Strong Cyp3a4 Inducers (e.g., Rifampicin, Carbamazepine, Phenytoin, Phenobarbital, St. John's Wort)Severe
Database
Significantly decreased plasma concentrations of benidipine, leading to reduced therapeutic efficacy and potential loss of blood pressure control.
Concomitant use should be avoided. If co-administration is unavoidable, a significant dose increase of benidipine may be required, along with close monitoring of blood pressure. Consider alternative antihypertensive agents or alternative CYP3A4 inducers.
Strong Cyp3a4 Inhibitors (e.g., Ketoconazole, Itraconazole, Clarithromycin, Ritonavir)Severe
Database
Significantly increased plasma concentrations of benidipine, leading to enhanced hypotensive effects, bradycardia, peripheral edema, and other dose-dependent adverse reactions.
Concomitant use should be avoided or undertaken with extreme caution. If co-administration is unavoidable, a significant dose reduction of benidipine is required, along with close monitoring of blood pressure and for adverse effects. Consider alternative antihypertensive agents.
Increased risk of hypotension, dizziness, and syncope.
Advise patients to limit or avoid alcohol consumption while on benidipine. Monitor for symptoms of hypotension.
Alpha Blockers (e.g., Prazosin, Tamsulosin)Moderate
Database
Increased risk of orthostatic hypotension, dizziness, and syncope.
Initiate with low doses of both drugs and titrate carefully. Advise patients to stand up slowly and report symptoms of orthostatic hypotension. Monitor blood pressure, especially standing blood pressure.
Grapefruit JuiceModerate
Database
Increased plasma concentrations of benidipine, leading to enhanced hypotensive effects and other adverse reactions.
Advise patients to avoid consuming grapefruit or grapefruit juice while on benidipine. If consumption is unavoidable, monitor blood pressure and for adverse effects closely.
Moderate Cyp3a4 Inducers (e.g., Efavirenz, Nevirapine)Moderate
Database
Decreased plasma concentrations of benidipine, potentially leading to reduced therapeutic efficacy and loss of blood pressure control. The effect is less pronounced than with strong inducers.
Monitor blood pressure closely. A benidipine dose increase may be necessary. Consider using alternative agents if blood pressure control is inadequate.
Moderate Cyp3a4 Inhibitors (e.g., Erythromycin, Diltiazem, Verapamil, Fluconazole)Moderate
Database
Increased plasma concentrations of benidipine, potentially leading to enhanced hypotensive effects, bradycardia, and other adverse reactions. The effect is less pronounced than with strong inhibitors.
Monitor blood pressure and for adverse effects closely. A benidipine dose reduction may be necessary. Consider using alternative agents if adverse effects are significant.
Other Antihypertensive Agents (e.g., Ace Inhibitors, Arbs, Diuretics, Beta Blockers)Moderate
Database
Enhanced hypotensive effect, potentially leading to symptomatic hypotension, dizziness, and syncope.
Monitor blood pressure closely, especially during initiation or dose titration of either drug. A dose adjustment of benidipine or the other antihypertensive agent may be required. Advise patients to report symptoms of hypotension.
Slightly increased plasma concentrations of benidipine, potentially leading to enhanced hypotensive effects.
Monitor blood pressure and for adverse effects. A benidipine dose adjustment is usually not required but may be considered if significant adverse effects occur.
Potentially increased plasma concentrations of digoxin, leading to an increased risk of digoxin toxicity (e.g., nausea, vomiting, arrhythmias).
Monitor digoxin levels and for signs of digoxin toxicity, especially when initiating or discontinuing benidipine. A digoxin dose adjustment may be necessary.
Non Steroidal Anti Inflammatory Drugs (nsaids)Mild
Database
Potentially reduced antihypertensive effect of benidipine, leading to less effective blood pressure control.
Monitor blood pressure. If blood pressure control is inadequate, consider alternative pain relief or a benidipine dose adjustment. This interaction is generally less significant than with other antihypertensives.