Dynacirc CR (Isradipine)
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Dynacirc CR (Isradipine)

DynaCirc CR®
(isradipine) Controlled Release Tablets

DRUG DESCRIPTION

DynaCirc CR® contains isradipine, a calcium antagonist. It is available for once-daily oral administration as a controlled release 5 mg and 10 mg tablet for DynaCirc CR® (isradipine). DynaCirc CR® is a registered trademark for isradipine GITS (Gastrointestinal Therapeutic System) tablets.

The structural formula of isradipine is:

DynaCirc CR (isradipine)  Structural Formula Illustration

Chemically, isradipine is 3,5-Pyridinedicarboxylic acid, 4-(4-benzofurazanyl)-1,4-dihydro-2,6-dimethyl-, methyl 1-methylethyl ester. Isradipine is a yellow, fine crystalline powder which is odorless or has a faint characteristic odor. Isradipine is practically insoluble in water ( < 10 mg/L at 37°C), but is soluble in ethanol and freely soluble in acetone,chloroform and methylene chloride.

Active Ingredient: isradipine

Inactive Ingredients: butylated hydroxytoluene; cellulose acetate; hydroxypropyl methylcellulose; magnesium stearate; polyethylene glycol; polyethylene oxide; polysorbate 80; propylene glycol; red ferric oxide; silicon dioxide; sodium chloride; titanium dioxide; yellow ferric oxide.

System Components and Performance

Isradipine is delivered from the DynaCirc CR® (isradipine) Controlled Release Tablet as follows: a semipermeable membrane surrounds an osmotically active drug core.The core is composed of two layers: an "active"layer containing the drug, and a pharmacologically inert but osmotically active "push" layer. After ingestion, the tablet overcoating is quickly dissipated in the gastrointestinal tract,allowing water to enter the tablet through the semipermeable membrane. The polyethylene oxide polymer swells in the osmotic ("push") layer and exerts pressure against the "active"drug layer, releasing isradipine as a fine suspension through the laser-drilled tablet orifice which has been positioned on the "active" drug layer side. Drug delivery is essentially constant as long as the osmotic gradient remains constant and, after either 5 mg or 10 mg of isradipine is released, gradually falls to a negligible amount.The controlled rate of drug delivery into the gastrointestinal lumen is independent of pH or gastrointestinal motility. The delivery of isradipine in DynaCirc CR® (isradipine) Controlled Release Tablets depends on the existence of an osmotic gradient between the contents of the bilayer core and the fluid in the GI tract.The biologically inert core of the tablet remains intact and,unless it becomes trapped, is eliminated in the feces.

What are the possible side effects of isradipine (Dynacirc, Dynacirc CR)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • feeling like you might pass out;
  • feeling short of breath, even with mild exertion;
  • swelling in your hands and feet;
  • fast or pounding heartbeats; or
  • chest pain.

Less serious side effects may include:

  • dizziness;
  • warmth, redness, or tingly feeling under your...

Read All Potential Side Effects and See Pictures of Dynacirc CR »

What are the precautions when taking isradipine (Dynacirc CR)?

Before taking isradipine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain structural heart problems (aortic stenosis).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, stomach/intestine problems (such as narrowing, blockage).

This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure...

Read All Potential Precautions of Dynacirc CR »

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

INDICATIONS

Hypertension

DynaCirc CR® (isradipine) is indicated in the management of hypertension. It may be used alone or concurrently with thiazide-type diuretics.

DOSAGE AND ADMINISTRATION

The dosage of DynaCirc CR® (isradipine) Controlled Release Tablets should be individualized.The recommended initial dose of DynaCirc CR® (isradipine) is 5 mg once-daily as monotherapy or in combination with a thiazide diuretic. An antihypertensive response usually occurs within 2 hours,with the peak antihypertensive response occurring 8-10hours post-dose; blood pressure reduction is maintained for at least 24 hours following drug administration.If necessary,the dose may be adjusted in increments of 5 mg at 2-4 week intervals up to a maximum dose of 20 mg/day. Adverse experiences are increased in frequency above 10 mg/day.

DynaCirc CR® (isradipine) Controlled Release Tablets should be swallowed whole and should not be bitten or divided.

The bioavailability (increased AUC) of immediate-release DynaCirc® (isradipine) is increased in elderly patients (above 65 years of age), patients with hepatic functional impairment, and patients with mild renal impairment. Ordinarily, a starting dose of DynaCirc CR® (isradipine) 5 mg once-daily should be used in these patients.

