II. Indications
-
Hypertension
- Not recommended as first-line Hypertension Management or for monotherapy
- Preterm Labor
III. Contraindications
- Congestive Heart Failure
- Aortic Stenosis
- Avoid in Diabetes Mellitus (may increase Proteinuria)
- Concomitant use of Magnesium Sulfate
- Theoretically deactivates Calcium Gluconate antidote
IV. Precautions
-
General
- Take on an empty Stomach
- Extended Release Tablets
- Write for generic Nifedipine ER to allow pharmacist to substitute between multiple similar ER preparations
- (2016) Presc Lett 23(7): 39-40
- Immediate release tablets
- Do not use for Hypertension, Hypertensive Emergency or STEMI (risk of worsening coronary ischemia)
- Do not chew, swallow or take sublingually
V. Mechanism
- See Dihydropyridine Calcium Channel Blocker
- Prototypes for Dihydropyridine Calcium Channel Blockers: Amlodipine, Nimodipine
- Potent peripheral vasodilation
- Minimal SA Node or AV Node depression
- No Coronary Artery dilation
VI. Dosing: Hypertension (Adults)
- Nifedipine Extended Release or ER (Procardia XL)
- Start Nifedipine ER 30 to 60 mg orally daily
- Maximum 120 mg/day
- Nifedipine Immediate Release (rare use)
- Do not use for Hypertension, Hypertensive Emergency or STEMI (risk of worsening coronary ischemia)
- Start 10 mg orally three times daily
- Target: 10 to 20 mg orally three times daily
- Maximum 120 mg/day
VII. Dosing: Preterm Labor (Adults, Not FDA approved)
- See Tocolytic
- Load: Nifedipine 10 mg sublingual every 20 minutes for 3 doses as needed (up to a cummulative 40 mg in first hour)
- Maintenance: Nifedipine Immediate Release 10 to 20 mg orally every 4 to 8 hours
- Alternative: Nifedipine ER 60 to 160 mg once daily
- Monitoring: When used in Preterm Labor
VIII. Dosing: Ureterolithiasis (Adults)
- See Medical Expulsive Therapy
- Nifedipine ER 30 mg orally daily until stone passage (up to 30 days)
IX. Dosing: Hypertension (Children, Not FDA approved)
- Start 0.25 to 0.5 mg/kg/dose every 4 to 6 hours as needed
- Maximum: 3 mg/kg/day or 10 mg/dose
X. Adverse Effects
- See Calcium Channel Blockers
-
Angina
- Avoid short acting agents for Hypertension or STEMI (increased coronary risk)
- Gastrointestinal obstruction (extended release tablet)
- Reflex Tachycardia
- Transient Hypotension
- Peripheral Edema
- Pulmonary Edema
- Dizziness
- Nausea
XI. Safety
- Pregnancy Category C
- Risk of Intrauterine Growth Retardation
- Avoid in Lactation
XII. Metabolism
XIII. Drug Interactions
- Agents that lower Nifedipine levels
- Agents that increase Nifedipine levels
- Agents whose levels are increased by Nifedipine
-
Perioperative Beta Blocker and Fentanyl
- Severe Hypotension risk
- Discontinue Nifedipine 36 hours before surgery
XIV. Resources
- Nifedipine ER (DailyMed)
XV. References
- (2022) Presc Lett, Resource #381108, Comparison of Calcium Channel Blockers
- (2020) Med Lett Drugs Ther 62(1598): 73-80
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| nifedipine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| NIFEDIPINE 10 MG CAPSULE | Generic | $0.32 each |
| NIFEDIPINE 20 MG CAPSULE | Generic | $0.97 each |
| NIFEDIPINE ER 30 MG TABLET | Generic | $0.13 each |
| NIFEDIPINE ER 60 MG TABLET | Generic | $0.15 each |
| NIFEDIPINE ER 90 MG TABLET | Generic | $0.28 each |
Ontology: Nifedipine (C0028066)
| Definition (CHV) | a drug used for hypertension |
| Definition (NCI) | A dihydropyridine calcium channel blocking agent. Nifedipine inhibits the transmembrane influx of extracellular calcium ions into myocardial and vascular smooth muscle cells, causing dilatation of the main coronary and systemic arteries and decreasing myocardial contractility. This agent also inhibits the drug efflux pump P-glycoprotein which is overexpressed in some multi-drug resistant tumors and may improve the efficacy of some antineoplastic agents. (NCI04) |
| Definition (MSH) | A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. |
| Definition (CSP) | calcium channel blocker used as a coronary vasodilator in the treatment of coronary insufficiency and angina. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009543 |
| SnomedCT | 319352009, 387490003, 85272000 |
| LNC | LP17866-2, MTHU024723 |
| English | Nifedipine, 3,5-Pyridinedicarboxylic acid, 1,4-dihydro-2,6-dimethyl-4-(2-nitrophenyl)-, dimethyl ester, nifedipine, nifedipine (medication), Nifedipine [2], NIFEDIPINE, Nifedipine [Chemical/Ingredient], NIFEdipine, Nifedipine [2] (product), Nifedipine (product), Nifedipine (substance), Nifedipine [2] (substance) |
| Swedish | Nifedipin |
| Czech | nifedipin |
| Finnish | Nifedipiini |
| Russian | NIFEDIPIN, ADALAT, FENIGIDIN, KORINFAR, АДАЛАТ, КОРИНФАР, НИФЕДИПИН, ФЕНИГИДИН |
| Japanese | ニフェジピン |
| Croatian | NIFEDIPIN |
| Spanish | nifedipino (producto), nifedipino (sustancia), nifedipina (producto), nifedipina, nifedipino, nifedipina (2), nifedipina (2) (producto), nifedipina (sustancia), Nifedipino |
| Polish | Nifedypina |
| French | Nifédipine |
| German | Nifedipin |
| Italian | Nifedipina |
| Portuguese | Nifedipino |
Ontology: Procardia (C0700861)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009543 |
| English | Nifedipine Pfizer Brand, Pfizer Brand of Nifedipine, procardia, Procardia |
