Isradipine: Drug information

For additional information see "Isradipine: Patient drug information" and "Isradipine: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table

Pharmacologic Category

Antihypertensive;
Calcium Channel Blocker;
Calcium Channel Blocker, Dihydropyridine

Dosing: Adult

Hypertension, chronic

Hypertension, chronic:

Note: For patients who warrant combination therapy (BP >20/10 mm Hg above goal or suboptimal response to monotherapy), may use with another appropriate agent (eg, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, or thiazide diuretic) (Ref).

Oral: Initial: 2.5 mg twice daily; evaluate response after ~2 to 4 weeks and titrate dose as needed up to 5 mg twice daily; if additional BP control is needed, consider combination therapy (Ref). Note: Most patients show no additional response with doses >10 mg/day and adverse reactions occur more frequently.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; however, bioavailability is increased with mild renal impairment and decreased with severe renal impairment. Isradipine is not removed by hemodialysis; therefore, supplemental doses after hemodialysis are not necessary (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; however, peak serum concentrations are increased by 32% and AUC is increased by 52%.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Isradipine: Pediatric drug information")

Hypertension

Hypertension: Limited data available: Infants, Children, and Adolescents: Immediate release: Oral: Initial: 0.05 to 0.1 mg/kg/dose 2 to 3 times daily; titrate upwards at 2- to 4-week intervals; maximum daily dose: 0.6 mg/kg/day not to exceed 10 mg/day (Ref). Based on retrospective observations, initial doses of 0.05 to 0.15 mg/kg/dose administered 3 to 4 times daily have been suggested in patients with secondary hypertension and acute severe hypertension; usual daily dose: 0.3 to 0.4 mg/kg/day in divided doses (eg, every 8 hours); reported range: 0.04 to 1.2 mg/kg/day (Ref). Note: Most adult patients show no improvement with doses >10 mg daily, and adverse reaction rate increases (Ref).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling; however, bioavailability is increased with mild renal impairment; trend is reversed with further renal function deterioration. Other sources recommend that no initial dosage adjustment is required in pediatric and adult patients (Ref). Isradipine is not removed by hemodialysis; therefore, supplemental doses after hemodialysis are not necessary (Ref).

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling; however, adult pharmacokinetic data has shown peak serum concentrations are increased by 32% and bioavailability is increased by 52%; use with caution.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Incidences may include combination therapy.

>10%: Nervous system: Headache (22%)

1% to 10%:

Cardiovascular: Chest pain (3%), edema (4% to 9%), flushing (2% to 5%), palpitations (5%), tachycardia (1% to 3%)

Dermatologic: Skin rash (2%)

Gastrointestinal: Abdominal distress (3%), diarrhea (3%), nausea (3% to 5%), vomiting (1%)

Genitourinary: Pollakiuria (1% to 3%)

Nervous system: Dizziness (5% to 8%), fatigue (2% to 9%)

Respiratory: Dyspnea (3%)

<1%:

Cardiovascular: Hypotension

Dermatologic: Hyperhidrosis, pruritus

Endocrine & metabolic: Decreased libido

Gastrointestinal: Constipation, xerostomia

Genitourinary: Erectile dysfunction, nocturia

Nervous system: Asthenia, depression, drowsiness, insomnia, lethargy, nervousness, numbness

Neuromuscular & skeletal: Foot cramps, lower limb cramp

Ophthalmic: Visual disturbance

Respiratory: Cough, pharyngitis

Postmarketing:

Cardiovascular: Acute myocardial infarction, atrial fibrillation, heart failure, syncope, ventricular fibrillation

Dermatologic: Psoriasis (Song 2021), urticaria

Hematologic & oncologic: Leukopenia

Hepatic: Increased liver enzymes

Nervous system: Cerebrovascular accident, paresthesia, transient ischemic attacks

Contraindications

Hypersensitivity to isradipine or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Angina/MI: Increased angina and/or MI has occurred with initiation or dosage titration of dihydropyridine calcium channel blockers. Reflex tachycardia may occur resulting in angina and/or MI in patients with obstructive coronary disease, especially in the absence of concurrent beta-blockade.

