From the Guidelines
Nifedipine oral suspension can be given daily, with a usual dose of 30 to 90 mg daily orally for immediate release and 30 to 180 mg orally for slow release, as indicated in the management of hypertension and angina. The dosage and administration of nifedipine, a calcium channel blocker, are crucial for managing hypertension and angina. According to the guidelines 1, nifedipine is typically prescribed in immediate-release and extended-release formulations. For hypertension, the recommended starting dose of extended-release nifedipine is 30-60 mg once daily, which can be titrated up to a maximum of 90-120 mg daily based on blood pressure response. For angina, extended-release nifedipine is usually started at 30 mg once daily and can be increased to 60-90 mg daily if needed.
- Key considerations for nifedipine administration include:
- The immediate-release formulation is rarely used for chronic management due to the risk of reflex tachycardia and sudden blood pressure drops.
- Extended-release tablets should be swallowed whole, not crushed or chewed, and taken consistently with or without food.
- Elderly patients and those with hepatic impairment typically require lower initial doses.
- Nifedipine works by blocking calcium channels in vascular smooth muscle and cardiac tissue, causing vasodilation and reduced cardiac workload, which lowers blood pressure and improves oxygen supply to the heart muscle in angina.
- Side effects may include peripheral edema, headache, dizziness, and flushing, as noted in the guidelines 1.
- Blood pressure should be monitored regularly during dose adjustments, and the patient's response to the medication should be closely observed to minimize potential adverse effects.
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 usual maintenance dose is 30 mg to 60 mg once daily.
La nifedipina oral puede ser administrada diariamente, con una dosis de mantenimiento usual de 30 mg a 60 mg una vez al día 2.
From the Research
Dosage and Administration of Nifedipine
- Nifedipine is a calcium channel blocker used to manage hypertension and angina pectoris 3, 4.
- The formulation of nifedipine has undergone modifications to improve its pharmacokinetic profile and administration regimen from 3 times daily to once daily 3.
- Nifedipine Gastrointestinal Therapeutic System (GITS) is the most widely studied once daily formulation, with extensive clinical pharmacology and clinical trial data supporting its use 3, 4.
Once Daily Formulations
- Other once daily modified release nifedipine formulations are available, but limited published data is available on these formulations 3.
- Pharmacokinetic studies have failed to show that any of these formulations are consistently bioequivalent to nifedipine GITS 3.
- Clinical studies have shown significant differences in favor of nifedipine GITS in terms of blood pressure control and activation of the sympathetic nervous system 3.
Administration Regimen
- Nifedipine can be administered orally, with a gradual increase in plasma concentration over a 24-hour period preferred to avoid baroreflex sympathetic activation 4.
- The dosage and administration regimen of nifedipine may vary depending on the specific formulation and the patient's condition 3, 4.
- Sublingual nifedipine has been used to treat hypertensive urgencies and emergencies, with a single dose of 10-20 mg administered sublingually 5.
Safety and Efficacy
- Nifedipine has been shown to be effective and safe in the treatment of angina pectoris, with a favorable safety profile 6.
- The haemodynamic effects of nifedipine, including increases in cardiac output and coronary blood flow, have been well characterized 7.
- Nifedipine can be safely administered to a broad spectrum of patients, including those with concomitant diagnoses of congestive heart failure and those receiving concurrent therapy with beta-blocking agents 6.