Ctrl

K

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
Achalasia • Off-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 pregnancy • Acute, severe • Off-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 hypertension • Off-label
•
Start at: 10 mg PO TID
•
Maintenance: 20-60 mg PO BID-TID
Raynaud's phenomenon • Off-label
•
10-20 mg PO TID
Tenesmus in patients with cancer • Off-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)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource