Coracten Sr Capsules 20mg
Out of date information, search anotherSUMMARY OF PRODUCT CHARACTERISTICS
1 NAME OF THE MEDICINAL PRODUCT
Coracten SR Capsules 20mg
2 QUALITATIVE AND QUANTITATIVE COMPOSITION
Each capsule contains 20mg Nifedipine USP in sustained release form.
For excipients, see 6.1
3 PHARMACEUTICAL FORM
Modified-release capsule, hard
Sustained release capsules with opaque brownish-pink body and opaque reddish-brown cap, overprinted in white with ‘Coracten’ on the body and ‘20mg’ on the cap, and filled with yellow pellets.
4 CLINICAL PARTICULARS
4.1 Therapeutic indications
Coracten SR Capsules are indicated for the prophylaxis of chronic stable angina pectoris and the treatment of hypertension.
They are also indicated for the treatment of Prinzmetal (variant) angina when diagnosed by a cardiologist.
4.2 Posology and method of administration
Adults only: The recommended starting dose of Coracten SR Capsules is 10mg every 12 hours swallowed with water, with subsequent titration of dosage according to response. The dose may be adjusted to 40mg every 12 hours.
Children: Coracten SR Capsules are not recommended for use in children.
Elderly 65 years): The pharmacokinetics of nifedipine are altered in the elderly so that lower maintenance doses of nifedipine may be required.
Hepatic impairment: Caution should be exercised in treating patients with hepatic impairment. In these patients the use of one 10mg Coracten SR Capsule every 12 hours, together with careful monitoring, is suggested when commencing therapy.
Renal impairment: Dosage adjustments are not usually required in patients with renal impairment.
4.3 Contraindications
Coracten SR Capsules are contra-indicated in patients with known hypersensitivity to nifedipine or other dihydropyridines because of the theoretical risk of cross reactivity. They should also not be used in cases of known hypersensitivity to any of the excipients (see Section 6.1). They should not be used in women who are or who may become pregnant (see Section 4.6 Pregnancy and Lactation).
Coracten SR Capsules should not be used in clinically significant aortic stenosis, unstable angina, or during or within one month of a myocardial infarction. They should not be used in patients in cardiogenic shock.
Coracten SR Capsules should not be used for the treatment of acute attacks of angina, or in patients who have had ischaemic pain following its administration previously.
The safety of Coracten SR Capsules in malignant hypertension has not been established.
Coracten SR Capsules should not be used for secondary prevention of myocardial infarction.
Coracten SR Capsules are contra-indicated in patients with acute porphyria.
Coracten SR Capsules should not be used in patients with Kock pouch (ileosetomy after proctocolectomy).
Coracten SR Capsules should not be administered concomitantly with rifampicin since effective plasma levels of nifedipine may not be achieved owing to enzyme induction.
4.4 Special warnings and precautions for use
The dose of nifedipine should be reduced in patients with hepatic impairment (see section 4.2. Posology and Method of Administration). Nifedipine should be used with caution in patients who are hypotensive; in patients with poor cardiac reserve; in patients with heart failure or significantly impaired left ventricular function as their condition may deteriorate; in diabetic patients as they may require adjustment of their diabetic therapy; and in dialysis patients with malignant hypertension and irreversible renal failure with hypovolaemia, since a significant drop in blood pressure may occur due to the vasodilator effects of nifedipine.
Excessive falls in blood pressure may result in transient blindness. If affected the patient should not attempt to drive or use machinery (see section 4.8. Undesirable Effects).
Although a ‘steal’ effect has not been demonstrated, patients experiencing this effect should discontinue nifedipine therapy.
Since nifedipine has no beta-blocking activity, it gives no protection against the dangers of abrupt withdrawal of beta-blocking drugs. Withdrawal of any previously prescribed beta-blockers should be gradual, preferably over 8 to 10 days.
Nifedipine may be used in combination with beta-blockers and other antihypertensive agents, but the possibility of an additive effect resulting in postural hypotension and/or cardiac failure must be borne in mind.
Nifedipine is metabolised via the cytochrome P450 3A4 system. Drugs that are known to either inhibit or to induce this enzyme system may therefore alter the first pass or the clearance of nifedipine.
