What is the recommended dosing for Nifedipine (Calcium Channel Blocker) for hypertension management?

From the Guidelines

For hypertension management, the recommended dosing for extended-release nifedipine is 30-90 mg once daily, as indicated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The dosing can be titrated based on blood pressure response. Extended-release formulations are preferred for hypertension management due to their ability to provide consistent blood pressure control and reduce the risk of reflex tachycardia. Some key points to consider when prescribing nifedipine include:

• Nifedipine works by blocking calcium channels in vascular smooth muscle cells, causing vasodilation and reducing peripheral resistance, thereby lowering blood pressure.
• Patients should take extended-release tablets whole without crushing or chewing them, as this would alter the controlled-release mechanism.
• Common side effects include peripheral edema, headache, flushing, and dizziness.
• Blood pressure monitoring is essential when initiating therapy or adjusting doses, and the medication should be taken consistently with respect to meals. It's also important to note that immediate-release nifedipine is generally not recommended for routine hypertension management due to rapid blood pressure fluctuations, but when used, the typical dose is 10-20 mg three times daily, as seen in other studies 1. However, the most recent and highest quality guideline 1 provides the recommended dosing for extended-release nifedipine, which should be prioritized in clinical practice.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be adjusted according to each patient's needs. It is recommended that nifedipine extended-release tablets, USP be administered orally once daily on an empty stomach. The nifedipine extended-release tablet, USP is an extended release dosage form and tablets should be swallowed whole, not bitten or divided In general, titration should proceed over a 7-14 day period starting with 30 mg once daily. Upward titration should be based on therapeutic efficacy and safety. The usual maintenance dose is 30 mg to 60 mg once daily. Titration to doses above 90 mg daily is not recommended

The recommended dosing for Nifedipine extended-release tablets for hypertension management is:

• Initial dose: 30 mg once daily
• Maintenance dose: 30 mg to 60 mg once daily
• Maximum dose: Do not exceed 90 mg daily 2

From the Research

Nifedipine ER Dosing for Hypertension Management

• The recommended dosing for Nifedipine (Calcium Channel Blocker) for hypertension management can be found in several studies 3, 4, 5, 6, 7.
• According to a study published in 2003, the initial treatment for hypertension with Nifedipine GITS consisted of 30 mg once daily, which could be increased to 60 mg once daily if the blood pressure was not below 140/90 mmHg or the reduction in diastolic blood pressure was lower than 10 mmHg after a treatment period of 6 weeks 3.
• Another study published in 1993 compared the efficacy and safety of enalapril versus extended-release nifedipine for the treatment of mild-to-moderate essential hypertension, and found that the initial dose of nifedipine-ER was 30 mg once daily, which could be titrated up to a maximum of 120 mg once daily 4.
• A review of calcium channel blockers published in 2011 noted that nifedipine is available in various formulations, including extended-release and immediate-release forms, and that the dosing frequency and amount may vary depending on the specific formulation and the patient's response to treatment 5.
• A study published in 2001 found that nifedipine once daily slowed down the progression of coronary calcification in hypertensive patients compared with diuretics, with a mean daily dose of 57 mg of nifedipine-ER 6.
• A systematic review and meta-analysis published in 2018 compared the effects of long- and intermediate-acting dihydropyridine calcium channel blockers in hypertension, and found that amlodipine therapy was associated with a lower risk of stroke, but a higher risk of heart failure, compared to major alternative antihypertensive therapy 7.

Key Considerations

• The dosing of Nifedipine ER for hypertension management should be individualized based on the patient's response to treatment and their specific medical needs.
• Patients should be monitored regularly for changes in blood pressure, and the dose of Nifedipine ER should be adjusted as needed to achieve optimal blood pressure control.
• Nifedipine ER can be used in combination with other antihypertensive medications to achieve better blood pressure control, but the dosing and potential interactions should be carefully considered.