HOW SUPPLIED

DynaCirc CR® (isradipine) Controlled Release Tablets:

5 mg: A light pink, round, standard biconvex and film coated tablet. Printing is in red with "DynaCirc CR (isradipine) " in a semicircle with "5"centered below the semicircle.

Bottles of 100 controlled release tablets (NDC 65726-235-25)
Bottles of 30 controlled release tablets (NDC 65726-235-10)

10 mg: A beige, round, standard biconvex and film coated tablet. Printing is in red with "DynaCirc CR (isradipine) " in a semicircle with "10"centered below the semicircle.

Bottles of 100 controlled release tablets (NDC 65726-236-25)
Bottles of 30 controlled release tablets (NDC 65726-236-10)

Store and Dispense

Below 86°F (30°C) in a tight container,protected from moisture and humidity.

Distributed by: Reliant Pharmaceuticals,Inc. Liberty Corner,NJ 07938. Address Medical Inquiries to: Reliant Medical Inquiries, c/o PPD 2655 Meridian Parkway, Durham,NC 27713-2203. or Call: 877-311-7515. FDA Rev date: 5/18/2005

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

SIDE EFFECTS

In a controlled clinical trial with DynaCirc CR® (isradipine), dose-related edema occurred at an incidence of approximately 9% at 5 mg; 13% at 10 mg; 16% at 15 mg; and 36% at the highest dose studied (20 mg), was mild to moderate in severity,and was not related to age or gender.

The incidences of elicited or volunteered adverse reactions (excluding non-drug related) in the following tables are based on 6-week multicenter, placebo-controlled, double-blind hypertension studies. Less than 1% of DynaCirc CR® (isradipine) or placebo-treated patients discontinued from these studies due to adverse reactions.

The most common adverse experiences ( ≥ 1.0%) reported with DynaCirc CR® (isradipine) in a dose-response study are shown in the following table.There were no discontinuations of patients treated with DynaCirc CR® (isradipine) in this study due to these common side effects.

Most Frequently Reported Newly-Occurring Adverse Reactions in Dose-Response Study

Adverse Reactions (Excluding Non-Drug Related) DynaCirc CR® (isradipine)
5 mg
(N=79)
10 mg
(N=79)
15 mg
(N=82)
20 mg
(N=78)
Placebo Group
(N=83)
Headache 13.9% 12.7% 18.3% 10.3% 15.7%
Edema 8.9% 12.7% 15.9% 35.9% 3.6%
Dizziness 5.1% 6.3% 3.7% 6.4% 2.4%
Constipation 3.8% 1.3% 1.2% 2.6% 0.0%
Fatigue 2.5% 7.6% 3.7% 3.8% 2.4%
Flushing 2.5% 3.8% 1.2% 1.3% 1.2%
Abdominal Discomfort 1.3% 5.1% 3.7% 5.1% 1.2%
Rash 1.3% 1.3% 0.0% 2.6% 0.0%

The table below shows elicited or volunteered adverse experiences for DynaCirc CR® (isradipine) treated patients in two 6-week, placebo-controlled, multicenter studies, at doses from 5-20 mg, and considered by the investigator to be at least possibly drug related.The results for DynaCirc CR® (isradipine) treated patients are presented for all doses pooled together (reported by at least 1.0% of active drug treated patients).The incidence of adverse reactions are listed below:

Adverse Reactions (Excluding Non-Drug Related) Treatment Group
DynaCirc CR®(isradipine)
(N=422)
Placebo
(N=186)
Edema 15.2% 2.2%
Headache 13.0% 12.4%
Dizziness 4.7% 2.7%
Fatigue 4.3% 2.2%
Abdominal Discomfort 2.8% 0.5%
Flushing 1.9% 0.5%
Constipation 1.7% 0.0%
Palpitations 1.2% 0.0%
Nausea 1.2% 1.6%
Abdominal Distention 1.2% 0.0%

The following adverse experiences were reported in 0.5%-1.0% or less of DynaCirc CR® (isradipine) or immediate-release DynaCirc® (isradipine) treated patients in hypertensive studies,or were noted in postmarketing experience with immediate-release DynaCirc® (isradipine) Capsules. More serious events are shown in italics. The relationship of these adverse experiences to isradipine administration is uncertain.

SKIN:Pruritus, urticaria, angioedema.

