Nifedipine Tapering Protocol
There is no established evidence-based protocol for tapering nifedipine, but the FDA label recommends gradual dose reduction under close physician supervision when discontinuation is necessary. 1
Key Principle: Gradual Reduction Required
The FDA-approved prescribing information states that "if discontinuation of nifedipine extended-release tablet is necessary, sound clinical practice suggests that the dosage should be decreased gradually with close physician supervision." 1
Unlike abrupt discontinuation, gradual tapering minimizes the risk of rebound hypertension or angina exacerbation, though specific withdrawal symptoms from calcium channel blockers are less severe than with other cardiovascular medications. 1
Practical Tapering Approach
Since no specific taper schedule exists in guidelines for nifedipine, a reasonable approach based on general cardiovascular medication principles includes:
Reduce the dose by approximately 25-50% every 1-2 weeks, monitoring blood pressure and symptoms closely at each step. 1
For patients on nifedipine extended-release 60 mg daily, consider: Week 1-2: 30 mg daily, then Week 3-4: discontinue if blood pressure remains controlled. 1
For patients on higher doses (90 mg daily), extend the taper over 4-6 weeks with intermediate dose reductions. 1
Monitoring During Taper
Measure blood pressure at least weekly during the taper to detect rebound hypertension, which can occur when calcium channel blockers are withdrawn. 1
Watch specifically for return of anginal symptoms in patients being treated for coronary artery disease, as vasospastic angina may recur after nifedipine withdrawal. 2
In patients with vasospastic angina who have been symptom-free for 6-12 months on nifedipine, spontaneous remission occurs in approximately 50% of cases, making it acceptable to attempt gradual discontinuation. 2
Important Caveats
Never use sublingual short-acting nifedipine for acute blood pressure reduction due to risk of precipitous hypotension and reflex tachycardia with potential ventricular arrhythmias. 2, 3
The extended-release formulation (GITS) provides stable 24-hour coverage and should not be crushed, chewed, or divided during tapering. 1
If withdrawal symptoms (headache, rebound hypertension, or angina) emerge during tapering, return to the previous well-tolerated dose and slow the taper further. 1
Consider transitioning to alternative antihypertensive therapy before completing the nifedipine taper if ongoing blood pressure control is needed. 1