Nifedipine Dosing Guidelines for Hypertension and Angina
For hypertension and angina, nifedipine is available in immediate-release formulation (30-90 mg daily) and slow-release formulation (30-180 mg daily), with the slow-release formulation being preferred for most patients due to better safety profile. 1
Dosing Recommendations
For Hypertension:
- Initial dose: Start with 30 mg once daily of extended-release (slow-release) formulation on an empty stomach 2
- Titration: Increase dose gradually over 7-14 days based on blood pressure response 2
- Maintenance dose: 30-60 mg once daily of extended-release formulation 2
- Maximum dose: 90 mg daily (doses above 90 mg are not recommended) 2
For Angina:
- Immediate-release: 30-90 mg daily (divided doses) 1
- Slow-release: 30-180 mg daily 1
- Important safety note: Immediate-release nifedipine is not recommended for unstable angina/NSTEMI except with concomitant beta-blockade due to increased adverse potential 1
Formulation Considerations
- Extended-release tablets should be swallowed whole, not bitten or divided 2
- GITS (Gastrointestinal Therapeutic System) formulation provides sustained plasma concentrations throughout the 24-hour dosing interval 3, 4
- Some patients well-controlled on 30 mg GITS may be successfully managed on 20 mg GITS with continued efficacy 3
Special Populations
Pediatric Pulmonary Hypertension:
- Starting dose: 0.1-0.2 mg/kg orally 3 times daily 1
- Dose range: 2-3 mg/kg/day 1
- Maximum adult dose: 180 mg/day orally 1
Administration Timing
- Bedtime administration of nifedipine GITS may provide better efficacy at higher doses and reduced incidence of edema (91% reduction) compared to morning dosing 4
Common Side Effects
- Hypotension, dizziness, flushing, nausea, constipation, edema 1
- Side effects are generally dose-related and associated with vasodilatory action 5
- Most side effects are mild to moderate and transient, typically diminishing with continued treatment 5
Important Precautions
- Avoid rapid-release, short-acting nifedipine in the absence of concomitant beta-blockade due to increased adverse potential 1, 6
- Contraindicated in patients with recent myocardial infarction or unstable angina 6
- Avoid co-administration with grapefruit juice 2
- If discontinuation is necessary, decrease dosage gradually with close physician supervision 2
- In hypertensive emergencies, careful assessment of risks and benefits of rapid blood pressure reduction is essential 6
Clinical Pearls
- Nifedipine is a dihydropyridine calcium channel blocker that primarily causes peripheral arterial dilation with minimal effects on AV or sinus node 1
- For patients with stable angina, nifedipine should be combined with a beta-blocker for optimal effect 6
- Only about 10-15% of patients with pulmonary arterial hypertension will have a positive acute vasoreactive response to calcium channel blockers 1