Nifedipine Dosing for Hypertension and Angina
For hypertension and angina, nifedipine extended-release formulation is recommended at a starting dose of 30 mg once daily, with maintenance doses of 30-60 mg once daily (maximum 90 mg daily), taken on an empty stomach with tablets swallowed whole. 1
Formulations and General Recommendations
- Extended-release (slow-release) formulations are strongly preferred over immediate-release nifedipine due to better safety profile and reduced risk of adverse events 2
- Immediate-release nifedipine is contraindicated for unstable angina/NSTEMI except when used with concomitant beta-blockade due to increased risk of adverse cardiovascular events 3
- Titration should proceed gradually over 7-14 days starting with 30 mg once daily, based on therapeutic efficacy and safety 1
- Co-administration with grapefruit juice should be avoided 1
Dosing for Hypertension
- Starting dose: 30 mg extended-release once daily 1
- Usual maintenance dose: 30-60 mg once daily 1
- Maximum recommended dose: 90 mg daily 1
- For resistant hypertension, dihydropyridine calcium channel blockers like nifedipine extended-release are among the most studied agents 2
- Extended-release formulations may have greater antihypertensive effects than amlodipine but are associated with more edema 2
Dosing for Angina
- For stable angina: 30-180 mg daily of slow-release formulation 2
- For unstable angina: Immediate-release nifedipine should be avoided unless combined with beta-blockers 3, 4
- Nifedipine is contraindicated in recent myocardial infarction or unstable angina 4
- For stable angina, nifedipine should be considered a second-line choice and preferably combined with a beta-blocker 4
Administration Considerations
- Extended-release tablets should be swallowed whole, not bitten or divided 1
- Should be administered on an empty stomach 1
- If discontinuation is necessary, dosage should be decreased gradually with physician supervision 1
Side Effects and Precautions
- Common side effects include hypotension, dizziness, flushing, nausea, constipation, and edema 3, 2
- Side effects are generally dose-related and associated with vasodilatory action 2
- Rapid-release, short-acting nifedipine must be avoided without concomitant beta-blockade due to increased adverse potential 3
- Abrupt hypotension from immediate-release nifedipine can induce neurological and cardiac events, particularly in hypertensive emergencies 4
Special Considerations
- Long-acting formulations improve patient compliance through once-daily dosing 5
- Nifedipine GITS (Gastrointestinal Therapeutic System) formulation provides constant drug levels for a full 24-hour period 6
- When combined with beta-blockers (like atenolol), lower doses of each component may be effective compared to monotherapy 7
- In patients with coronary artery disease already on beta-blockers, adding nifedipine GITS (30-90 mg once daily) can provide additional antianginal protection 6
Clinical Pearls
- Nifedipine primarily causes peripheral arterial dilation with minimal effects on AV or sinus node 2
- The extended-release formulation is generally better tolerated than conventional formulations, particularly regarding reflex tachycardia 5
- Adverse effects are usually mild to moderate and transient, often diminishing with continued treatment 5