Maximum Recommended Dose of Nifedipine IR
The maximum recommended dose of immediate-release (IR) nifedipine is 30 mg every 4-6 hours, with a total daily maximum of 120 mg. 1
Dosing Guidelines for Nifedipine IR
Nifedipine IR is a dihydropyridine calcium channel blocker (DHP) that requires careful dosing due to its rapid onset of action and potential for side effects. The dosing should follow these parameters:
- Starting dose: 10 mg three times daily 2
- Titration interval: 2-3 days 1
- Maximum single dose: 30 mg 1, 2
- Maximum daily dose: 120 mg 1, 2
Administration Considerations
When administering nifedipine IR, consider these important factors:
- Begin with lower doses (10 mg) and titrate cautiously to avoid hypotension 2
- Monitor for common side effects including:
- Dose should be adjusted based on clinical response and blood pressure measurements 3
Important Precautions and Contraindications
Nifedipine IR should be used with caution or avoided in patients with:
- Heart failure with reduced ejection fraction (HFrEF) 2
- Severe left ventricular dysfunction 2
- Pulmonary edema 2
- Advanced aortic stenosis 2
- Unstable angina or recent myocardial infarction 2
Clinical Considerations
- Immediate-release nifedipine should not be used without concomitant beta-blockade due to increased risk of adverse cardiovascular events 2
- Response to nifedipine IR is highly variable between patients, necessitating individualized dose titration 3
- Extended-release formulations are generally preferred over immediate-release due to more stable plasma concentrations and reduced side effects 2, 4
- Elderly patients, those with hepatic impairment, and those with renal disease require more cautious dosing 2
Monitoring Recommendations
- Monitor blood pressure regularly during dose titration
- Watch for signs of peripheral edema, which is more common with nifedipine than other calcium channel blockers 2
- Assess for symptomatic hypotension, especially after initial doses or dose increases
While immediate-release nifedipine can be effective for hypertension management, sustained-release formulations are generally preferred for chronic therapy due to their improved side effect profile and once or twice-daily dosing convenience 4.