[No. 7] Inquiry Problem <Nephrology: Chronic Renal Failure Edition>

Question 7

Nephrology, 68-year-old male, height 164 cm, weight 80 kg
Lab values: WBC: 4000, GOT: 16, GPT: 12, sCre: 2.87, CRP: 0.12

History of present illness
Renal function has been poor from the start, and he visited as usual. Recently, his blood pressure has been high, around 160/90. He also requested a sleeping pill due to persistent insomnia.
Past medical history: Gout

Prescription
Rp1. Nifedipine CR 20mg, 1 tablet, twice daily, after breakfast and dinner, 7-day supply
Rp2. Allopurinol tablets 100mg, 0.5 tablets, once daily, after breakfast, 7-day supply
Rp3. Etizolam tablets 0.5mg, 1 tablet, once daily, at bedtime, 7-day supply

Now, what would you do for an inquiry regarding this?

The hint is, take a good look at the medicine!

Prescription
Rp1. Nifedipine CR 20mg, 1 tablet, twice daily, after breakfast and dinner 7-day supply
Rp2. Allopurinol tablets 100mg, 0.5 tablets, once daily, after breakfast, 7-day supply
Rp3. Etizolam tablets 0.5mg, 1 tablet, once daily, at bedtime, 7-day supply

The answer is here.
This is a famous story among pharmacists and was also featured in Unsung Cinderella. Nifedipine is originally a short-acting Ca antagonist. It is made to be long-acting through formulation techniques. If you take one tablet twice a day, you would have to split it in half, right? If you do that, the long-acting effect of Nifedipine CR will be lost, and there is a possibility that blood pressure will drop transiently.

Therefore, check with the prescribing physician to see if they should use Nifedipine CR 10mg, or if 20mg twice a day was indeed the intended dose.

See you next time! Please be sure to watch tomorrow as well.
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