Nifedipine

Indications
 Oral
Hypertension
Adult: Long-acting preparation: 10-40 mg bid, or 20-90 mg once daily.
Child: 1 mth-12 yr: 200-300 mcg/kg tid (max: 3 mg/kg daily or 90 mg daily); 12-18 yr: 5-20 mg tid (max: 90 mg daily). Dose frequency may vary based on the preparation used. For hypertensive crisis: 1 mth-18 yr: 250-500 mcg/kg as a single dose.
Elderly: Dose reduction may be necessary.
Hepatic impairment: Reduce dose by 50%-60% in patients with cirrhosis.
Oral
Angina pectoris
Adult: Long-acting preparation: 10-40 mg bid or 30-90 mg once daily. Liquid-filled capsules: 5-20 mg tid.
Child: Angina in Kawasaki disease or progeria: 1 mth-18 yr: 200-300 mcg/kg tid (max: 3 mg/kg/day or 90 mg/day). Dose frequency may vary based on the preparation used.
Elderly: Dose reduction may be necessary.
Hepatic impairment: Reduce dose by 50%-60% in patients with cirrhosis.
Oral
Raynaud's syndrome
Adult: Liquid-filled capsules: 5-20 mg tid.
Child: 2-18 yr: 2.5-10 mg 2-4 times daily; intiate with low doses at night. Increase slowly to prevent postural hypotension. Dose frequency may vary based on the preparation used.
Elderly: Dose reduction may be necessary.
Hepatic impairment: Reduce dose by 50%-60% in patients with cirrhosis

Special Populations: Reduce dose in elderly and hepatic impairment.
Contraindications
 Acute MI, cardiogenic shock, acute unstable angina, treatment of anginal attack in chronic stable angina.
Warnings / Precautions
 Hypotension, poor cardiac reserve, heart failure (deterioration has been noted), severe aortic stenosis, hepatic impairment, DM, porphyric patients, pregnancy. Avoid abrupt withdrawal (associated with exacerbation of angina). Discontinue if with ischaemic pain following administration.
Adverse Reactions
 Peripheral oedema, hypotension, palpitations, tachycardia, flushing, dizziness, headache, nausea, increased micturition frequency, lethargy, eye pain, mental depression, visual disturbances, gingival hyperplasia, myalgia, tremor, impotence, fever, paradoxical increase in ischaemic chest pain during initiation of treatment, rashes, abnormalities in liver function (including cholestasis), GI obstruction in some tablets covered in indigestable membrane.
Overdose Reactions
 Hypotension and bradycardia; hyperglycaemia, metabolic acidosis, coma. Management is mainly supportive and symptomatic.
Drug Interactions
 Potentiates antihypertensives. Increases the effects of neuromuscular-blocking agents and CYP1A2 substrates (e.g. theophylline, aminophylline). Enhances toxic effects of magnesium. Enhanced antihypertensive effects with alpha 1-blockers, aldesleukin, and antipsychotics. Reduced effects with calcium. With concurrent use with quinidine, serum concentration is increased while reduced in quinidine. Decreased levels/effects with CYP3A4 inducers (e.g. carbamazepine, nafcillin, phenobarbital, phenytoin, and rifampicin). Increased levels/effects with CYP3A4 inhibitors (e.g. azole antifungals, cimetidine, erythromycin, and HIV-protease inhibitors).
See Below for More nifedipine Drug Interactions
Lab Interactions
 Falsely elevated spectrophotometric values of urinary vanillylmandelic acid.
Food Interactions
 Serum levels may be decreased with food, St John's wort. Increased levels/effects with grapefruit juice, ethanol, garlic. Avoid ephedra, yohimbe, ginseng (may worsen hypertension).
Mechanism of Actions
 Nifedipine blocks the slow calcium channels thus preventing the flow of calcium ions into the cell. It produces peripheral and coronary vasodilatation, reduces afterload, peripheral resistance and BP, increases coronary blood flow and causes reflex tachycardia. It has little or no effect on cardiac conduction and rarely has negative inotropic activity.
Absorption: Rapidly and completely absorbed from the GI tract (oral); peak plasma concentrations after 30 min (as liquid-filled capsules).
Distribution: Enters breast milk. Protein-binding: 92-98%.
Metabolism: Extensive hepatic first-pass metabolism.
Excretion: Via urine (70-80% as inactive metabolites); 2 hr(elimination half-life).
Administration
 Immediate-release: May be taken with or without food. (Avoid grapefruit juice.)
Retard, GITS & OROS: May be taken with or without food. (Avoid grapefruit juice. Swallow whole, do not chew/crush.)
ATC Classification
 C08CA05 - nifedipine ; Belongs to the class of dihydropyridine derivative selective calcium-channel blockers with mainly vascular effects. Used in the treatment of cardiovascular diseases.
Available As
  • Nifedipine 10 mg
  • Nifedipine 20 mg
  • Nifedipine 30 mg
  • Nifedipine 5 mg

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