How do you administer Nifedipine?

[winter_green]

At our L&D unit we are trying to minimize the use of terbutaline and have started to use Nifedipine (sublingual) to stop contractions.

We would puncture the capsule and squeeze the medication onto the patient's sublingually... now my question is, in the drug book it is advised to not puncture the capsule and administer sublingually because it can cause a sudden drop in BP.

Just curious how everyone else is administering Nifedipine???

[LR59]

I have been an RN for 20 plus years Long ago we used nifedipine this way but stopped beacause of sudden drops in BP Surprised to hear the y are doing it again:confused:

[Esme12, ASN, BSN, RN]

I suggest you follow policy and procedure for you facility. Check with your pharmacy and your formulary. There have been many studies with both oral and sublinguial nifedipine and pre-term labor being given ad a tocolytic. It can cause rapid drop in blood pressure which cardiac patients with cardiomyopathy are especially sensitinve to calcium channel blockers. Here are a few links.

http://scholar.google.com/scholar?q=nifedipine+and+preterm+labor&hl=en&as_sdt=0&as_vis=1&oi=scholart

http://emedicine.medscape.com/article/260998-overview

http://emedicine.medscape.com/article/260998-overview#aw2aab6b6

http://www.ncbi.nlm.nih.gov/pubmed/2603904

[caliotter3]

We used to do that when I worked in long term care facilities. Nobody said anything about other ways to administer it.

[SEDK]

WHy are you no longer using terbutaline?

[RachelRNC426]

WHy are you no longer using terbutaline?

http://www.fda.gov/Drugs/DrugSafety/ucm243539.htm

[Mulan]

I've never given it for that reason.

Have given it plenty of times in med-surg, usually as a prn for elevated BP, either sublingually or po, the route depending on how the doctor ordered it.

[TransplantRN3]

I work in with children who have had intestinal transplants. Not only are they young and unable to swallow pills, but many have oral aversions. We give many meds through GT/NGT/JT etc. When we have to give nifedipine, we puncture the capsule with a blunt tip needle and draw out the liquid medication. We know from our drug books that a 10 mg capsule has 0.34 mL of liquid in it, so we do our drug calculation and dilute it to make the concentration 1:1 with NS (for example, draw up 0.17 and mix with 5 mL of NS) so that it easier to draw up the correct dose. Sorry if this was confusing... :)

[babyktchr, BSN, RN]

We give the whole capsule, no sublingual. Pregnant patients are vasodilated by nature, so you really shouldn't see dramatic drops in BP (usually). I would think the sublingual route would tend to give you that sharp dip.

[keasc20]

We have a procardia protocol that we administer 10mg every 4 hours as long as mom's BP is > 90/50. It is very effective with less side effects. Very, very effective in preventing preterm labor.

[nocturnalnurse]

we give 10mg q20min X4 and then 10 or 20mg q4hrs after that as long as b/p >90/50. havn't had any big drops, never had to hold a dose. however, with terb, we frequently had to hold subsequent doses for pulses >110. I like the procardia.