Nifedipine

Aka: Nifedipine, Procardia, Adalat, Afeditab

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II. Indications

  1. Hypertension
    1. Not recommended as first-line Hypertension Management or for monotherapy
  2. Preterm Labor

III. Contraindications

  1. Congestive Heart Failure
  2. Aortic Stenosis
  3. Avoid in Diabetes Mellitus (may increase Proteinuria)
  4. Concomitant use of Magnesium Sulfate
    1. Theoretically deactivates Calcium Gluconate antidote

IV. Precautions

  1. General
    1. Take on an empty Stomach
  2. Extended Release Tablets
    1. Write for generic Nifedipine ER to allow pharmacist to substitute between multiple similar ER preparations
    2. (2016) Presc Lett 23(7): 39-40
  3. Immediate release tablets
    1. Do not use for Hypertension, Hypertensive Emergency or STEMI (risk of worsening coronary ischemia)
    2. Do not chew, swallow or take sublingually

V. Mechanism

  1. See Dihydropyridine Calcium Channel Blocker
  2. Prototypes for Dihydropyridine Calcium Channel Blockers: Amlodipine, Nimodipine
  3. Potent peripheral vasodilation
  4. Minimal SA Node or AV Node depression
  5. No Coronary Artery dilation

VI. Dosing: Hypertension (Adults)

  1. Nifedipine Extended Release or ER (Procardia XL)
    1. Start Nifedipine ER 30 to 60 mg orally daily
    2. Maximum 120 mg/day
  2. Nifedipine Immediate Release (rare use)
    1. Do not use for Hypertension, Hypertensive Emergency or STEMI (risk of worsening coronary ischemia)
    2. Start 10 mg orally three times daily
    3. Target: 10 to 20 mg orally three times daily
    4. Maximum 120 mg/day

VII. Dosing: Preterm Labor (Adults, Not FDA approved)

  1. See Tocolytic
  2. Load: Nifedipine 10 mg sublingual every 20 minutes for 3 doses as needed (up to a cummulative 40 mg in first hour)
  3. Maintenance: Nifedipine Immediate Release 10 to 20 mg orally every 4 to 8 hours
    1. Alternative: Nifedipine ER 60 to 160 mg once daily
  4. Monitoring: When used in Preterm Labor
    1. Blood Pressure
    2. Edema
    3. Serial Fetal Ultrasounds

VIII. Dosing: Ureterolithiasis (Adults)

  1. See Medical Expulsive Therapy
  2. Nifedipine ER 30 mg orally daily until stone passage (up to 30 days)

IX. Dosing: Hypertension (Children, Not FDA approved)

  1. Start 0.25 to 0.5 mg/kg/dose every 4 to 6 hours as needed
  2. Maximum: 3 mg/kg/day or 10 mg/dose

X. Adverse Effects

  1. See Calcium Channel Blockers
  2. Angina
    1. Avoid short acting agents for Hypertension or STEMI (increased coronary risk)
  3. Gastrointestinal obstruction (extended release tablet)
  4. Reflex Tachycardia
  5. Transient Hypotension
  6. Peripheral Edema
  7. Pulmonary Edema
  8. Dizziness
  9. Nausea

XI. Safety

  1. Pregnancy Category C
    1. Risk of Intrauterine Growth Retardation
  2. Avoid in Lactation

XII. Metabolism

  1. Rapid and near complete absorption of sublingual (SL) route
  2. Highly Protein bound (98%)
  3. CYP3A4 metabolism to inactive metabolites
  4. Immediate Release Half Life: 3 hours
  5. Reduce dosing in hepatic dysfunction

XIII. Drug Interactions

  1. Agents that lower Nifedipine levels
    1. Carbamazepine
    2. Phenobarbital
    3. Phenytoin
    4. Rifampin
    5. St John's Wort
  2. Agents that increase Nifedipine levels
    1. Clarithromycin
    2. Erythromycin
    3. Fluconazole
    4. Fluoxetine
    5. Protease Inhibitors
    6. Ketoconazole
    7. Itraconazole
    8. Grapefruit Juice
  3. Agents whose levels are increased by Nifedipine
    1. Tacrolimus
    2. Anticoagulants
  4. Perioperative Beta Blocker and Fentanyl
    1. Severe Hypotension risk
    2. Discontinue Nifedipine 36 hours before surgery

XIV. Resources

  1. Nifedipine ER (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d1a78ff2-7672-3e69-00ef-63d203c80484

XV. References

  1. (2022) Presc Lett, Resource #381108, Comparison of Calcium Channel Blockers
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Cost: Medications

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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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