MUSCULOSKELETAL: Backache/pain, joint pain,neck pain/sore/stiff,legs ache/pain,cramps of legs/feet.

RESPIRATORY: Dyspnea, nasal congestion,cough.

CARDIOVASCULAR: Epistaxis,tachycardia,chest pain,shortness of breath,hypotension, syncope,atrial or ventricular fibrillation,myocardial infarction,heart failure.

GASTROINTESTINAL:Diarrhea,vomiting,appetite increased or decreased.

UROGENITAL: Pollakiuria,impotence,dysuria,nocturia.

CENTRAL NERVOUS: Drowsiness, insomnia, lethargy,nervousness, libido decrease/frigidity,impotence, depression, paresthesia (which includes numbness and tingling), transient ischemic attack,stroke.

AUTONOMIC: Dry mouth,hyperhidrosis,visual disturbance.

MISCELLANEOUS: Weight gain, throat discomfort, drug fever, leukopenia, elevated liver function tests.

No gastrointestinal bleeding has been reported in clinical trials with DynaCirc CR® (isradipine) Controlled Release Tablets.

In a long-term (one-year) DynaCirc CR® (isradipine) open-label, hypertension trial, the adverse events reported were generally the same as those seen in the short-term placebo-controlled studies. About 6% of DynaCirc CR® (isradipine) treated patients discontinued the long-term trial due to adverse reactions.

With immediate-release DynaCirc® (isradipine) Capsules, most of the adverse experiences were transient, mild, and related to vasodilatory effects.The following table shows the most common adverse events reported in U.S.clinical tri-als for immediate-release DynaCirc® (isradipine) Capsules, volunteered or elicited, and considered by the investigator to be at least possibly drug related.

Adverse Experience DynaCirc® (isradipine) Placebo
(N=297)
%
ActiveControls*
(N=414)
%
All Doses 2.5 mg b.i.d. 5 mg b.i.d. 10 mg b.i.d.††
Headache 13.7 12.6 10.7 22.0 14.1 9.4
Dizziness 7.3 8.0 5.3 3.4 4.4 8.2
Edema 7.2 3.5 8.7 8.5 3.0 2.9
Palpitations 4.0 1.0 4.7 5.1 1.4 1.5
Fatigue 3.9 2.5 2.0 8.5 0.3 6.3
Flushing 2.6 3.0 2.0 5.1 0.0 1.2
Chest Pain 2.4 2.5 2.7 1.7 2.4 2.9
Nausea 1.8 1.0 2.7 5.1 1.7 3.1
Dyspnea 1.8 0.5 2.7 3.4 1.0 2.2
Abdominal Discomfort 1.7 0.0 3.3 1.7 1.7 3.9
Tachycardia 1.5 1.0 1.3 3.4 0.3 0.5
Rash 1.5 1.5 2.0 1.7 0.3 0.7
Pollakiuria 1.5 2.0 1.3 3.4 0.0 <1.0
Weakness 1.2 0.0 0.7 0.0 0.0 1.2
Vomiting 1.1 1.0 1.3 0.0 0.3 0.2
Diarrhea 1.1 0.0 2.7 3.4 2.0 1.9
Initial dose of 2.5 mg b.i.d.followed by maintenance dose of 5.0 mg b.i.d.
††Initial dose of 2.5 mg b.i.d.followed by sequential titration to 5.0 mg b.i.d.,7.5 mg b.i.d.,and maintenance dose of 10.0 mg b.i.d.
*Propranolol,prazosin,hydrochlorothiazide,enalapril,captopril.

In open-label,long-term studies of up to two years in duration with immediate-release DynaCirc® (isradipine) Capsules, the adverse experiences reported were generally the same as those reported in the short-term controlled trials. The overall frequencies of these adverse events were slightly higher in the long-term than in the controlled studies, but in the controlled studies most adverse reactions were mild and transient.

Read the Dynacirc CR (isradipine) Side Effects Center for a complete guide to possible side effects »

DRUG INTERACTIONS

Nitroglycerin: Immediate-release DynaCirc® (isradipine) has been safely coadministered with nitroglycerin.

Hydrochlorothiazide: A study in normal healthy volunteers has shown that concomitant administration of immediate-release DynaCirc® (isradipine) and hydrochlorothiazide does not result in altered pharmacokinetics of either drug. In a study in hypertensive patients, addition of isradipine to existing hydrochlorothiazide therapy did not result in any unexpected adverse effects, and isradipine had an additional antihypertensive effect.

