Isradipine (tradenames DynaCirc, Prescal) is a

calcium channel blocker Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as ...

of the

dihydropyridine 1,4-Dihydropyridine (DHP) is an organic compound with the formula CH2(CH=CH)2NH. The parent compound is uncommon, but derivatives of 1,4-dihydropyridine are important commercially and biologically. The pervasive cofactors NADH and NADPH are deriv ...

class. It is usually prescribed for the treatment of

high blood pressure Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major ri ...

in order to reduce the risk of

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

and

heart attack A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...

. It was patented in 1978 and approved for medical use in 1989.

Medical uses

Isradipine is given as either a 2.5 mg or 5 mg capsule.

Side effects

Common side effects include: *Dizziness *Warmth, redness, or tingly feeling under your skin *Headache *Weakness, tired feeling *Nausea, vomiting, diarrhea, upset stomach *Skin rash or itching Serious side effects include: *Lightheadedness or fainting *Shortness of breath, especially from minimal physical activity *Swelling in the hands and feet *Rapid and/or heavy heartbeat *Chest pain

Drug interactions

It is advised that those using isradipine not take dolasetron (Anzemet), as both agents can cause a dose-dependent

PR interval In electrocardiography, the PR interval is the period, measured in milliseconds, that extends from the beginning of the P wave (the onset of atrial depolarization) until the beginning of the QRS complex (the onset of ventricular depolarization ...

and

QRS complex The QRS complex is the combination of three of the graphical deflections seen on a typical electrocardiogram (ECG or EKG). It is usually the central and most visually obvious part of the tracing. It corresponds to the depolarization of the ri ...

prolongation.

Itraconazole Itraconazole, sometimes abbreviated ITZ, is an antifungal medication used to treat a number of fungal infections. This includes aspergillosis, blastomycosis, coccidioidomycosis, histoplasmosis, and paracoccidioidomycosis. It may be given ...

(Onmel/Sporanox) exhibits a negative

inotropic An inotrope or inotropic is a drug or any substance that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscular contractions. Positively inotropic agents increase the strength of muscular co ...

effect on the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

and thus could spur an additive effect when used concomitantly with isradipine. Itraconazole also inhibits an important

cytochrome Cytochromes are redox-active proteins containing a heme, with a central iron (Fe) atom at its core, as a cofactor. They are involved in the electron transport chain and redox catalysis. They are classified according to the type of heme and its ...

liver enzyme ( CYP 450 3A4) which is needed to

metabolize Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the ...

isradipine and other

s. This will increase plasma levels of isradipine and could cause an unintentional overdose of the medication. Caution is advised when administering both agents together.

Tizanidine Tizanidine, sold under the brand name Zanaflex among others, is an alpha-2 (α2) adrenergic receptor agonist, similar to clonidine, that is used to treat muscle spasticity due to spinal cord injury, multiple sclerosis, and spastic cerebral ...

demonstrates anti-hypertensive effects and should be avoided in patients taking isradipine due to the possibility of synergism between both medications. The

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

rifampin Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), ''Mycobacterium avium'' complex, leprosy, and Legionnaires' disease. It is almost always used tog ...

lowered plasma concentrations of isradipine to below detectable limits.

Cimetidine Cimetidine, sold under the brand name Tagamet among others, is a histamine H2 receptor antagonist that inhibits stomach acid production. It is mainly used in the treatment of heartburn and peptic ulcers. With the development of proton pump ...

increased isradipine mean peak plasma levels. A downward dose adjustment may be necessary with this particular instance of

polypharmacy Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard ...

. Severe

hypotension Hypotension, also known as low blood pressure, is a cardiovascular condition characterized by abnormally reduced blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood and is ...

was reported with

fentanyl Fentanyl is a highly potent synthetic piperidine opioid primarily used as an analgesic (pain medication). It is 30 to 50 times more Potency (pharmacology), potent than heroin and 50 to 100 times more potent than morphine. Its primary Medici ...

anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

when it was combined with other calcium channel blockers. Even though isradipine, another calcium channel blocker, has not been used in conjunction with fentanyl anesthesia in any studies, caution is advised.

Overdose

Symptoms of an isradipine overdose include: *

Lethargy Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness, or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overw ...

Sinus tachycardia Sinus tachycardia is a sinus rhythm of the heart, with an increased rate of electrical discharge from the sinoatrial node, resulting in a tachycardia, a heart rate that is higher than the upper limit of normal (90–100 beats per minute for adu ...

* Transient

Stereochemistry

Isradipine contains a stereocenter and consists of two enantiomers, more precisely

atropisomer Atropisomers are stereoisomers arising because of hindered rotation about a covalent bond, single bond, where Gibbs free energy, energy differences due to steric strain or other contributors create a barrier to rotation that is high enough to all ...

s. This is a racemate, i.e. a 1: 1 mixture of (''R'')- and the (''S'')-forms:Rote Liste Service GmbH (Hrsg.): ''Rote Liste 2017 – Arzneimittelverzeichnis für Deutschland (einschließlich EU-Zulassungen und bestimmter Medizinprodukte)''. Rote Liste Service GmbH, Frankfurt/Main, 2017, Aufl. 57, , S. 193.

References

External links

* *
Drug offers hope for Parkinson's
- BBC News, 11 June 2007.

- Commentary of Chan et al. publication

- ArsTechnica - Why neurons die in Parkinson's patients {{Calcium channel blockers Calcium channel blockers Dihydropyridines Benzoxadiazoles Carboxylate esters Methyl esters Isopropyl esters