Nifedipine Dosing for Hypertension
For treating hypertension, nifedipine slow-release formulations should be used at doses of 30-180 mg daily, while immediate-release formulations should be avoided unless combined with beta-blockers. 1
Formulation-Specific Dosing
Slow-Release/Extended-Release Formulations (Preferred)
- Initial dose: 30 mg once daily 2
- Titration: Can be increased to 60-90 mg daily based on blood pressure response
- Maximum dose: 180 mg daily 2
- Efficacy: More than 50% of patients achieve blood pressure control on 30-60 mg daily 2
Immediate-Release Formulations (Limited Use)
- Not recommended for routine hypertension management due to risk of rapid, unpredictable blood pressure drops 1
- Should only be used with concomitant beta-blockade to prevent reflex tachycardia 1
- If used (with beta-blocker): 30-90 mg daily in divided doses 1
Special Populations
Hypertensive Emergencies
- Immediate-release nifedipine is no longer recommended for hypertensive emergencies due to risk of unpredictable blood pressure drops, cerebral ischemia, and stroke 1
- For hypertensive emergencies requiring calcium channel blockers, IV nicardipine (5-15 mg/h) or clevidipine (1-32 mg/h) are preferred options 1
Pregnancy-Related Hypertension
- Nifedipine is considered a first-line antihypertensive during pregnancy 3
- For acute severe hypertension in preeclampsia: 10 mg orally, repeated every 20 minutes to maximum of 30 mg 1
- Long-acting formulations preferred for maintenance therapy 3
Elderly Patients
- Start at the lower end of the dosing range
- No specific dose adjustment required for nicardipine 1
- For clevidipine, use low-end dose range 1
Monitoring and Adverse Effects
Common Side Effects
- Hypotension, dizziness, flushing, headache
- Nausea, constipation, peripheral edema 1
- Reflex tachycardia (especially with immediate-release formulations) 3
Contraindications
- Advanced aortic stenosis
- Caution when combined with magnesium sulfate due to risk of precipitous blood pressure drop 3
Efficacy Data
- Average blood pressure reduction: 17-24 mmHg systolic and 13-14 mmHg diastolic 2, 4
- Similar efficacy in both men and women, and across racial groups 2
- Long-term efficacy maintained without development of tolerance 5
Clinical Pearls
- High-dose controlled-release nifedipine (80 mg daily) is well-tolerated and effective for patients with inadequate blood pressure control on standard doses 6
- Avoid sublingual or "chewed" nifedipine administration despite historical use 7, as this practice has been associated with unpredictable drops in blood pressure and adverse outcomes
- When switching from immediate-release to sustained-release preparations, blood pressure control is typically maintained or improved 4
Remember that calcium channel blockers like nifedipine are particularly effective in elderly patients, African Americans, and those with isolated systolic hypertension. They can be used as monotherapy or in combination with other antihypertensive classes.