From the Guidelines
No, you should not combine nifedipine and amlodipine as they are both calcium channel blockers that work in the same way, increasing the risk of side effects such as severe hypotension, dizziness, fainting, and edema without providing additional therapeutic benefit. Taking these medications together can lead to an increased risk of adverse effects due to their similar mechanisms of action, which involve blocking calcium from entering the cells of the heart and blood vessels, causing blood vessels to relax and widen, and lowering blood pressure 1.
When prescribed, a doctor will typically choose either nifedipine or amlodipine, not both simultaneously. If you are currently taking one of these medications and your blood pressure is not adequately controlled, your healthcare provider might adjust the dosage, switch to the other medication, or add a different class of antihypertensive medication that works through a different mechanism, such as an ACE inhibitor or diuretic 1.
Some key points to consider include:
- The risks and benefits of combining nifedipine and amlodipine are not well-defined, suggesting a cautious approach, especially in the absence of beta blockade 1.
- The CCB evidence base in UA/NSTEMI is greatest for verapamil and diltiazem, with limited data on the use of amlodipine and felodipine in this context 1.
- Calcium channel blockers may be used to control ongoing or recurring ischemia-related symptoms in patients who already are receiving adequate doses of nitrates and beta blockers, or in patients who are unable to tolerate adequate doses of these agents 1.
Always consult with your healthcare provider before making any changes to your medication regimen.
From the Research
Combination of Nifedipine and Amlodipine
- The combination of nifedipine and amlodipine, both calcium channel blockers, is not directly addressed in the provided studies as a combination therapy 2, 3, 4, 5, 6.
- However, studies have compared the efficacy and adverse effects of nifedipine and amlodipine when used separately in patients with hypertension and angina pectoris 4, 5.
- A study found that amlodipine had better anti-anginal efficacy than nifedipine, while both drugs showed comparable antihypertensive action and were well tolerated by angina patients 4.
- Another study compared the blood pressure-lowering effect of nifedipine and amlodipine in patients with essential hypertension, and found that amlodipine given once daily was at least as effective as nifedipine tablets given twice daily 5.
- A systematic review and network meta-analysis found that the combination of dihydropyridine calcium channel blockers (including nifedipine and amlodipine) with renin-angiotensin system blockers can reduce the risk of peripheral edema associated with dihydropyridine calcium channel blockers 3.
- The study also found that nifedipine plus angiotensin receptor blocker did not mitigate peripheral edema, while amlodipine plus angiotensin-converting enzyme inhibitors reduced peripheral edema the most 3.
Adverse Effects and Interactions
- Peripheral edema is a common adverse effect of dihydropyridine calcium channel blockers, including nifedipine and amlodipine 3.
- The combination of nifedipine and amlodipine may increase the risk of peripheral edema, although this is not directly addressed in the provided studies.
- The fixed combination of nifedipine and atenolol (a beta-blocker) has been shown to be effective in treating arterial hypertension and angina pectoris, with no notable depressive effects on myocardial contractility except in patients with severely compromised basal resting contractile function 6.