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Nifedipine

Class
Antihypertensives
Subclass
Dihydropyridine calcium channel blockers
Substance name
NIFEdipine
Common formulations
Capsule
See also
Nifedipine ER (Procardia XL®, Adalat CC®)
Dosage and administration
Adults patients
Symptomatic relief
AchalasiaOff-label
10-30 mg SL PRN 30-45 minutes before meal
Treatment
Stable angina
Start at: 10 mg PO TID
Maintenance: 10-30 mg PO q6-8h
Maximum: 120 mg per day
Titrate over 7-14 days.
Vasospastic angina
Start at: 10 mg PO TID
Maintenance: 10-30 mg PO q6-8h
Maximum: 120 mg per day
Titrate over 7-14 days.
Hypertension in pregnancyAcute, severeOff-label
Loading: 10-20 mg PO once, repeated in 20 minutes if needed
Maintenance: 10-20 mg PO q2-6h
Maximum: 180 mg per day
Pulmonary arterial hypertensionOff-label
Start at: 10 mg PO TID
Maintenance: 20-60 mg PO BID-TID
Raynaud's phenomenonOff-label
10-20 mg PO TID
Tenesmus in patients with cancerOff-label
10-20 mg PO BID
Other off-label uses
Treatment of anal fissure
Treatment of diffuse esophageal spasm
Adjunctive treatment for preterm labor
Indications for use
Labeled indications
Adults
Treatment of stable angina
Treatment of vasospastic angina
Off-label indications
Adults
Symptomatic relief of achalasia
Treatment of Raynaud's phenomenon
Treatment of anal fissure
Treatment of diffuse esophageal spasm
Treatment of hypertension in pregnancy (acute, severe)
Treatment of pulmonary arterial hypertension
Treatment of tenesmus in patients with cancer
Adjunctive treatment for preterm labor
Safety risks
Contraindications
Hypersensitivity to nifedipine or its components
Cardiogenic shock
Concomitant use of high-dose fentanyl
Discontinue nifedipine 36 hours before surgery.
Concomitant use of potent CYP3A inducers
Do not use nifedipine with potent CYP3A inducers, such as rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, and St. John's Wort.
Warnings and precautions
HF
Use caution in patients with severe aortic stenosis receiving β-blockers.
Increased serum nifedipine levels
Use caution in patients taking CYP3A inhibitors. Consider reducing nifedipine dose when co-administering with CYP3A inhibitors, such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir. Eliminate grapefruit juice from diet while taking nifedipine.
Peripheral edema, severe hypotension, angina pectoris, myocardial infarction
Maintain a high level of suspicion, as nifedipine has been associated with an increased risk for these adverse events.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
Use acceptable. No dose adjustment required. Monitor renal function. Monitor for hypotension and peripheral edema.
Renal replacement therapy
Continuous renal replacement
Reduce starting dose. Monitor renal function. Monitor for hypotension and peripheral edema.
Intermittent hemodialysis
Reduce starting dose. Monitor renal function. Monitor for hypotension and peripheral edema.
Peritoneal dialysis
Reduce starting dose. Monitor renal function. Monitor for hypotension and peripheral edema.
Hepatic impairment
Any severity
Use with caution. Monitor for toxicity.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
Use only if benefits outweigh potential risks. Evidence of fetal harm in humans. Cases of perinatal asphyxia, Cesarean delivery, prematurity, and intrauterine growth retardation have been reported.
Obtain careful monitoring of BP in pregnant patients receiving nifedipine in combination with IV magnesium sulfate due to the risk of significant hypotension that could harm the mother and fetus.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
Gingival swelling, peripheral edema, asthenia, dizziness, headache, heartburn, nausea, skin flushing
Common 1-10%
Heart failure, hypotension, myocardial infarction, pulmonary edema, constipation, cough, wheezing, itching, urticaria, sweating, abdominal cramps, diarrhea, flatulence, chills, incoordination, sleeping disorder, blurred vision, nasal congestion, dyspnea, fever, mood changes, nervousness, muscle cramps, tremor, palpitations
Uncommon < 1%
Exfoliative dermatitis, gout, gastroesophageal reflux disease, polyuria, ventricular arrhythmia, facial edema, erythromelalgia, syncope, tachycardia, hair loss, ↓ libido, gynecomastia, weight gain, dysgeusia, gastrointestinal bleeding, melena, vomiting, dysuria, hematuria, nocturia, breast pain, anemia, ↓ WBC count, purpura, ↓ platelet count, angioedema, anxiety, ataxia, depression, malaise, hypertonia, hypoesthesia, paranoid ideation, nightmares, back pain, myalgia, visual disturbances, nosebleed, tinnitus
Unknown frequency
Acute cholecystitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, bezoar, acute generalized exanthematous pustulosis, lip cancer, ↑ serum LDH, ↑ serum transaminases, ↑ serum ALP, ↑ serum CK, erythema multiforme, gastrointestinal ulceration, bowel obstruction, photosensitivity of skin
Interactions
Drug(s)
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