Nifedipine for Hypertension: Treatment and Dosing
For hypertension, use nifedipine extended-release 30-90 mg once daily on an empty stomach, starting at 30 mg and titrating over 7-14 days based on blood pressure response; avoid immediate-release formulations for chronic hypertension management. 1
Formulation Selection
Extended-release nifedipine is the only appropriate formulation for chronic hypertension management. 2, 3
- The extended-release formulation provides consistent 24-hour blood pressure control with once-daily dosing 3
- Immediate-release nifedipine should NOT be used for routine hypertension treatment due to increased risk of adverse cardiovascular events 3, 4
- If immediate-release nifedipine must be used, it requires concomitant beta-blockade 4
Standard Dosing Protocol
Starting dose: 30 mg once daily 1
Titration schedule:
- Increase dose over 7-14 day intervals based on blood pressure response and tolerability 1
- Usual maintenance dose: 30-60 mg once daily 1
- Maximum recommended dose: 90 mg once daily for routine hypertension 1
- Doses above 90 mg daily are not recommended for standard hypertension management 1
Administration details:
- Take on an empty stomach 1
- Swallow tablets whole—do not bite, chew, or divide 1
- Avoid grapefruit juice, which increases nifedipine levels 1
Special Clinical Situations
Severe Hypertension (Acute Management)
For severe hypertension requiring rapid blood pressure reduction, oral nifedipine is recommended as a treatment option 2
- In hypertensive emergencies, nifedipine can reduce blood pressure from approximately 248/134 mmHg to 165/87 mmHg (21.6% mean arterial pressure reduction) 5
- Onset of action: 30-45 minutes orally 5
- Peak effect: 60 minutes 5
- Duration: 4-6 hours 5
Resistant Hypertension
Nifedipine extended-release is among the most studied agents for resistant hypertension 3
- Consider as part of combination therapy when blood pressure remains uncontrolled on three-drug regimens 3
- Some data suggest nifedipine may have slightly greater antihypertensive effects than amlodipine but is associated with more edema 3
Pulmonary Arterial Hypertension (Vasoreactive Patients)
Much higher doses are required for pulmonary hypertension: 120-240 mg daily 2, 4
- Only 10-15% of pulmonary arterial hypertension patients demonstrate vasoreactivity to calcium channel blockers 2, 3
- Start with 30 mg slow-release twice daily, then increase cautiously over subsequent weeks to maximal tolerated dose 2
- Nifedipine is preferred in patients with relative bradycardia (versus diltiazem for tachycardia) 2
- Limiting factors: systemic hypotension and lower limb edema 2
Common Side Effects and Management
Dose-related vasodilatory effects: 3, 4
- Peripheral edema (more common than with amlodipine) 3
- Headache 3
- Flushing 3, 4
- Dizziness 4
- Hypotension 4
Management strategies:
- Addition of digoxin and/or diuretics can decrease calcium channel blocker side effects 2
- Consider switching to amlodipine or felodipine if edema is problematic 6
Critical Contraindications and Precautions
Avoid in:
- Heart failure with reduced ejection fraction (HFrEF) as routine therapy 2
- Severe heart failure 6
- Unstable angina/NSTEMI without concomitant beta-blockade 3, 4
Use with caution in:
- Patients with left ventricular dysfunction (amlodipine may be better tolerated) 6
- Patients requiring beta-blockers (nifedipine can cause reflex tachycardia) 6
Discontinuation
If discontinuation is necessary, decrease dosage gradually with close physician supervision 1
Comparison with Amlodipine
Nifedipine extended-release (once daily) is at least as effective as nifedipine immediate-release (twice daily) for blood pressure control 7
- Amlodipine provides more consistent 24-hour blood pressure control without peak/trough effects 7
- Nifedipine immediate-release shows significant peak/trough variation (BP higher at 12 hours vs. 2 hours post-dose) 7
- When comparing extended-release formulations, nifedipine may have slightly greater antihypertensive effect but more edema than amlodipine 3