedical® XL
- Nifedipine
- Nifeditab® CR
- Procardia®
- Procardia® XL
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 20, 2023
Interaction Effect
Reduced hypotensive effect of calcium channel blockers
Interaction Summary
Theoretically, Ma Huang (ephedra) may decrease the effectiveness of antihypertensive medications. Ma Huang had variable effects on blood pressure in normotensive subjects, and may have caused an acute hypertensive response in a patient ingesting an herbal preparation suspected of containing Ma Huang . Ma Huang (ephedra) is a natural source of ephedrine and pseudoephedrine . Ma Huang contains 0.5 to 2.5% of ephedra alkaloids. Ephedrine is the dominant alkaloid, comprising 30% to 90% of the total ephedra alkaloid content, depending on growing conditions . Pseudoephedrine has been recognized as generally safe, but ephedrine should be avoided by patients with hypertension . Patients who are sensitive to either ephedrine or pseudoephedrine, or who have pheochromocytoma should avoid products containing Ma Huang.
Severity
Moderate
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Concomitant use of ma huang is not advised in patients using antihypertensives. The ephedrine content of Ma Huang may exacerbate hypertension. ma huang is contraindicated in patients who are ephedrine or pseudoephedrine sensitive, and those with renal failure or pheochromocytoma.
Mechanism Of Interaction
Antagonistic effect through sympathomimetic activity of ephedrine and pseudoephedrine in Ma Huang
Literature Reports
A) Variable effects on blood pressure were found in 12 normotensive patients administered 4 capsules of ma huang (containing ephedrine 19.4 mg and pseudoephedrine 4.9 mg per dose) with breakfast, followed by another 4 capsules nine hours later with the evening meal. Four subjects experienced a significant increase in systolic blood pressure three hours post ingestion, whereas two individuals experienced a decrease in the diastolic blood pressure. Six (50%) patients experienced a significant increase in the mean 12-hour heart rate from 81 to 94 beats per minute (bpm), 79 to 84 bpm, 87 to 97 bpm, 77 to 83 bpm, 69 to 74 bpm, and 77 to 84 bpm (p less than 0.05 for all) .
B) A 21-year-old man presented to the emergency department with hypertension following ingestion of one glass of alcohol, one marijuana cigarette, and four capsules of "herbal ecstacy" supposedly containing ginseng, kola nut, and nutmeg (time elapsed: 90 minutes). His initial blood pressure was 220/110 mmHg and was 190/116 mmHg upon reaching the emergency department, with accompanying ventricular dysrhythmias. His symptoms resolved within 9 hours following treatment with lidocaine and sodium nitroprusside. The urine screen was positive for ephedrine or pseudoephedrine, cannabinoid metabolites, and traces of opiate and caffeine. The authors attribute the patient's condition to the ephedrine content of the herbal preparation. Since all of the product had been consumed, the herbal product was not assayed to determine its relative contents of ephedrine and caffeine .
Nifedipine Overview
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Nifedipine is used to treat high blood pressure and to control angina (chest pain). Nifedipine is in a class of medications called calcium-channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood and oxygen to the heart.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.