• Hypotension/syncope: Symptomatic hypotension with or without syncope can rarely occur; blood pressure must be lowered at a rate appropriate for the patient's clinical condition.

• Peripheral edema: A common side effect is peripheral edema (dose-dependent); may begin within 2 to 3 weeks of starting therapy.

Disease-related concerns:

• Aortic stenosis: Use with extreme caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia.

• Heart failure (HF): The AHA/ACC/HFSA heart failure guidelines recommend to avoid use in patients with heart failure due to lack of benefit and/or worse outcomes with calcium channel blockers in general (AHA/ACC/HFSA [Heidenreich 2022]).

• Hepatic impairment: Use with caution in patients with hepatic impairment; may require lower starting dose.

• Hypertrophic cardiomyopathy (HCM) with outflow tract obstruction: Use with caution in patients with HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Generic: 2.5 mg, 5 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Isradipine Oral)

2.5 mg (per each): $1.90 - $4.03

5 mg (per each): $2.78 - $4.15

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Oral: May be administered without regard to meals.

Administration: Pediatric

Oral: May be administered without regard to meals.

Use: Labeled Indications

Hypertension, chronic: Management of hypertension.

Medication Safety Issues

International issues:

Dynacirc [multiple international markets] may be confused with Dynacin brand name for clindamycin, systemic [Philippines]

Metabolism/Transport Effects

Substrate of CYP3A4 (Major with inducers), CYP3A4 (Minor with inhibitors); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Atosiban: Calcium Channel Blockers may increase adverse/toxic effects of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Calcium Salts: May decrease therapeutic effects of Calcium Channel Blockers. Risk C: Monitor

Cimetidine: May increase serum concentration of Calcium Channel Blockers. Risk C: Monitor

CycloSPORINE (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase serum concentration of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor

CYP3A4 Inducers (Moderate): May decrease serum concentration of Isradipine. Risk C: Monitor

CYP3A4 Inducers (Strong): May decrease serum concentration of Isradipine. Risk C: Monitor

CYP3A4 Inhibitors (Moderate): May increase serum concentration of Isradipine. Risk C: Monitor

CYP3A4 Inhibitors (Strong): May increase serum concentration of Isradipine. Risk C: Monitor

Dantrolene: May increase hyperkalemic effects of Calcium Channel Blockers. Dantrolene may increase negative inotropic effects of Calcium Channel Blockers. Risk X: Avoid

Dapoxetine: May increase orthostatic hypotensive effects of Calcium Channel Blockers. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Fosphenytoin-Phenytoin: Isradipine may increase serum concentration of Fosphenytoin-Phenytoin. Fosphenytoin-Phenytoin may decrease serum concentration of Isradipine. Risk C: Monitor

Grapefruit Juice: May increase serum concentration of Isradipine. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Inhalational Anesthetics: May increase hypotensive effects of Calcium Channel Blockers. Risk C: Monitor

Isocarboxazid: May increase antihypertensive effects of Antihypertensive Agents. Risk X: Avoid

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Magnesium Sulfate: May increase adverse/toxic effects of Calcium Channel Blockers (Dihydropyridine). Specifically, the risk of hypotension or muscle weakness may be increased. Risk C: Monitor

Melatonin: May decrease antihypertensive effects of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Calcium Channel Blockers may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification

Tacrolimus (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Food Interactions

Administration with food delays absorption, but does not affect availability. Management: Administer without regard to meals.

Reproductive Considerations

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be continued in patients trying to conceive. Isradipine is generally not considered a preferred agent for use during pregnancy (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019); however, use may be considered (ESC [Cífková 2020]).

Pregnancy Considerations

Isradipine crosses the human placenta. In a study of 16 women, umbilical cord concentrations were variable but less than maternal serum (Lunell 1993).

Chronic maternal hypertension is associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke, and myocardial infarction (ACOG 2019).

Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of oral isradipine may be altered (Christensen 1994).