Propranolol: In a single dose study in normal volunteers using immediate-release DynaCirc® (isradipine),co-administration of propranolol had a small effect on the rate but no effect on the extent of isradipine bioavailability. Significant increases in AUC (27%) and Cmax (58%) and decreases in tmax (23%) of propranolol were noted in this study.

Digoxin: The concomitant administration of immediate-release DynaCirc® (isradipine) and digoxin in a single-dose pharmacokinetic study did not affect renal, non-renal and total body clearance of digoxin.

Fentanyl Anesthesia: Severe hypotension has been reported during fentanyl anesthesia with concomitant use of a beta blocker and a calcium channel blocker. An increased volume of circulating fluids might be required if such an interaction were to occur.

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

WARNINGS

None

PRECAUTIONS

General

Blood Pressure: Because DynaCirc CR® (isradipine) decreases peripheral resistance, like other calcium blockers DynaCirc CR® (isradipine) may occasionally produce symptomatic hypotension. However, symptoms like syncope and severe dizziness have rarely been reported in hypertensive patients administered DynaCirc CR® (isradipine), particularly at the initial recommended doses (see DOSAGE AND ADMINISTRATION).

Use in Patients with Congestive Heart Failure: Although acute hemodynamic studies in patients with congestive heart failure have shown that immediate-release DynaCirc® (isradipine) reduced afterload without impairing myocardial contractility, it has a negative inotropic effect at high doses in vitro and possibly in some patients. Caution should be exercised when using DynaCirc CR® (isradipine) in congestive heart failure patients, particularly in combination with a beta-blocker.

Peripheral Edema: Peripheral edema, when it occurs, is usually mild to moderate in severity. It is a localized phenomenon thought to be associated with vasodilation of arterioles and other small blood vessels,and not due to left ventricular dysfunction or generalized fluid retention. Peripheral edema is dose-related with an incidence ranging from approximately 9% at 5 mg; 13% at 10 mg; 16% at 15 mg; and 36% at the highest dose studied (20 mg once-daily). With patients whose hypertension is complicated by congestive heart failure, care should be taken to differentiate this edema from the effects of decreasing left ventricular function. Although the frequency of edema is correlated with dose, no DynaCirc CR® (isradipine) treated patients discontinued the short-term (6 weeks or less), placebo-controlled hypertension studies as a result of edema. Less than 5% of DynaCirc CR® (isradipine) treated patients in long-term studies discontinued due to edema.

Other: As with any other non-deformable material, caution should be used when administering DynaCirc CR® (isradipine) in patients with pre-existing severe gastrointestinal narrowing (pathologic or iatrogenic).There have been reports of obstructive symptoms in patients with known strictures associated with ingestion of other GITS products.

Carcinogenesis, Mutagenesis,Impairment of Fertility

Treatment of male rats for 2 years with 2.5, 12.5, or 62.5 mg/kg/day isradipine admixed with the diet (approximately 6, 31, and 156 times the maximum recommended daily dose based on a 50 kg man) resulted in dose dependent increases in the incidence of benign Leydig cell tumors and testicular hyperplasia relative to untreated control animals. These findings, which were replicated in a subsequent experiment, may have been indirectly related to an effect of isradipine on circulating gonadotropin levels in the rats; a comparable endocrine effect was not evident in male patients receiving therapeutic doses of the drug on a chronic basis. Treatment of mice for two years with 2.5, 15, or 80 mg/kg/day isradipine in the diet (approximately 6,38,and 200 times the maximum recommended dose based on a 50 kg man) showed no evidence of oncogenicity. There was no evidence of mutagenic potential based on the results of a battery of mutagenic tests.No effect on fertility was observed in male and female rats treated with up to 60 mg/kg/day isradipine.

Pregnancy

Pregnancy Category C: Isradipine was administered orally to rats and rabbits during organogenesis. Treatment of pregnant rats with doses of 6, 20, or 60 mg/kg/day produced a significant reduction in maternal weight gain during treatment with the highest dose (150 times the maximum recommended human daily dose) but with no lasting effects on the mother or the offspring.Treatment ofpregnant rabbits with doses of 1,3,or 10mg/kg/day (2.5,7.5,and 25 times the maximum recommended human daily dose) produced decrements in maternal body weight gain and increased fetal resorption at the two higher doses.There was no evidence of embryotoxicity at doses which were not maternotoxic and no evidence of teratogenicity at any dose tested.In a peri/postnatal administration study in rats,reduced maternal body weight gain during late pregnancy at oral doses of 20 and 60 mg/kg/day isradipine was associated with reduced birth weights and decreased peri and postnatal pup survival.

