European Journal of Clinical Pharmacology

, Volume 43, Issue 6, pp 587–590 | Cite as

24-hour anti-ischaemic action with once daily nifedipine

Experience obtained with a fatty-alcohol matrix tablet in patients with coronary artery disease
  • B. G. Woodcock
  • P. A. Thürmann
  • S. Pfleiderer
  • N. Reifart


The ability of a fatty-alcohol matrix, slow-release tablet of nifedipine 60 mg to maintain a 24-hour antiischaemic action in the fixed dose of 60 mg once daily has been investigated in a randomised, placebo-controlled, double-blind trial.

12 normotensive patients with angiographically proven coronary artery disease (stenosis of at least one major vessel ≥ 70%) were studied. The anti-ischaemic response was assessed over a period of 4 days as changes in the exercise-induced ST-segment depression 6 h and 24 h postdose, and ST segment changes in 24-h ambulatory ECGs.

A measurable anti-ischaemic response was observed in 8 of the 12 patients. Exercise-induced ST-segment depression 6 h after the administration of nifedipine was reduced by 30% compared to placebo, and there was still a measurable anti-ischaemic response 24-h post-dosing. Both responses were independent of changes in exercise blood pressure. In 7 patients with ischaemic episodes in the 24-h ECGs, nifedipine treatment had only a minor effect on the intensity and duration of ischaemia.

It is concluded that a significant anti-ischaemic effect lasting 24 h could be demonstrated using effort-induced ST-segment changes in patients with angiographically proven coronary heart disease, who were treated once daily with nifedipine 60 mg as a fatty-alcohol slow release tablet.

Key words

Nifedipine, Coronary artery disease slow release, ST-segment depression, adverse effects 


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  1. 1.
    Moskowitz RM, Piccini PA, Nacarelli GV, Zelis R (1979) Nifedipine therapy for stable angina pectoris: preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol 44:811–816Google Scholar
  2. 2.
    Kleinbloesem CH, van Brummelen P, van de Linde JA, Voogd PJ, Breimer DD (1984) Nifedipine: Kinetics and dynamics in healthy subjects. Clin Pharmacol Ther 35:742–749Google Scholar
  3. 3.
    Vetrovec GW, Parker VE, Cole S, Procacci PM, Tabatznik B, Terry R (1987) Nifedipine gastrointestinal therapeutic system in stable angina pectoris. Am J Med 83 [Suppl 6B]: 24–29Google Scholar
  4. 4.
    Woodcock BG, Menke G, Fischer A, Köhne H, Rietbrock N (1988) Drug input rate from the GI-tract. Michaelis-Menten kinetics and the bioavailability of slow release verapamil and nifedipine. Drug Design Delivery 2: 298–309Google Scholar
  5. 5.
    Raftery EB, Brigden G, Woodcock BG (1990) 24-Stunden Blutdruckprofile eines langwirkenden Nifedipinpräparates unter Anwendung intraarterieller Blutdruckmessungen. In: Deutsche Liga zur Bekämpfung des Bluthochdrucks (ed) Abstracts der 3. Nationalen Blutdruck-Konferenz, Heidelberg, S 81Google Scholar
  6. 6.
    Feris JV, McHenry PL, Morris SN (1978) Concepts and applications of treadmill exercise testing and the exercise electrocardiogram. Am Heart J 95: 102–114Google Scholar
  7. 7.
    Kaltenbach M, Klepzig H, Tschirdewahn B (1964) Die Kletterstufe, eine einfache Vorrichtung für exakt meβbare und reproduzierbare Belastungsuntersuchungen. Med Klin 59: 248–254Google Scholar
  8. 8.
    Thürmann P, Odenthal HJ, Reitbrock N (1991) Converting enzyme inhibition in coronary artery disease: A randomised placebo-controlled trial with benazepril. J Cardiovasc Pharmacol 17: 718–723Google Scholar
  9. 9.
    Nayler WG (1988) Calcium Antagonists. Academic Press, London San Diego, pp 177–192Google Scholar
  10. 10.
    Vetrovec GW (1989) Once-daily therapy for angina pectoris with nifedipine gastrointestinal therapeutic system. Am J Med 86 [Suppl 1A]: 29–32Google Scholar
  11. 11.
    Deanfield J, Wright C, Fox K (1983) Treatment of angina pectoris with nifedipine: importance of dose titration. Br Med J 286: 1467–1470Google Scholar
  12. 12.
    Bacracheva N, Thürmann P, Rietbrock N (1990) Dose adjustment of nifedipine in hypertensive patients. Eur J Clin Pharmacol 38: 17–20Google Scholar
  13. 13.
    Caitman BR, Wagniart P, Pasternac A, Brevers G, Scholl JM, Lam J, Methe M, Ferguson RJ, Bourassa MG (1984) Improved exercise tolerance after propranolol, diltiazem or nifedipine in angina pectoris: comparison at 1, 3 and 8 hours and correlation with plasma drug concentration. Am J Cardiol 53: 1–9Google Scholar
  14. 14.
    Ardissino D, De Servi S, Salerno JA, Specchia G, Prevital M, Mussini A, Bobba P (1983) Efficacy, duration and mechanism of action of nifedipine in stable exercise-induced angina pectoris. Eur Heart J 4: 873–881Google Scholar
  15. 15.
    Khurmi NS, Raftery EB (1988) Lack of diurnal variation in maximal symptom e-limited exercise test response in chronic stable angina. Am J Cardiol 61: 38–42Google Scholar
  16. 16.
    Mulcahy D, Keegan J, Crean P, Quyyumi A, Shapiro L, Wright C, Fox K (1988) Silent myocardial ischaemia in chronic stable angina: a study of its frequency and characteristics in 150 patients. Br Heart J 60: 417–423Google Scholar
  17. 17.
    Fox KM, Mulcahy DA (1990) Circadian variation of the total ischemic burden and influence byβ-blocking agents. J Cardiovase Pharmacol 16 [Suppl 5]: S100–104Google Scholar
  18. 18.
    Shell WE, Dobson D (1990) Dissociaton of exercise tolerance and total myocardial ischemic burden in chronic stable angina pectoris. Am J Cardiol 66: 42–48Google Scholar
  19. 19.
    von Arnim T (1987) Influence of isosorbide-5-mononitrate 20 mg, sustained-release 50 mg and sustained-release nifedipine 20 mg on ischaemic ST segment changes during holter monitoring. Cardiology 74 [Suppl 1]: 40–45Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • B. G. Woodcock
    • 1
  • P. A. Thürmann
    • 1
  • S. Pfleiderer
    • 1
  • N. Reifart
    • 2
  1. 1.Department of Clinical PharmacologyJohann Wolfgang Goethe UniversityFrankfurt/MainGermany
  2. 2.Group Practice for Cardiological DiseasesRed Cross-HospitalFrankfurt/MainGermany

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