Drugs, which are inhibitors on the cytochrome P450 3A4 system and therefore may lead to increased plasma concentrations of nifedipine are, e.g.:
• macrolide antibiotics (e.g. erthromycinc)
• anti-HIV protease inhibitors (e.g. ritonavir)
• azole antimycotics (e.g. ketoconazole)
• the antidepressants nefazodone and fluoxetine
• quinupristin/dalfopristin
• valproic acid
• cimetidine.
Upon co-administration with these drugs, the blood pressure should be monitored and if necessary, a reduction of the nifedipine dose should be considered.
Since this medicinal product contains lactose, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
4.5 Interaction with other medicinal products and other forms of interaction
As with other dihydropyridines, nifedipine should not be taken with grapefruit juice because bioavailability is increased.
The simultaneous administration of nifedipine and digoxin may lead to reduced digoxin clearance and hence an increase in the plasma digoxin. Digoxin levels should be monitored and, if necessary, the digoxin dose reduced.
Nifedipine may increase the spectrophotometric values of urinary vanillylmandelic acid falsely. However, HPLC measurements are unaffected.
Coracten SR Capsules should not be administered concomitantly with rifampicin since effective plasma levels of nifedipine may not be achieved owing to enzyme induction (see section 4.3. Contra-indications).
Increased plasma levels of nifedipine have been reported during concomitant use of H2-receptor antagonists (specifically cimetidine), other calcium channel blockers (specifically diltiazem), alcohol, cyclosporin, macrolide antibiotics, gingko biloba and ginseng. Azole antifungals (e.g. ketoconazole) may increase serum concentrations of nifedipine.
Plasma levels of nifedipine are possibly decreased by the concomitant use of antiepileptics (such as phenytoin, carbamazepine and phenobarbitone) and St John’s Wort.
When used in combination with nifedipine, plasma concentrations of quinidine have been shown to be suppressed regardless of quinidine dosage. The plasma concentrations of phenytoin, theophylline and non-depolarising muscle relaxants (e.g. tubocurarine) are increased when used in combination with nifedipine. Tacrolimus concentrations may be increased by nifedipine. Data recently published indicate that the dose of tacrolimus administered simultaneously with nifedipine may be reduces in individual cases. Upon co-administration of both drugs the tacroliums plasma concentrations should be monitored and if necessary a reduction in the tacrolium dose considered.
Enhanced hypotensive effect of nifedipine may occur with: Aldesleukin, Alprostadil, Anaesthetics, Antipsychotics, Diuretics, Phenothiazides, Prazosin and Intravenous ionic X-ray contrast medium. Profound hypotension has been reported with nifedipine and intravenous magnesium sulphate in the treatment of pre-eclampsia.
Anti-protease inhibitors (e.g. ritonavir), fluoxetine, nefazodone, valproic acid and quinupristin/dalfopristin may result in increased plasma concentrations of nifedipine.
No interaction studies have been carried out between nifedipine and macrolide antibiotics. Certain macrolide antibiotics are known to inhibit the cytochrome P450 3A4 mediated metabolism of other drugs. Therefore the potential for an increase of nifedipine plasma concentrations upon co-administrations of both durgs cannot be excluded.
There is an increased risk of excessive hypotension, bradycardia and heart failure with P-blockers.
An increased rate of absorption of nifedipine from sustained release preparation may occur if given concurrently with cisapride. Simultaneous administration of cisapride and nifedipine may lead to increase plasma concentrations of nifedipine.
Nifedipine may result in increased levels of mizolastine due to inhibition of cytochrome CYP3A4.
Nifedipine may increase the neuromuscular blocking effects of vecuronium.
4.6 Fertility, pregnancy and lactation
Pregnancy
Because animal studies show embryotoxicity and teratogenicity, Coracten SR Capsules are contra-indicated during pregnancy (see also section 4.3. Contraindications). Embryotoxicity was noted at 6 to 20 times the maximum recommended dose for Coracten SR Capsules given to rats, mice and rabbits, and teratogenicity was
noted in rabbits given 20 times the maximum recommended dose for Coracten SR Capsules.
An increase in perinatal asphyxia, caesarean delivery as well as prematurity and intrauterine growth retardation has been reported, however it is unclear whether these reports are due to the underlying hypertension, its treatment or to a specific drug effect.
Lactation
Nifedipine is excreted in breast milk, therefore Coracten SR Capsules are not recommended during lactation.