There are no adequate and well controlled studies in pregnant women. The use of DynaCirc CR® (isradipine) during pregnancy should only be considered if the potential benefit outweighs potential risks.

Nursing Mothers

It is not known whether DynaCirc® (isradipine) is excreted in human milk.Because many drugs are excreted in human milk,and because of the potential for adverse effects of DynaCirc® (isradipine) on nursing infants,a decision should be made as to whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness have not been established in children.

Geriatric Use

Clinical studies of DynaCirc CR® (isradipine) did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Elderly patients have deceased clearance of DynaCirc® (isradipine) with a higher average AUC and Cmax (see Pharmacokinetics and Metabolism).The larger extent of bioavailability may be a result of a reduced clearance and/or reduced first-pass metabolism of the drug. In general, dose selection for an elderly patient should be cautious,reflecting the greater frequency of decreased hepatic, renal,or cardiac function,and of concomitant disease or other drug therapy (see DOSAGE AND ADMINISTRATION).

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

OVERDOSE

Although there is no well documented experience with DynaCirc® (isradipine) overdosage,available data suggest that, as with other dihydropyridines, gross overdosage would result in excessive peripheral vasodilation with subsequent marked and probably prolonged systemic hypotension. Clinically significant hypotension overdosage calls for active cardiovascular support including monitoring of cardiac and respiratory function, elevation of lower extremities and attention to circulating fluid volume and urine output. A vasoconstrictor (such as epinephrine, norepinephrine, or levarterenol) may be helpful in restoring vascular tone and blood pressure,provided that there is no contraindication to its use.Since isradipine is highly protein bound, dialysis is not likely to be of benefit.

Significant lethality was observed in mice given oral doses of over 200 mg/kg and rabbits given about 50 mg/kg of isradipine. Rats tolerated doses of over 2000 mg/kg without effects on survival.

CONTRAINDICATIONS

DynaCirc CR® (isradipine) is contraindicated in individuals who have shown hypersensitivity to any of the ingredients in the formulation.

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

CLINICAL PHARMACOLOGY

Mechanism of Action

Isradipine is a dihydropyridine calcium channel blocker. It binds to calcium channels with high affinity and specificity and inhibits calcium flux into cardiac and smooth muscle. The effects observed in mechanistic experiments in vitro and studied in intact animals and man are compatible with this mechanism of action and are typical of the class.

Except for diuretic activity,the mechanism of which is not clearly understood,the pharmacodynamic effects of isradipine observed in whole animals can also be explained by calcium channel blocking activity, especially dilating effects in arterioles which reduce systemic resistance and lower blood pressure, with a small increase in resting heart rate. Although like other dihydropyridine calcium channel blockers, isradipine has negative inotropic effects in vitro, studies conducted in intact anesthetized animals have shown that the vasodilating effect occurs at doses lower than those which affect contractility. In patients with normal ventricular function,isradipine's afterload reducing properties lead to some increase in cardiac output.

Effects in patients with impaired ventricular function have not been fully studied.

Clinical Effects

In randomized, placebo-controlled, double-blind, clinical trials, DynaCirc CR® (isradipine) Controlled Release Tablets have been shown to have antihypertensive effects proportional to doses between 5 and 20 mg,administered once daily. DynaCirc CR® (isradipine) produced statistically significant reductions in supine and standing blood pressure, compared with placebo, 24 hours postdose.The endpoint results of one parallel group dose-ranging trial showed mean responses 24 hours after ingestion of DynaCirc CR® (isradipine) (systolic/diastolic) -5.2/-2.8, -13.4/-9.7, -15.6/-10.2 and -15.5/-11.8 mmHg, for 5, 10, 15 and 20 mg doses, respectively, change from baseline greater than concurrent placebo.The antihypertensive effect of any one dose begins in about 2 hours and reaches a peak at about 8-10 hours postdose.At the recommended starting dose (5 mg) the trough response (24 hours after dosing) was about 76% that of the peak.At doses of 10,15 and 20 mg,the trough blood pressure response was about equal to that at peak effect.In association with the fall in blood pressure, resting heart rate is slightly increased, on average from 1-3 beats/minute. The antihypertensive response to DynaCirc CR® (isradipine) has not been detected to be influenced by gender or age.

