Nifedipine Dosage for Hypertension
For treating hypertension, nifedipine should be administered as extended-release tablets at a starting dose of 30 mg once daily, with maintenance doses ranging from 30-60 mg once daily and not exceeding 90 mg daily. 1
Dosage Recommendations
Initial Dosing
- Start with 30 mg extended-release tablets once daily 1
- Administer on an empty stomach 1
- Tablets should be swallowed whole, not bitten or divided 1
Titration and Maintenance
- Titration should proceed over a 7-14 day period 1
- Usual maintenance dose: 30-60 mg once daily 1
- Maximum recommended dose: 90 mg daily 1
- Doses above 90 mg daily are not recommended 1
Formulation Considerations
- Extended-release/slow-release formulations are strongly preferred over immediate-release 2
- Immediate-release nifedipine should be avoided for routine hypertension management due to risk of rapid, unpredictable blood pressure drops 2
- If discontinuation is necessary, dosage should be decreased gradually with physician supervision 1
Special Considerations
Combination Therapy
- Nifedipine is often used as part of multiple-drug therapy to achieve blood pressure targets 3
- Dihydropyridine calcium channel blockers like nifedipine are one of the recommended first-line agents for hypertension, along with thiazide diuretics, ACE inhibitors, or ARBs 3
- When used with other antihypertensives, lower doses may be effective (20 mg may be sufficient in some patients previously controlled on 30 mg) 4
Population-Specific Considerations
- Particularly effective in elderly patients, African Americans, and those with isolated systolic hypertension 2
- For patients with diabetes and hypertension, nifedipine can be used as part of the treatment algorithm 3
Adverse Effects and Precautions
- Common side effects: hypotension, dizziness, flushing, headache, peripheral edema, and reflex tachycardia 2
- Co-administration with grapefruit juice should be avoided 1
- If used with immediate-release formulation (not recommended), concomitant beta-blockade is advised to prevent reflex tachycardia 2
Clinical Pearls
- Response rates are high, with studies showing 95.7% of patients achieving goal diastolic blood pressure (<95 mmHg) on 20 mg daily and 100% on 30 mg daily 4
- Blood pressure control (diastolic <90 mmHg) was achieved in 74.5% of patients on 20 mg and 87.5% on 30 mg 4
- The 60 mg dose provides greater blood pressure reduction than 30 mg, but the maximum effect may not be maintained for the full 24 hours 5
- Tolerance to the antihypertensive effect does not develop with long-term therapy 6
Remember that nifedipine extended-release tablets are the preferred formulation for hypertension management, and immediate-release formulations should be avoided due to the risk of rapid, unpredictable blood pressure reductions.