What is the recommended dose of Procardia (nifedipine) for a patient with hypertension?

Procardia (Nifedipine) Dosing for Hypertension

Immediate-release nifedipine (Procardia capsules) should NOT be used for treating elevated blood pressure in asymptomatic patients, as it poses significant risks including hypotension, myocardial ischemia, stroke, and death. 1

Critical Safety Warning

The immediate-release nifedipine capsule formulation is contraindicated for hypertension management and should never be prescribed for this indication. 1 Multiple case reports document serious adverse events including:

• Acute myocardial infarction 1
• Cardiac ischemia and ECG changes 1
• Severe hypotension 1
• Ventricular arrhythmias 2
• Stroke and death 1

The British Hypertension Society explicitly states that "nifedipine in capsule form should no longer be prescribed." 1

Extended-Release Nifedipine Dosing (If Appropriate)

For chronic hypertension management, only extended-release nifedipine formulations should be used, starting at 30 mg once daily and titrating up to 60-90 mg once daily as needed. 3

Dosing Protocol:

• Initial dose: 30 mg once daily (extended-release) 3
• Titration: Increase to 60 mg once daily after 7-14 days if blood pressure remains uncontrolled 3
• Maximum dose: 90 mg once daily 3
• Allow 4 weeks between dose adjustments to observe full therapeutic response 1

High-Dose Regimens for Refractory Cases:

For patients with pulmonary arterial hypertension who demonstrate acute vasoreactivity, doses up to 120-240 mg/day have been used, though this is not standard for systemic hypertension. 1

When Nifedipine Should NOT Be Used

Avoid nifedipine in the following situations:

• Asymptomatic hypertension in the emergency department - rapid blood pressure lowering provides no benefit and increases harm 1
• Without concurrent beta-blocker therapy when using any dihydropyridine for acute coronary syndromes 1
• Heart failure or severe left ventricular dysfunction - use verapamil or diltiazem instead if a calcium channel blocker is needed 1
• Urgent/emergent hypertension - use intravenous agents that can be titrated (not oral nifedipine) 2

Preferred Approach for Elevated Blood Pressure

For patients with blood pressure ≥160/100 mmHg, initiate combination therapy with two drugs rather than monotherapy with nifedipine. 4 The preferred combinations are:

• ACE inhibitor or ARB + dihydropyridine calcium channel blocker (extended-release nifedipine or amlodipine) 4
• ACE inhibitor or ARB + thiazide/thiazide-like diuretic 4

Single-pill combination therapy improves adherence and achieves blood pressure control more rapidly. 4

Key Clinical Pitfalls

• Never use immediate-release nifedipine capsules for hypertension - this formulation causes unpredictable, rapid blood pressure drops 1
• Do not treat asymptomatic hypertension acutely - blood pressure often decreases spontaneously by 6-12% without intervention, and rapid lowering causes more harm than benefit 1
• Avoid in elderly patients without dose adjustment - bioavailability is 70% higher and half-life is nearly doubled in patients >60 years 3
• Do not combine with grapefruit juice - this increases nifedipine levels 2-fold via CYP3A4 inhibition 3