From the Guidelines
Nifedipine is effective in helping with angina, particularly for stable angina, vasospastic (Prinzmetal's) angina, and as part of combination therapy for difficult-to-control angina. Nifedipine is a calcium channel blocker that works by relaxing and widening blood vessels, which improves blood flow to the heart muscle and reduces its workload 1. It comes in immediate-release forms (5-20 mg three times daily) and extended-release formulations (30-90 mg once daily), with the extended-release versions generally preferred for angina management due to more consistent blood levels and fewer side effects.
Key Points to Consider
- When starting nifedipine, patients may experience headaches, dizziness, flushing, or ankle swelling as common side effects 1.
- The medication works by blocking calcium entry into heart and blood vessel muscle cells, preventing muscle contraction and thereby decreasing blood pressure and cardiac oxygen demand.
- Nifedipine should be used with caution, especially in patients with significantly impaired left ventricular function or atrioventricular conduction, and should not be used without concomitant beta-blocker therapy in certain cases 1.
- Patients should take nifedipine regularly as prescribed, even when symptom-free, and should not stop it suddenly without medical guidance.
Important Considerations for Treatment
- Nifedipine can be used to control ongoing or recurring ischemia-related symptoms in patients who already are receiving adequate doses of nitrates and beta blockers, in patients who are unable to tolerate adequate doses of 1 or both of these agents, and in patients with variant angina 1.
- The choice of nifedipine or other calcium channel blockers should be based on individual patient characteristics and medical history, and should be made in consultation with a healthcare provider.
From the FDA Drug Label
Nifedipine extended-release tablets are indicated for the management of vasospastic angina confirmed by any of the following criteria: 1) classical pattern of angina at rest accompanied by ST segment elevation, 2) angina or coronary artery spasm provoked by ergonovine, or 3) angiographically demonstrated coronary artery spasm Nifedipine extended-release tablets are indicated for the management of chronic stable angina (effort-associated angina) without evidence of vasospasm in patients who remain symptomatic despite adequate doses of beta blockers and/or organic nitrates or who cannot tolerate those agents In chronic stable angina (effort-associated angina), nifedipine has been effective in controlled trials of up to eight weeks duration in reducing angina frequency and increasing exercise tolerance
Nefedipine helps with angina. The drug is indicated for the management of:
- Vasospastic angina
- Chronic stable angina (effort-associated angina) Nifedipine has been shown to be effective in reducing angina frequency and increasing exercise tolerance in patients with chronic stable angina 2.
From the Research
Nifedipine and Angina
- Nifedipine, a calcium-channel blocker, has been shown to be effective in the treatment of angina pectoris 3, 4, 5.
- The American Heart Association/American College of Cardiology guidelines recommend calcium channel blockers, such as nifedipine, as an alternative to β-blockers for the prevention of angina pectoris 6.
- Studies have demonstrated that nifedipine can be safely administered to a broad spectrum of angina patients, including those with a concomitant diagnosis of congestive heart failure and those receiving concurrent therapy with beta-blocking agents 3.
Dose Titration and Efficacy
- The response to different doses of nifedipine can be highly variable, and careful titration of doses is necessary to achieve the maximum benefit in patients with exertional angina 4.
- A systematic review of articles over the past 50 years found that evidence of equivalence was demonstrated for the use of beta-blockers, calcium antagonists (including nifedipine), and channel inhibitors in the treatment of angina 7.
- A study comparing the efficacy of once-daily treatment with nifedipine CR and twice-daily treatment with benidipine found that nifedipine CR was more effective in preventing symptomatic attacks in patients with coronary spastic angina pectoris 5.
Comparison with Other Anti-Anginal Drugs
- There is a paucity of data comparing the efficacy of anti-anginal agents, and the available evidence shows that no anti-anginal drug is superior to another 7.
- Guidelines for the treatment of angina draw conclusions not from evidence but from clinical beliefs, highlighting the need for further research in this area 7.