Fertility
In single cases of in-vitro fertilization calcium-antagonists like nifedipine have been associated with reversible biochemical change in the spermatozoa’s head section that may result in impaired sperm function. Nifedipine should be considered as a possible cause if there is no other explanation of unsuccessful fathering.
4.7 Effects on ability to drive and use machines
Dizziness and lethargy are potential undesirable effects. If affected do not attempt to drive or use machinery (see also section 4.8. Undesirable Effects).
Excessive falls in blood pressure may result in transient blindness. If affected do not attempt to drive or use machinery (see also section 4.8. Undesirable Effects).
4.8 Undesirable effects
ADRs listed under “common” were observed with a frequency below 3% with the exception of oedema (9.9%) and headache (3.9%). Most side-effects are consequences of the vasodilatory effects of nifedipine.
The frequencies of ADRs reported with nifedipine containing products are summarised in the table below. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Frequencies are defined as common (> 1/100 to < 1/10), uncommon (> 1/1,000 to < 1/100) and rare (> 1/10,000 to < 1/1,000). The ADRs identified only during the ongoing postmarketing surveillance and for which a frequency could not be estimated, are listed under “Not known”.
|
System Organ Class (MedDRA) |
Common |
Uncommon |
Rare |
Not known |
|
Blood and lymphatic system disorders |
Agranulocytosis Leukopenia | |||
|
Immune system disorders |
Allergic reaction Allergic oedema / angioedema (incl. larynx oedema 1) |
Pruritus Urticaria Rash |
Anaphylactic/ anaphylactoid reaction Systemic allergic reactions | |
|
Psychiatric disorders |
Anxiety reactions Sleep disorders |
Mood changes |
Depression |
|
System Organ Class (MedDRA) |
Common |
Uncommon |
Rare |
Not known |
|
Metabolism and nutrition disorders |
Hyperglycaemia | |||
|
Nervous system disorders |
Headache |
Vertigo Migraine Dizziness Tremor |
Par-/ Dysaesthesia |
Hypoaesthesia Somnolence Lethargy Cerebral ischemia (due to excessive fall in blood pressure) |
|
Eye disorders |
Visual disturbances |
Eye pain Transient blindness (due to excessive fall in blood pressure) | ||
|
Cardiac disorders |
Tachycardia Palpitations |
Chest pain (Angina Pectoris) Myocardial infarction2 Myocardial ischemia (due to excessive fall in blood pressure) | ||
|
Vascular disorders |
Oedema (incl. peripheral oedema) Vasodilatation |
Hypotension Syncope |
Flushing | |
|
Respiratory, thoracic, and mediastinal disorders |
Nosebleed Nasal congestion |
Dyspnea | ||
|
Gastrointestinal disorders |
Constipation |
Gastrointestinal and abdominal pain Nausea Dyspepsia Flatulence Dry mouth |
Gingival hyperplasia |
Vomiting Gastrooesophageal sphincter insufficiency Diarrhoea |
|
Hepatobiliary disorders |
Transient increase in liver enzymes |
Jaundice Intra-hepatic cholestasis | ||
|
Skin and subcutaneous tissue disorders |
Erythema |
Toxic Epidermal Necrolysis Photosensitivity allergic reaction Palpable purpura Telangiectasia Erythema multiforme Pemphigoid reaction Exfoliative dermatitis Purpura | ||
|
Musculoskeletal and connective tissue disorders |
Muscle cramps Joint swelling |
Arthralgia Myalgia Worsening of |
|
System Organ Class (MedDRA) |
Common |
Uncommon |
Rare |
Not known |
|
myasthenia gravis | ||||
|
Renal and urinary disorders |
Polyuria Dysuria |
Increased frequency of micturition | ||
|
Reproductive system and breast disorders |
Erectile dysfunction |
Gynaecomastia (long-term therapy) | ||
|
General disorders and administration site conditions |
Feeling unwell |
Unspecific pain Chills |
Fever |
= may result in life-threatening outcome.
2 = the occurrence of myocardial infarction has been described although it is not possible to distinguish such an event from the natural course of ischaemic heart disease.
In dialysis patients with malignant hypertension and hypovolaemia a distinct fall in blood pressure can occur as a result of vasodilation.
Reporting of Suspected Adverse Reactions
Reporting suspected adverse after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Health care professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov .uk/yellowcard.
