This drug is contraindicated

· In case of known hypersensitivity to nitrendipine or to any of the excipients (see section 4.4),
· In case of unstable angina or within 4 weeks following an infarction, acute myocardium

Caution

As with other substances, vasoactive, an angina can occur very rarely with nitrendipine, especially at the beginning of treatment (data from notification, spontaneous). Data from clinical studies confirm that the occurrence of this angina is rare.

This medicinal product should not normally be used

· In pregnant or nursing women (see section Pregnancy and breast-feeding)

· If combined with dantrolene (perfusion) (see section Interactions with other medicinal products and other forms of interaction)

Precaution of use

In subjects with hepatic impairment and subjects already treated with antihypertensive agents, start treatment with low doses of nitrendipine (see Dosage and Mode of Administration and Pharmacokinetic Properties). Code>
Associations, deprecated

+ Dantrolene administered by infusion

In animals, cases of fatal ventricular fibrillations are constantly observed during the administration of verapamil and dantrolene IV The combination of a calcium antagonist and dantrolene is therefore potentially dangerous Br>

However, a few patients have received the combination of nifedipine and dantrolene without any inconvenience.


+; Baclofen

Increased effect, antihypertensive.

Blood Pressure Monitoring and Dosage Adjustment of the Antihypertensive Medication If Needed

+; Itraconazole, Ketoconazole

Increased risk of adverse effects, including edema, by decreased hepatic metabolism of dihydropyridine

Clinical monitoring and possible adaptation of the dosage of dihydropyridine during treatment with itraconazole or ketoconazole and after discontinuation

+ Anticonvulsants enzymatic inducers (carbamazepine, phenobarbital, phenytoin, primidone, fosphenytoin)

Decreased plasma concentrations of nitrendipine by increasing its metabolism, hepatic by inducer

Clinical monitoring and possible adaptation of the dosage of nitrendipine during inducer treatment and after discontinuation

+; Rifampicin (described for verapamil, diltiazem and nifedipine)

Decreased plasma concentrations of the calcium antagonist by increased hepatic metabolism

Clinical monitoring and possible adaptation of calcium antagonist dosage regimen during treatment with rifampicin and after discontinuation

Associations to be taken into account

+; Medications lowering blood pressure

Increased risk of hypotension, especially orthostatic.

(Alfuzosin, doxazosin, prazosin, tamsulosin, terazosin, trimazosin, urapidil) Alpha-blockers including urological targets
Increase in hypotensive effect. Risk of increased orthostatic hypotension.

+ Amifostine

Increase in hypotension by addition of adverse effects

+ Antidepressants imipraminic, neuroleptic

Antihypertensive effect and risk of elevated orthostatic hypotension (additive effect)

+; Beta-blockers (except esmolol)

Hypotension, cardiac failure, in patients with latent or non-latent heart failure, controlled (addition of inotropic, negative effects). The beta-blocker can also minimize the reflex sympathetic reaction involved in case of excessive hemodynamic repercussion

+; Beta-blockers in heart failure

Hypotension, cardiac failure, in patients with latent or non-latent cardiac insufficiency, controlled (negative inotropic in vitro effect of dihydropyridines more or less marked and likely to add to the negative inotropic effects of beta-blockers). The presence of a beta-blocker may also minimize the reaction: sympathetic reflex involved in case of excessive hemodynamic repercussion

Glucocorticoids (except hydrocortisone in the treatment of substitution) and mineralocorticoids (pathway, general including rectal)

Decreased antihypertensive effect (hydrosodic retention of corticosteroids).

+; Curarisers

Increased duration and intensity of action of curarizers

Fertility

Reversible anomalies in the acrosomal reaction of spermatozoa which may cause impaired fertilization have been reported in some patients with calcium antagonists.

Pregnancy

Studies carried out in animals do not lead to the conclusion that there is a teratogenic or fetotoxic potential of nitrendipine.

< Br>
Therefore, the use of nitrendipine is discouraged during pregnancy This is not the systematic argument for advising termination of pregnancy but leads to an attitude of caution and prenatal-oriented surveillance. Code>
Breastfeeding

As a precautionary measure, it is advisable to avoid, if possible, administering this medicinal product to a nursing woman.