Nifedipine with Quinidine Interaction Details

Brand Names Associated with Nifedipine

Brand Names Associated with Quinidine

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 20, 2023

Interaction Effect

Increased NIFEdipine exposure and possibly decreased quinidine exposure

Interaction Summary

Concomitant use of NIFEdipine, a CYP3A4 substrate, with a CYP3A4 inhibitor such as quinidine may increase NIFEdipine exposure and increase hypotensive effects. Additionally, quinidine exposure may be decreased by coadministration of NIFEdipine, although this is very rare and the mechanism is not understood . When adding NIFEdipine to a patient on quinidine, the quinidine concentration could decline by 30% to 50% and the patient could have increased sensitivity to NIFEdipine . If coadministration is required, NIFEdipine dose adjustment and monitoring may be necessary .

Severity

Major

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Concomitant use of NIFEdipine, a CYP3A4 substrate, with a CYP3A4 inhibitor such as quinidine may increase NIFEdipine exposure and increase hypotensive effects. Additionally, quinidine exposure may be decreased by coadministration of NIFEdipine, although this is very rare and the mechanism is not understood . If coadministration is required, NIFEdipine dose adjustment and monitoring may be necessary .

Mechanism Of Interaction

Inhibition of CYP3A4-mediated metabolism of NIFEdipine; an unknown mechanism

Literature Reports

A) The AUC for NIFEdipine almost doubled for 7 healthy volunteers when quinidine was added to the regimen . Oral NIFEdipine 5 mg was given alone or 15 minutes after a dose of quinidine 200 mg. Alternatively, several patients have experienced elevated quinidine levels when NIFEdipine was discontinued; 2 patients had a doubling of the level .

B) In a randomized cross-over study of 10 healthy volunteers , the concurrent use of quinidine and NIFEdipine demonstrated a 37% increase in NIFEdipine AUC, compared with NIFEdipine alone. Heart rate was significantly increased during the first 2 hours of coadministration, and the initial increase was significantly correlated with NIFEdipine serum concentration. Quinidine pharmacokinetics appeared to be unchanged .

C) The interaction between NIFEdipine and quinidine was studied in 12 patients who were being treated with quinidine for ventricular or supraventricular arrhythmias. Overall, concurrent NIFEdipine did not significantly alter quinidine's total body clearance or AUC compared to quinidine alone. However, 1 patient with a 70% ejection fraction experienced a 41% decrease in mean steady-state quinidine concentration and AUC and a 68% increase in clearance. The mechanism of the interaction did not appear to be a hemodynamic alteration since nitroprusside plus quinidine did not alter quinidine's pharmacokinetics in the same patient. The interaction may be related to enhanced quinidine metabolism as a result of enzyme induction or protein binding displacement .

D) Pharmacokinetic and pharmacodynamic effects of concurrent administration of either NIFEdipine or felodipine and quinidine were evaluated in 12 healthy volunteers. Subjects were pretreated for 3 days with prolonged action NIFEdipine 20 mg twice daily or felodipine extended release 10 mg daily, followed by quinidine 400 mg. Pharmacokinetic parameters of quinidine were unchanged by either NIFEdipine or felodipine. However, 3-hydroxyquinidine (an active metabolite of quinidine) AUC and 3-hydroxyquinidine/quinidine AUC ratio were both was decreased by felodipine, suggesting reduced metabolite formation. The authors concluded that the changes induced in quinidine disposition by either NIFEdipine or felodipine were not clinically significant .

Nifedipine Overview

• 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.

• 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.

Quinidine Overview

• Quinidine is used to treat certain types of irregular heartbeats. Quinidine is in a class of medications called antiarrhythmic medications. It works by making your heart more resistant to abnormal activity.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.