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# Mylotat ## Overview Mylotat is a brand name for **nifedipine**, a dihydropyridine calcium channel blocker. It is primarily available as extended-release (ER) formulations. ## Primary Indications * Hypertension (high blood pressure) * Angina pectoris (chest pain) due to coronary artery spasm (Prinzmetal's angina) or chronic stable angina. ## Adult Dosing * **Hypertension:** Start with 30 mg orally once daily. Titrate dose based on blood pressure response, typically every 7-14 days. Usual maintenance dose is 30-60 mg once daily. **Maximum dose: 90-120 mg once daily** (depending on specific ER formulation and prescriber preference). * **Angina:** Start with 30 mg orally once daily. Titrate dose as needed for symptom control, typically every 7-14 days. Usual maintenance dose is 30-90 mg once daily. **Maximum dose: 90-120 mg once daily** (depending on specific ER formulation and prescriber preference). *Note: Exact dosing and titration schedule may vary based on the specific extended-release formulation and local protocols.* ## Pediatric Dosing Nifedipine is generally **not recommended for use in pediatric patients** for hypertension due to limited data and potential safety concerns. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Dosage reduction may be necessary, especially in patients with severe hepatic impairment, as nifedipine is extensively metabolized by the liver. * **Renal Impairment:** No specific dose adjustment is usually required for mild to moderate renal impairment. ## Contraindications * Known hypersensitivity to nifedipine or any component of the formulation. * Cardiogenic shock. * Acute myocardial infarction (MI) and within the first 4 weeks post-MI. * Worsening or unstable angina. * Severe aortic stenosis. * **Concurrent use with strong CYP3A4 inhibitors:** e.g., ketoconazole, itraconazole, ritonavir, clarithromycin, grapefruit juice. * **Concurrent use with rifampin:** (a strong CYP3A4 inducer) – may significantly decrease nifedipine levels. ## Adverse Effects * **Common:** Peripheral edema (swelling, especially in ankles/feet), headache, flushing, dizziness, fatigue, hypotension. * **Less Common:** Nausea, rash, gastrointestinal upset, gingival hyperplasia (gum overgrowth, particularly with long-term use). * **Serious:** Worsening heart failure, severe hypotension, syncope (fainting), myocardial infarction (rare, can occur with initiation or dose increase), paradoxical increase in anginal pain (rare). ## Key Drug Interactions * **CYP3A4 Inhibitors (e.g., grapefruit juice, azole antifungals, macrolide antibiotics, protease inhibitors):** Can significantly increase nifedipine plasma concentrations, increasing risk of hypotension and other adverse effects. Avoid concurrent use. * **CYP3A4 Inducers (e.g., rifampin, phenytoin, carbamazepine, St. John's wort):** Can significantly decrease nifedipine plasma concentrations, reducing efficacy. Avoid concurrent use with rifampin; monitor blood pressure closely if other inducers are used. * **Beta-blockers:** Use with caution. While generally considered safe, combination can lead to additive hypotension and may mask reflex tachycardia. * **Digoxin:** Nifedipine may increase serum digoxin levels. Monitor digoxin levels. * **Antihypertensives:** Additive hypotensive effects may occur. ## Monitoring * **Blood Pressure:** Monitor regularly, especially during initiation and titration, and at home. * **Heart Rate:** Monitor for bradycardia or reflex tachycardia. * **Signs of Heart Failure:** Monitor for worsening edema, dyspnea, or weight gain. * **Renal and Hepatic Function:** Consider baseline and periodic monitoring, especially in patients with pre-existing impairment. * **Serum Digoxin Levels:** If co-administered. ## Clinical Pearls * Mylotat (nifedipine ER) should be swallowed whole and **not chewed, crushed, or broken.** The tablet shell may pass through the stool. * Onset of action for blood pressure reduction is typically within 20-30 minutes for immediate-release formulations, but ER formulations provide slower onset and longer duration of action. * Patients may experience a harmless "ghost tablet" in their stool due to the insoluble shell. * Sudden withdrawal can lead to rebound hypertension or angina. * Patients should be advised to avoid grapefruit and grapefruit juice while taking nifedipine. *** ***Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always verify current prescribing information, indications, contraindications, warnings, precautions, drug interactions, and dosage guidelines with the most up-to-date official product literature or a qualified healthcare provider before making any treatment decisions.*