What is the recommended dosing for Procardia XL (nifedipine)?

Procardia XL (Nifedipine Extended-Release) Dosing

Start with 30 mg once daily and titrate up to a maximum of 120 mg daily (or 60 mg twice daily) based on blood pressure response, with dose adjustments every 5-7 days in stable patients. 1

Standard Dosing Regimen

Initial Dose

• 30 mg once daily is the recommended starting dose for hypertension 1
• This provides full 24-hour therapeutic coverage as a single daily dose 2

Titration Schedule

• Adjust dose every 5-7 days in stable patients 1
• Increase in increments (typically 30 mg) based on blood pressure response 3, 4

Maximum Dose

• 120 mg once daily OR 60 mg twice daily 1
• Doses up to 120 mg daily have been evaluated in clinical trials 3, 4

Timing of Administration

Bedtime dosing is superior to morning dosing for patients requiring higher doses (60 mg/day), as it provides:

• Twice the efficacy compared to morning administration 2
• 91% reduction in edema incidence 2
• 74% reduction in total adverse events 2

For the standard 30 mg daily dose, timing is less critical as efficacy is similar regardless of administration time 2

Special Populations

Pregnancy and Postpartum Hypertension

• Starting dose: 30 mg daily 1
• Maximum dose: 120 mg daily or 60 mg twice daily 1
• Titration interval: 5-7 days 1
• Safe for breastfeeding with relative infant dose (RID) of 2.3%-3.4% 1

Hypertensive Emergencies

• For acute severe hypertension, intravenous nicardipine (not oral nifedipine) is preferred 1
• Oral or sublingual nifedipine should be avoided in emergencies due to risk of excessive blood pressure reduction causing myocardial infarction or fetal distress 1

Important Clinical Considerations

Contraindications and Precautions

• Contraindicated in heart failure 1
• Common side effects include flushing, headache, and peripheral edema 1
• Avoid rapid or excessive blood pressure reduction, particularly with immediate-release formulations 1

Drug Interactions

• Do not combine with intravenous magnesium as this may cause myocardial depression 1
• Monitor carefully when used with other antihypertensive agents 1

Formulation Requirements

• Extended-release tablets (Procardia XL, Adalat CC) must be swallowed whole 1
• Different extended-release formulations are bioequivalent and provide similar 24-hour blood pressure control 4

Monitoring

• Blood pressure should be measured just prior to the next dose to assess trough effect and determine if dose adjustment is needed 1
• Approximately 91-95% of patients achieve blood pressure control with appropriate titration 3