From the Guidelines
Nifedipine should be held in patients with certain conditions, including advanced aortic stenosis, severe hypotension, and heart failure, as it can worsen these conditions or lead to adverse effects such as hypotension, dizziness, and edema 1.
Key Conditions to Hold Nifedipine
- Advanced aortic stenosis: Nifedipine is contraindicated in advanced aortic stenosis, as it can lead to decreased cardiac output and worsen symptoms 1.
- Severe hypotension: Nifedipine can cause hypotension, and its use should be avoided in patients with severe hypotension or those who are at risk of hypotension, such as patients with dehydration or volume depletion 1.
- Heart failure: Nifedipine can worsen heart failure, particularly in patients with decompensated heart failure or those who are at risk of developing heart failure, such as patients with left ventricular dysfunction 1.
- Concomitant beta-blocker therapy: Immediate-release nifedipine should not be used without concomitant beta-blocker therapy, as it can increase the risk of adverse effects such as hypotension and heart failure 1.
Additional Considerations
- Elderly patients: Nifedipine should be used with caution in elderly patients, as they may be more susceptible to its adverse effects, such as hypotension and edema 1.
- Pregnancy: Nifedipine should be used with caution in pregnant women, particularly in those with preeclampsia, as it can cause hypotension and other adverse effects 1. It is essential to carefully evaluate the patient's condition and medical history before initiating nifedipine therapy and to monitor them closely for potential adverse effects.
From the FDA Drug Label
WARNINGS Excessive Hypotension Although in most patients the hypotensive effect of nifedipine is modest and well tolerated, occasional patients have had excessive and poorly tolerated hypotension. In nifedipine-treated patients where surgery using high dose fentanyl anesthesia is contemplated, the physician should be aware of these potential problems and, if the patient's condition permits, sufficient time (at least 36 hours) should be allowed for nifedipine to be washed out of the body prior to surgery
- Hold nifedipine:
- When excessive hypotension occurs
- At least 36 hours before surgery using high dose fentanyl anesthesia, if possible
- When discontinuing nifedipine, the dosage should be decreased gradually with close physician supervision 2
- Clinical considerations:
- Beta-blocker withdrawal: Patients recently withdrawn from beta blockers may develop a withdrawal syndrome with increased angina, and initiation of nifedipine treatment will not prevent this occurrence 2
- Congestive heart failure: Rarely, patients have developed heart failure after beginning nifedipine, especially those with tight aortic stenosis 2
From the Research
Nifedipine Administration
- Nifedipine can be administered in various forms, including sublingual, buccal, and oral routes 3, 4.
- The onset of action for nifedipine is rapid, with effects seen within 10-15 minutes for buccal administration and 30-45 minutes for oral administration 3.
- The peak effect of nifedipine is achieved within 30 minutes for buccal administration and 60 minutes for oral administration 3.
Indications for Holding Nifedipine
- Nifedipine should be held or used with caution in patients with certain medical conditions, such as:
- Nifedipine should also be held or used with caution in patients taking certain medications, such as other calcium channel blockers or vasodilators, as this can increase the risk of hypotension or other adverse effects 3, 6.
Monitoring and Dosing
- Patients taking nifedipine should be monitored closely for signs of hypotension, such as dizziness or lightheadedness, and for changes in blood pressure or heart rate 3, 4.
- The dose of nifedipine should be adjusted based on the patient's response to treatment and their medical condition, with typical doses ranging from 10-20 mg for acute treatment and 30-80 mg daily for long-term treatment 3, 4, 7.