What is the recommended dose of nifedipine (calcium channel blocker) for hypertension?

Recommended Nifedipine Dosing for Hypertension

For hypertension treatment, nifedipine extended-release tablets should be administered at an initial dose of 30 mg once daily, with titration over 7-14 days to a usual maintenance dose of 30-60 mg once daily, not exceeding 90 mg daily. 1

Dosing Guidelines

• Nifedipine extended-release tablets should be administered orally once daily on an empty stomach 1
• Tablets should be swallowed whole, not bitten or divided as this would disrupt the extended-release mechanism 1
• Initial starting dose should be 30 mg once daily 1, 2
• Titration should proceed over a 7-14 day period based on therapeutic efficacy and safety 1
• The usual maintenance dose range is 30-60 mg once daily 1, 2
• Doses above 90 mg daily are not recommended for hypertension 1
• If discontinuation is necessary, dosage should be decreased gradually under physician supervision 1

Formulation Considerations

• Extended-release formulations (GITS - Gastrointestinal Therapeutic System) are preferred over immediate-release formulations for hypertension 2, 3
• Immediate-release nifedipine (10-30 mg three times daily, maximum 90 mg/day) should not be used without concomitant beta-blockade due to risk of adverse cardiovascular events 4
• The extended-release formulation provides sustained blood concentrations over 24 hours, improving adherence and reducing side effects 3

Efficacy and Dose Response

• In clinical trials, 74.5% of patients achieved blood pressure control with 30 mg once daily, while 25.5% required titration to 60 mg 3
• At week 20 of treatment, mean systolic/diastolic blood pressure decreased from 160.1/97.4 mmHg at baseline to 141.5/84.8 mmHg in the 30-mg group and 146.6/88.8 mmHg in the 60-mg group 3
• Response to nifedipine is independent of age and type of previous antihypertensive therapy 3
• Some patients with well-controlled hypertension on nifedipine GITS 30 mg may be able to switch to 20 mg once daily with continued efficacy 5

Side Effects and Monitoring

• The three most common adverse events are headache (12.2%), peripheral edema (8.1%), and dizziness (2.9%) 3
• Side effects are generally dose-related and associated with vasodilatory action 2
• The frequency of adverse events is typically highest in the first 3 weeks of treatment and decreases subsequently 3
• Co-administration with grapefruit juice should be avoided 1

Special Considerations

• Nifedipine is a dihydropyridine calcium channel blocker that primarily causes peripheral arterial dilation with minimal effects on AV or sinus node 2
• For patients with resistant hypertension, dihydropyridine CCBs like amlodipine and nifedipine extended-release are among the most studied agents 6
• Some data suggest that long-acting formulations of nifedipine may have slightly greater antihypertensive actions than amlodipine but are associated with more edema 6
• Nifedipine may be particularly useful for patients with relative bradycardia 4

Common Pitfalls

• Using immediate-release formulations without beta-blockade can lead to reflex tachycardia and increased cardiovascular risk 4
• Failing to administer the extended-release tablet whole (biting or dividing) disrupts the controlled-release mechanism 1
• Not allowing sufficient time for dose titration (should be 7-14 days) 1
• Exceeding the maximum recommended dose of 90 mg daily for hypertension 1
• Not monitoring for peripheral edema, which is a common dose-limiting side effect 3