What is the recommended dosage of Nifedipine (Calcium Channel Blocker) ER for treating hypertension or angina?

From the Guidelines

The recommended dosage of Nifedipine ER for treating hypertension or angina is 30 to 180 mg orally, with a usual maintenance dose range of 30-60 mg once daily. This dosage is based on the properties of calcium channel blockers in clinical use, as outlined in the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1.

Key Considerations

• The medication should be taken at the same time each day, preferably in the morning, and swallowed whole without crushing or chewing to maintain the extended-release properties.
• Dose adjustments should be made gradually, usually at 7-14 day intervals, to allow assessment of blood pressure response.
• Elderly patients or those with hepatic impairment may require lower initial doses (e.g., 30 mg daily).
• Nifedipine ER works by blocking calcium channels in vascular smooth muscle and cardiac cells, causing vasodilation and reduced peripheral resistance, which lowers blood pressure and decreases cardiac workload.
• Common side effects include peripheral edema, headache, flushing, and dizziness.
• Patients should avoid grapefruit juice while taking nifedipine as it can significantly increase drug levels and side effects.

Evidence-Based Recommendations

The evidence from the guidelines suggests that calcium channel blockers, including 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. However, rapid-release, short-acting dihydropyridines (e.g., nifedipine) must be avoided in the absence of concomitant beta blockade because of increased adverse potential.

Important Safety Information

• Verapamil and diltiazem should be avoided in patients with pulmonary edema or evidence of severe LV dysfunction.
• Amlodipine and felodipine are reasonably well tolerated by patients with mild LV dysfunction, although their use in UA/NSTEMI has not been studied.
• The CCB evidence base in UA/NSTEMI is greatest for verapamil and diltiazem.

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 dosage of Nifedipine ER for treating hypertension or angina 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 Dosage

The recommended dosage of Nifedipine ER for treating hypertension or angina is as follows:

• The initial dose is typically 30-60 mg once daily, with a maximum dose of 120 mg once daily 3
• The dose may be titrated based on the patient's response to the medication, with some studies suggesting that a dose of 60 mg/day may be more effective than 30 mg/day in non-responders to the initial dose 3
• The time of administration may also affect the efficacy and safety of the medication, with bedtime administration potentially reducing the incidence of edema and other adverse events 3

Administration Time-Dependent Effects

The administration time of Nifedipine ER may have an impact on its efficacy and safety:

• Bedtime administration of Nifedipine GITS (30 mg/day) was found to have a slightly larger BP reduction compared to morning dosing, although the difference was not significant 3
• However, the efficacy of 60 mg/day Nifedipine GITS in non-responders to the initial 30 mg/day dose was twice as great with bedtime as compared to morning dosing 3
• Bedtime administration also reduced the incidence of edema as an adverse event by 91% and the total number of all adverse events by 74% compared to morning dosing 3

Special Considerations

In certain cases, such as hypertensive emergencies, the dosage and administration of Nifedipine may differ:

• A dose of 10-20 mg of Nifedipine may be administered orally or buccally to rapidly reduce blood pressure in patients with severe hypertension 4, 5
• The medication may be administered every 2-3 hours, with a mean total dose of 52 mg/24 hours, to achieve successful control of blood pressure 6