Can Nifedipine and Amlodipine Be Taken Together?
No, nifedipine and amlodipine should not be taken together because they are both dihydropyridine calcium channel blockers with similar mechanisms of action, and combining two drugs from the same class is explicitly contraindicated. 1
Why This Combination Is Contraindicated
The 2017 ACC/AHA Hypertension Guidelines explicitly state that drug combinations with similar mechanisms of action should be avoided, and specifically that two drugs from the same class should not be administered together 1. Both nifedipine and amlodipine are dihydropyridine calcium channel blockers that work through identical mechanisms—they produce marked peripheral vasodilation with little direct effect on contractility, atrioventricular conduction, or heart rate 1.
The Exception That Doesn't Apply Here
The guidelines do note one exception: dihydropyridine and non-dihydropyridine CCBs can be combined 1. However, this exception is irrelevant to your question because:
- Nifedipine = dihydropyridine CCB 1
- Amlodipine = dihydropyridine CCB 1
- Both are in the same subclass, so the exception does not apply
The permissible combination would be something like amlodipine (dihydropyridine) with diltiazem or verapamil (non-dihydropyridines), not two dihydropyridines together 1.
Clinical Risks of Combining These Medications
Combining nifedipine and amlodipine would result in:
- Excessive vasodilation leading to severe hypotension 1
- Additive side effects, particularly peripheral edema, which is already common with either drug alone 2, 3, 4
- No additional therapeutic benefit since they target the same pathways 1
- Increased risk of adverse cardiovascular events without improved blood pressure control 1
What to Do Instead
If blood pressure is inadequately controlled on one dihydropyridine CCB alone, the evidence-based approach is:
Add a drug from a different class with complementary mechanisms 1:
- ACE inhibitor or ARB (blocks compensatory renin-angiotensin system activation) 1
- Thiazide diuretic (provides additive BP lowering through different mechanism) 1
- Beta blocker in specific circumstances (though not first-line for hypertension alone) 1
Or switch between nifedipine and amlodipine (not combine them) if one is poorly tolerated 5:
- Amlodipine may be better tolerated in patients with mild left ventricular dysfunction 5
- Nifedipine may be preferred in patients with relative bradycardia 5
- Extended-release nifedipine (30-180 mg once daily) can be used, but immediate-release nifedipine requires concomitant beta-blockade 5, 1
Common Pitfall to Avoid
Never use immediate-release nifedipine without a beta blocker, as this causes dose-related increases in mortality in patients with coronary artery disease and is specifically contraindicated in acute coronary syndromes 1, 5. If switching from amlodipine to nifedipine, use extended-release formulations 5.