Maximum Recommended Dose of Adalat (Nifedipine)
The maximum recommended dose of Adalat (nifedipine) is 90 mg once daily when using the extended-release formulation. 1
Dosage Forms and Administration
Nifedipine is available in several formulations with different dosing recommendations:
Extended-Release Tablets (Adalat XL/GITS):
- Initial dose: 30 mg once daily
- Usual maintenance dose: 30-60 mg once daily
- Maximum dose: 90 mg once daily
- Should be taken on an empty stomach
- Tablets must be swallowed whole, not bitten or divided 1
Immediate-Release Capsules:
Titration Guidelines
- Titration should proceed gradually over a 7-14 day period starting with 30 mg once daily 1
- Dose adjustments should be based on therapeutic efficacy and safety 1
- When discontinuing nifedipine, dosage should be decreased gradually with close physician supervision 1
Clinical Considerations
Efficacy
- In clinical trials, nifedipine GITS 30 mg was sufficient to maintain blood pressure control in 74.5% of patients, while 25.5% required 60 mg 3
- Nifedipine is more effective than atenolol in lowering systolic blood pressure, though neither drug alone controlled blood pressure in more than two-thirds of patients studied 4
- Even low doses (20 mg) of nifedipine GITS have shown significant blood pressure reduction compared to placebo 5
Contraindications
- Severe left ventricular dysfunction
- Pulmonary edema
- Heart failure with reduced ejection fraction
- Advanced aortic stenosis
- Unstable angina or recent myocardial infarction 2
Precautions
- Use with caution in elderly patients, those with hepatic impairment, and those with renal disease 2
- Co-administration with grapefruit juice should be avoided 1
- Immediate-release nifedipine is not recommended for hypertensive emergencies 2
Common Side Effects
- Peripheral edema (more common with nifedipine than other calcium channel blockers)
- Flushing
- Headache
- Dizziness
- Hypotension
- Nausea
- Constipation 2
Special Situations
Hypertensive Emergencies
While some older studies have used oral nifedipine in hypertensive emergencies 6, current guidelines do not recommend immediate-release nifedipine for hypertensive emergencies. Instead, other intravenous agents such as nicardipine or clevidipine are preferred 7, 2.
Combination Therapy
When nifedipine is used in combination with other antihypertensives:
- Dihydropyridine calcium channel blockers (like nifedipine) are preferred over non-dihydropyridine CCBs when combined with beta blockers to avoid excessive bradycardia or heart block 2
- Fixed-combination therapy with atenolol and nifedipine has shown better blood pressure control with lower doses of each drug 4
Remember that the maximum recommended dose of 90 mg daily should not be exceeded, as titration to doses above 90 mg daily is not recommended according to the FDA label 1.