Hemodynamics

In man, peripheral vasodilation produced by immediate-release DynaCirc® (isradipine) is reflected by decreased systemic vascular resistance and increased cardiac output. Hemodynamic studies conducted in patients with normal left ventricular function produced, following intravenous isradipine administration, increases in cardiac index, stroke volume index,coronary sinus blood flow,heart rate and peak positive left ventricular dP/dt.Systemic,coronary, and pulmonary vascular resistance was decreased. These studies were conducted with doses of isradipine which produced clinically significant decreases in blood pressure. The clinical consequences of these hemodynamic effects,if any,have not been evaluated.

Effects on heart rate are variable,dependent upon rate of administration and presence of underlying cardiac condition. While increases in both peak positive dP/dt and LV ejection fraction are seen when intravenous isradipine is given,it is impossible to conclude that these represent a positive inotropic effect due to simultaneous changes in preload and afterload. In patients with coronary artery disease undergoing atrial pacing during cardiac catheterization, intravenous isradipine diminished abnormalities of systolic performance.In patients with moderate left ventricular dysfunction,oral and intravenous isradipine in doses which reduce blood pressure by 12%-30%, resulted in improvement in cardiac index without increase in heart rate,and with no change or reduction in pulmonary capillary wedge pressure.Combina-tion of isradipine and propranolol did not significantly affect left ventricular dP/dt max. The clinical consequences of these effects have not been evaluated.

Electrophysiologic Effects

In general, no detrimental effects on the cardiac conduction system were seen with the use of immediate-release DynaCirc® (isradipine). Electrophysiologic studies were conducted on patients with normal sinus and atrioventricular node function. Intravenous isradipine in doses which reduce systolic blood pressure did not affect PR, QRS, AH* or HV* intervals.

No changes were seen in Wenckebach cycle length,atrial,and ventricular refractory periods.Slight prolongation of QTc interval of 3% was seen in one study.Effects on sinus node recovery time (CSNRT) were mild or not seen.

In patients with sick sinus syndrome, at doses which significantly reduced blood pressure, intravenous isradipine resulted in no depressant effect on sinus and atrioventricular node function.

*AH = conduction time from low right atrium to His bundle deflection, or AV nodal conduction time; HV = conduction time through His bundle and the bundle branch-Purkinje system.

Pharmacokinetics and Metabolism

With the immediate-release formulation DynaCirc® (isradipine) Capsules, 90%-95% of the orally administered dose is absorbed. Because of the biotransformation of isradipine during its first-pass through the portal circulation, the bioavailability of DynaCirc CR® (isradipine) ranges from 15%-24%.Isradipine is 95% bound to plasma proteins.

Peak concentrations of approximately 1 ng/mL/mg dosed occur about 1.5 hours after DynaCirc® (isradipine) Capsules administration. The elimination of isradipine is biphasic with an early half-life of 11/2-2 hours, and a terminal half-life of about 8 hours, resulting in trough concentrations of about 0.1 ng/mL/mg dosed of immediate-release DynaCirc® (isradipine) Capsules.

In single dose studies of DynaCirc CR® (isradipine) Controlled Release Tablets,after a 2-3 hour lag time,concentrations of isradipine plateau between 7 and 18 hours post-dosing (reaching aCmax of 3-4 ng/mL with an AUC of 62-73 ng•h/mL for a 10 mg dose) and then a concentration > 50% of the peak exists for 17-20 hours.

There is no evidence of dose dumping either in the presence or absence of food.Food has been shown to decrease the extent of bioavailability of DynaCirc CR® (isradipine) by up to 25%.

The pharmacokinetics of DynaCirc CR® (isradipine) Controlled Release Tablets are linear over the dose range of 5-20 mg,in that the plasma drug concentrations are proportional to the dose administered.

Isradipine is completely metabolized prior to excretion,and no unchanged drug is detected in the urine.The major routes of isradipine metabolism are ring oxidation of the dihydropyridine moiety to give the corresponding pyridine,and ester cleavage,with or without concomitant oxidation of the dihydropyridine moiety,giving the corresponding carboxylic acids. The cytochrome P-450 IIIA4 system is implicated in the formation of these metabolites, which are hemodynamically inactive. Approximately 60%-65% of an administered dose is excreted in the urine and 25%-30% in the feces. With immediate-release DynaCirc® (isradipine), mild renal impairment (creatinine clearance 30-80 mL/min) increases the AUC of isradipine by 45%. Progressive deterioration reverses this trend, and patients with severe renal failure (creatinine clearance < 10 mL/min) who have been on hemodialysis show a 20%-50% lower AUC than healthy volunteers. In elderly patients administered DynaCirc® (isradipine) Capsules, Cmax and AUC are increased by 13% and 40%,respectively; in patients with hepatic impairment,Cmax and AUC are increased by 32% and 52%,respectively (see DOSAGE AND ADMINISTRATION).