Patients with preexisting hypertension may continue their medication during pregnancy unless contraindications exist (ESC [Regitz-Zagrosek 2018]). When treatment of hypertension is initiated during pregnancy, agents other than isradipine may be preferred (ACOG 2019; ESC [Regitz-Zagrosek 2018]; SOGC [Magee 2022]); however, use of isradipine may be considered (ESC [Cífková 2020]).

Breastfeeding Considerations

It is not known if isradipine is present in breast milk.

Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue breastfeeding or to discontinue the drug, considering the importance of treatment to the mother. Use of a calcium channel blocker other than isradipine may be preferred in lactating patients (ESC [Cífková 2020]).

Monitoring Parameters

Blood pressure; heart rate.

Mechanism of Action

Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing relaxation of vascular smooth muscle, resulting in coronary vasodilation and reduced blood pressure; increases myocardial oxygen delivery in patients with vasospastic angina

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: 2 to 3 hours; Note: Full hypotensive effect may not occur for 2 to 4 weeks

Duration: >12 hours

Absorption: 90% to 95%, but large first-pass effect

Distribution: V_d: 3 L/kg

Protein binding: 95%

Metabolism: Extensive first-pass effect; hepatically metabolized via cytochrome P450 isoenzyme CYP3A4; major metabolic pathways include oxidation and ester cleavage; six inactive metabolites have been identified

Bioavailability: 15% to 24%

Mild renal impairment (CrCl 30 to 80 mL/minute): Increased by 45%; as renal function continues to decline, this increase in AUC is reversed to a reduction in AUC as seen with severe renal impairment.

Severe renal impairment (CrCl <10 mL/minute); concurrent hemodialysis: Decreased by 20% to 50%

Hepatic impairment: Increased by 52%

Half-life elimination: Alpha half-life: 1.5 to 2 hours; Terminal half-life: 8 hours

Time to peak, serum: 1 to 1.5 hours

Excretion: Urine (60% to 65% as metabolites); feces (25% to 30%)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: The C_max increases by 32%

Older adult: The AUC and C_max increases.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Lomir;
(AR) Argentina: Dynacirc;
(AT) Austria: Lomir;
(BE) Belgium: Lomir;
(BR) Brazil: Lomir;
(CH) Switzerland: Lomir;
(CL) Chile: Dynacirc;
(CO) Colombia: Dynacirc;
(CZ) Czech Republic: Lomir;
(DE) Germany: Lomir | Vascal;
(DK) Denmark: Lomir;
(DO) Dominican Republic: Dynacirc;
(EC) Ecuador: Dynacirc;
(EE) Estonia: Lomir;
(EG) Egypt: Lomir;
(FI) Finland: Lomir;
(FR) France: Icaz;
(GR) Greece: Lomir;
(HK) Hong Kong: Dynacirc;
(HU) Hungary: Lomir;
(IT) Italy: Clivoten | Esradin | Isradipina provvisoria | Lomir;
(JO) Jordan: Lomir;
(KR) Korea, Republic of: Dynacirc;
(KW) Kuwait: Lomir;
(LU) Luxembourg: Lomir;
(MA) Morocco: Icaz;
(MX) Mexico: Dynacirc;
(MY) Malaysia: Dynacirc;
(NL) Netherlands: Lomir;
(NO) Norway: Lomir sro;
(NZ) New Zealand: Dynacirc;
(PE) Peru: Dynacirc;
(PH) Philippines: Dynacirc | Icaz;
(PL) Poland: Lomir;
(PR) Puerto Rico: Dynacirc;
(PT) Portugal: Dilatol | Lomir;
(RU) Russian Federation: Lomir;
(SA) Saudi Arabia: Lomir;
(SE) Sweden: Lomir;
(SI) Slovenia: Tenzipin;
(TH) Thailand: Dynacirc;
(TN) Tunisia: Icaz;
(TR) Turkey: Dynacirc;
(TW) Taiwan: Dynacirc;
(VE) Venezuela, Bolivarian Republic of: Dynacirc;
(ZA) South Africa: Dynacirc

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Isradipine: Drug information