Drug interactions with nitrendipine

Interactions between calcium channel blockers like nifedipine and concurrently administered drugs like digoxin or cimetidine have been described in the literature. Therefore, possible interactions of the new calcium channel blocker nitrendipine (20 mg daily) with digoxin (0.5 mg daily), digitoxin (0.1 mg daily), cimetidine (1,000 mg daily), ranitidine (300 mg daily), atenolol (100 mg daily), metoprolol (200 mg daily), and acebutolol (400 mg daily) were studied following 1 week of combined treatment of nitrendipine with each of these drugs. Six healthy volunteers were investigated (mean age, 30.2 +/- 2.1 years; mean body weight, 69.7 +/- 4.7 kg; means +/- SEM). Under nitrendipine monotherapy, maximum plasma levels (Cmax) averaged 41.6 +/- 12.8 ng/ml, and they were reached after 2 h. Mean area under the curve was 131.5 +/- 40 ng ml-1 h, and "oral" plasma clearance (Clpl) amounted to 80.8 +/- 27.5 L/h. The H2 receptor antagonists cimetidine and ranitidine and the digitalis glycosides like digoxin or digitoxin did not alter nitrendipine kinetics significantly. Also simultaneous treatment with beta-blockers did not significantly influence kinetic values of the calcium channel blocker, but atenolol showed a tendency to increase Cmax of nitrendipine to 54.2 +/- 19.7 ng/ml, when its Clpl was distinctly lowered to 42.7 +/- 10.4 L/h (p greater than 0.05 compared with 80.8 +/- 27.5 L/h under nitrendipine monotherapy). Increased digoxin plasma levels and digoxin-induced side-effects were seen under nitrendipine co-administration.(ABSTRACT TRUNCATED AT 250 WORDS)