From the Guidelines
The recommended dose of Nifedipine ER is 30 to 180 mg orally, with the specific dose depending on the patient's condition and response to treatment. According to the guidelines outlined in the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1, the usual dose of Nifedipine ER is between 30 to 180 mg orally.
When considering the use of Nifedipine ER, it's essential to take into account the properties of calcium channel blockers in clinical use, as outlined in Table 16 of the guidelines 1. Key points to consider include:
- The duration of action: Nifedipine ER has a short duration of action
- Side effects: Common side effects include hypotension, dizziness, flushing, nausea, constipation, and edema
It's crucial to monitor patients for these side effects and adjust the dose accordingly. Additionally, the guidelines suggest that immediate-release nifedipine is not recommended for UA/NSTEMI except with concomitant beta blockade 1.
In terms of administration, Nifedipine ER should be taken consistently with respect to meals, preferably with food to minimize gastrointestinal irritation. The medication should be swallowed whole and not crushed or chewed, as this would destroy the extended-release mechanism and could lead to dangerously high blood levels.
Dose adjustments may be needed in patients with hepatic impairment, and elderly patients may require lower initial doses due to increased sensitivity. Regular blood pressure monitoring is necessary to ensure the medication is effective at the prescribed dose.
From the FDA Drug Label
Nifedipine extended-release tablets produced dose-related decreases in systolic and diastolic blood pressure as demonstrated in two double-blind, randomized, placebo-controlled trials in which over 350 patients were treated with nifedipine extended-release tablets 30,60 or 90 mg once daily for 6 weeks
The recommended dose of Nifedipine ER is 30-90 mg once daily.
- The dose can be adjusted based on the patient's response to the medication.
- The medication should be taken once daily, and the dose should not be exceeded without consulting a healthcare professional 2.
From the Research
Nifedipine ER Mac Dose
- The initial dose of nifedipine ER is 30 mg once daily, which can be titrated up to a maximum of 120 mg once daily 3.
- A study found that at a mean daily dose of 57 mg of nifedipine ER, more than three quarters of the treatment group achieved a satisfactory response in lowering blood pressure 3.
- Another study compared the dose response and length of action of nifedipine capsules and tablets in patients with essential hypertension, and found that 10 and 20 mg capsules or 20 mg tablets were effective in lowering blood pressure, with little difference between them 4.
- The efficacy of nifedipine ER in lowering blood pressure has been compared to other antihypertensive medications, including enalapril, and found to have approximately equal efficacy as once-daily antihypertensive treatments 3.
- A review of long-acting nifedipine formulations found that they were designed to address concerns raised by earlier formulations of nifedipine, and numerous clinical trials have been conducted comparing long-acting nifedipine to other antihypertensive medications 5.
Interaction with Other Medications
- Nifedipine ER may interact with nonsteroidal anti-inflammatory drugs (NSAIDs), which can induce an increase in blood pressure and potentially reduce the efficacy of antihypertensive drugs 6.
- However, calcium antagonists like nifedipine ER are unlikely to be affected by NSAIDs, and may be preferable to other antihypertensive medications for patients who require NSAID therapy 6.
Comparison with Other Antihypertensive Medications
- A study compared the efficacy of different classes of antihypertensive medications, including calcium blockers, diuretics, ACE inhibitors, and beta-blockers, and found that calcium blockers and diuretics were more effective in lowering systolic blood pressure in elderly patients 7.
- The study also found that monotherapy with any of these medications achieved target blood pressure in only a small number of patients, and combination therapy was usually required to achieve goal 7.