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

PATIENT INFORMATION

DynaCirc CR® (isradipine) Controlled Release Tablets should be swallowed whole.Do not chew,divide or crush tablets. Do not be concerned if you occasionally notice in your stool something resembling a tablet.In DynaCirc CR® (isradipine), the medication is contained within a nonabsorbable shell that has been specially designed to slowly release the drug for your body to absorb. When this process is completed, the empty tablet shell is eliminated in the stool.

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

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PATIENT INFORMATION

DynaCirc CR® (isradipine) Controlled Release Tablets should be swallowed whole.Do not chew,divide or crush tablets. Do not be concerned if you occasionally notice in your stool something resembling a tablet.In DynaCirc CR® (isradipine), the medication is contained within a nonabsorbable shell that has been specially designed to slowly release the drug for your body to absorb. When this process is completed, the empty tablet shell is eliminated in the stool.

Last reviewed on RxList: 12/30/2008
This monograph has been modified to include the generic and brand name in many instances.

Disclaimer

Dynacirc CR Consumer

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

ISRADIPINE CONTROLLED-RELEASE TABLET - ORAL

(is-RAD-i-peen)

COMMON BRAND NAME(S): Dynacirc CR

USES: Isradipine is used with or without other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Isradipine is called a calcium channel blocker. It works by relaxing blood vessels so blood can flow more easily.

HOW TO USE: Take this medication by mouth, usually once daily with or without food or as directed by your doctor. Do not crush or chew this medication. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

Avoid eating grapefruit or drinking grapefruit juice while being treated with this medication unless your doctor instructs you otherwise. Grapefruit can increase the amount of certain medications in your bloodstream. Consult your doctor or pharmacist for more details.

The dosage is based on your medical condition and response to treatment. Your doctor may gradually increase your dose. Follow your doctor's instructions carefully.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. It may take 2 to 4 weeks before you get the full benefit of this drug.

Tell your doctor if your condition does not improve or if it worsens (for example, your blood pressure readings remain high or increase).

Disclaimer

Dynacirc CR Consumer (continued)

SIDE EFFECTS: Dizziness, nausea, headache, tiredness, flushing and swelling of the ankles/feet may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

An empty tablet shell may appear in your stool. This is harmless since your body has already absorbed the medication.

To reduce dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: fainting, fast/irregular/pounding heartbeat.

Tell your doctor immediately if any of these rare but very serious side effects occurs: severe abdominal pain/constipation, vision changes.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Read the Dynacirc CR (isradipine) Side Effects Center for a complete guide to possible side effects »

PRECAUTIONS: Before taking isradipine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain structural heart problems (aortic stenosis).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, stomach/intestine problems (such as narrowing, blockage).

This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.

Before having surgery, tell your doctor or dentist that you are taking this medication.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.

Disclaimer

Dynacirc CR Consumer (continued)

DRUG INTERACTIONS: See also the How to Use section.

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

Other medications can affect the removal of isradipine from your body, which may affect how isradipine works. Examples include cimetidine, azole antifungals (such as itraconazole), macrolide antibiotics (such as erythromycin), rifamycins (such as rifabutin), St. John's wort, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.

Cimetidine is a nonprescription drug that is commonly used to treat extra stomach acid. Because cimetidine may interact with isradipine, ask your pharmacist about other products to treat stomach acid.

Check the labels on all your medicines (such as cough-and-cold products, diet aids, nonsteroidal anti-inflammatory drugs-NSAIDs for pain/fever reduction) because they may contain ingredients that could increase your blood pressure (such as pseudoephedrine, phenylephrine, ibuprofen, naproxen). Ask your pharmacist about using these products safely.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with others. Talk with your doctor about making changes to your lifestyle that may help this medication work better (such as stress reduction programs, exercise, and dietary changes).

Laboratory and/or medical tests (such as liver function tests, blood pressure, electrocardiograms) may be performed from time to time to monitor your progress or check for side effects. Consult your doctor for more details.

