What is the recommended treatment and dosage for Procardia (nifedipine) in patients with high blood pressure and angina?

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Recommended Treatment and Dosage for Procardia (Nifedipine) in Hypertension and Angina

For patients with hypertension and angina, immediate-release nifedipine (Procardia) should be dosed at 30-90 mg daily in divided doses, while extended-release formulations should be initiated at 30 mg once daily and titrated up to 30-60 mg once daily as maintenance therapy. 1

Dosing Guidelines for Nifedipine

Hypertension

  • Extended-release (Procardia XL):
    • Starting dose: 30 mg once daily
    • Titration: Adjust over 7-14 days based on response
    • Maintenance dose: 30-60 mg once daily
    • Maximum recommended dose: 90 mg daily 1
    • Take on an empty stomach
    • Swallow tablets whole; do not crush, chew, or divide

Angina

  • Immediate-release:
    • Dosage: 10-30 mg three times daily 2
    • Side effects: Hypotension, dizziness, flushing, nausea, constipation, edema
  • Extended-release:
    • Same dosing as for hypertension
    • Duration of action: Long (for extended-release)

Important Clinical Considerations

Efficacy and Safety

  • Nifedipine is a dihydropyridine calcium channel blocker that works by relaxing blood vessels, improving blood flow, and reducing cardiac workload
  • Immediate-release nifedipine is not recommended for unstable angina/NSTEMI except with concomitant beta-blockade due to risk of reflex tachycardia 2
  • For hypertensive emergencies, intravenous nicardipine is preferred over oral nifedipine 2

Combination Therapy

  • For angina patients, nifedipine is often more effective when combined with beta-blockers 2, 3
  • In patients with stable angina, the following combination is recommended:
    1. Beta-blocker (first-line, especially with prior MI or LV dysfunction)
    2. Add nifedipine if angina remains uncontrolled 2

Individualized Dose Titration

  • Response to nifedipine is highly variable between patients
  • Careful titration is essential to find the optimal dose for each patient
  • Some patients respond best to lower doses (10 mg TID) while others require higher doses 4
  • Monitor for hypotension, especially when initiating therapy

Contraindications and Cautions

  • Avoid immediate-release nifedipine in:
    • Unstable angina without beta-blockade
    • Recent myocardial infarction
    • Advanced aortic stenosis
    • Cardiogenic shock
  • Use with caution in elderly patients and those with liver impairment
  • Do not co-administer with grapefruit juice (increases drug levels) 1

Special Situations

Hypertensive Emergencies

  • Intravenous calcium channel blockers (nicardipine) are preferred over oral nifedipine for hypertensive emergencies 2
  • If oral therapy is needed, extended-release formulations are safer than immediate-release

Elderly Patients

  • Start at the lower end of the dosing range
  • Monitor closely for orthostatic hypotension
  • Consider potential drug interactions with other medications

Patients with Heart Failure

  • Nifedipine should be used with caution in patients with heart failure
  • Beta-blockers are preferred first-line agents for patients with reduced ejection fraction and angina 2

Remember that extended-release formulations provide more consistent blood levels and reduce the risk of reflex tachycardia compared to immediate-release nifedipine. Always monitor blood pressure response and adjust dosing accordingly to achieve optimal symptom control while minimizing side effects.

References

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Treatment of angina pectoris with nifedipine: importance of dose titration.

British medical journal (Clinical research ed.), 1983

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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