4.9 Overdose
Human experience:
Reports of nifedipine overdosage are limited and symptoms are not necessarily dose-related. Severe hypotension due to vasodilation, and tachycardia or bradycardia are the most likely manifestations of overdose.
Metabolic disturbances include hyperglycaemia, metabolic acidosis and hypo- or hyperkalaemia.
Cardiac effects may include heart block, AV dissociation and asystole, and cardiogenic shock with pulmonary oedema.
Other toxic effects include nausea, vomiting, drowsiness, dizziness, confusion, lethargy, flushing, hypoxia, unconsciousness and coma.
Management of overdose in man:
As far as treatment is concerned, elimination of nifedipine and the restoration of stable cardiovascular conditions have priority.
After oral ingestion, gastric lavage is indicated, if necessary in combination with irrigation of the small intestine. Ipecacuanha should be given to children.
Elimination must be as complete as possible, including the small intestine, to prevent the otherwise inevitable subsequent absorption of the active substance.
Haemodialysis serves no purpose, as nifedipine is not dialyzable, but as plasmapheresis is advisable (high plasma protein binding, relatively low volume of distribution).
Activated charcoal should be given in 4-hourly doses of 25g for adults, 10g for children.
Blood pressure, ECG, central arterial pressure, pulmonary wedge pressure, urea and electrolytes should be monitored.
Hypotension as a result of cardiogenic shock and arterial vasodilation should be treated with elevation of the feet and plasma expanders. If these measures are ineffective, hypotension may be treated with 10% calcium gluconate 10-20 ml intravenously over 5-10 minutes. If the effects are inadequate, the treatment can be continued, with ECG monitoring. In addition, beta-sympathomimetics may be given, e.g. isoprenaline 0.2 mg slowly i.v. or as a continuous infusion of 5pg/min. If an insufficient increase in blood pressure is achieved with calcium and isoprenaline, vasoconstricting sympathomimetics such as dopamine or noradrenaline should be administered. The dosage of these drugs should be determined by the patient’s response.
Bradycardia may be treated with atropine, beta-sympathomimetics or a temporary cardiac pacemaker, as required.
Additional fluids should be administered with caution to avoid cardiac overload.
5 PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
ATC Code: C08C A05
Nifedipine is a potent calcium-channel blocker which, by dilating peripheral arterial smooth muscle, decreases cardiac work and myocardial oxygen requirement. It also dilates coronary arteries, thereby improving myocardial perfusion and reducing coronary artery spasm. In hypertension, it reduces blood pressure but has little or no effect in normotensive subjects. It has no therapeutic antiarrhythmic effect.
5.2 Pharmacokinetic properties
Coracten SR Capsules are a sustained release formulation of nifedipine designed to provide less fluctuation and more prolonged nifedipine blood concentrations than standard immediate release preparations.
Nifedipine is highly protein bound. It undergoes hepatic oxidation to inactive metabolites which are excreted in the urine (80%) and faeces (20%).
5.3 Preclinical safety data
There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the Summary of Product Characteristics.
6 PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Capsule contents:
Sucrose Ph.Eur., Maize Starch Ph.Eur., Lactose Ph.Eur., Povidone K30 Ph.Eur., Methacrylic acid copolymer type A (Eudragit L100) NF, Talc Ph.Eur., Purified Water Ph.Eur.
Capsule shells:
Gelatin , Red iron oxide (E172), Yellow iron oxide (E172), Titanium dioxide (E171). Printing ink:
Titanium dioxide, shellac, propylene glycol, sodium hydroxide, povidone
6.2 Major incompatibilities
None known.
6.3 Shelf life
36 months.
6.4 Special precautions for storage
Store in original pack at a temperature not exceeding 30°C and protect from light.
6.5 Nature and contents of container
Coracten SR Capsules are presented in blister strips packed in cartons containing 60 capsules. The blister strips are formed from PVC with a coating of PVdC backed with aluminium foil.
(Cartons of 10, 15, 30, 56, 100, 150, 250, 500 and 600 capsules are licensed but not marketed.)
6.6 Instructions for use, handling and disposal
None.
7 MARKETING AUTHORISATION HOLDER
UCB Pharma Limited 208 Bath Road Slough Berkshire SL1 3WE
UK
8 MARKETING AUTHORISATION NUMBER(S)
PL 00039/0367
9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
11 April 1991
10 DATE OF REVISION OF THE TEXT
31/10/2014