There are different types of this medication available. They may not have the same effects. Do not change types without consulting your doctor or pharmacist.

Have your blood pressure checked regularly while taking this medication. Discuss with your doctor how to monitor your own blood pressure.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature below 86 degrees F (30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA) or 1-800-668-1507 (Canada).

Information last revised July 2010. Copyright(c) 2010 First Databank, Inc.

Dynacirc CR Patient Information Including Side Effects

Brand Names: Dynacirc, Dynacirc CR

Generic Name: isradipine (Pronunciation: is RAD i peen)

What is isradipine (Dynacirc CR)?

Isradipine is in a group of drugs called calcium channel blockers. It works by relaxing the muscles of your heart and blood vessels.

Isradipine is used to treat high blood pressure (hypertension). It is sometimes given with other blood pressure medications.

Isradipine may also be used for purposes other than those listed in this medication guide.

Dynacirc 2.5 mg

white, imprinted with S 2.5, DynaCirc

Isradipine 2.5 mg-ABR

beige, imprinted with ABRIKA 108

Isradipine 2.5 mg-COB

pink, imprinted with LOGO, IS 2.5

Isradipine 5 mg-ABR

yellow, imprinted with ABRIKA 109

Isradipine 5 mg-COB

yellow, imprinted with LOGO, IS 5

What are the possible side effects of isradipine (Dynacirc CR)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • feeling like you might pass out;
  • feeling short of breath, even with mild exertion;
  • swelling in your hands and feet;
  • fast or pounding heartbeats; or
  • chest pain.

Less serious side effects may include:

  • dizziness;
  • warmth, redness, or tingly feeling under your skin;
  • headache;
  • weakness, tired feeling;
  • nausea, vomiting, diarrhea, upset stomach; or
  • skin rash or itching.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Read the Dynacirc CR (isradipine) Side Effects Center for a complete guide to possible side effects »

What is the most important information I should know about isradipine (Dynacirc CR)?

You should not take this medication if you are allergic to isradipine.

Before taking isradipine, tell your doctor if you have kidney or liver disease, congestive heart failure, or a narrowing or blockage in your digestive tract.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking the pill may cause too much of the drug to be released at one time.

Isradipine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Some tablet forms of isradipine are made with a shell that is not absorbed or melted in the body. Therefore, you may see what looks like part of a tablet in your stool. This is a normal side effect of isradipine and will not make the medication less effective.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms, so you may not know when your blood pressure is high. You may need to use blood pressure medication for the rest of your life.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any scheduled appointments.

Side Effects Centers

Dynacirc CR Patient Information including How Should I Take

What should I discuss with my healthcare provider before taking isradipine (Dynacirc CR)?

You should not take this medication if you are allergic to isradipine.

Before taking isradipine, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease;
  • liver disease;
  • congestive heart failure; or
  • a narrowing or blockage in your digestive tract.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take isradipine.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Isradipine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take isradipine (Dynacirc CR)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Do not crush, chew, or break an extended-release tablet. Swallow the pill whole. Breaking the pill may cause too much of the drug to be released at one time.

Some tablet forms of isradipine are made with a shell that is not absorbed or melted in the body. Therefore, you may see what looks like part of a tablet in your stool. This is a normal side effect of isradipine and will not make the medication less effective.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms, so you may not know when your blood pressure is high. You may need to use blood pressure medication for the rest of your life.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Do not miss any scheduled appointments.

Store isradipine at room temperature away from moisture, heat, and light.

Side Effects Centers

Dynacirc CR Patient Information including If I Miss a Dose

What happens if I miss a dose (Dynacirc CR)?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose (Dynacirc CR)?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include fast heart rate, sluggish feeling, or feeling like you might pass out.

What should I avoid while taking isradipine (Dynacirc CR)?

Isradipine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

What other drugs will affect isradipine (Dynacirc CR)?

Before taking isradipine, tell your doctor if you are using any of the following drugs:

  • cimetidine (Tagamet, Tagamet HB);
  • fentanyl (Duragesic, Ionsys, Actiq); or
  • rifampin (Rifadin, Rimactane, Rifater).

This list is not complete and there may be other drugs that can interact with isradipine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about isradipine.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.11. Revision date: 12/15/2010.

Your use of the content provided in this service indicates that you have read,understood and agree to the End-User License Agreement,which can be accessed by clicking on this link.

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