What is the maximum dose of nifedipine, including both immediate‑release and extended‑release formulations?

Maximum Dose of Nifedipine

The maximum dose of nifedipine is 120 mg/day for extended-release formulations in adults, and 180 mg/day for specific indications such as angina or Raynaud's phenomenon. 1, 2

Extended-Release Formulations (Preferred)

Extended-release nifedipine should be used preferentially over immediate-release formulations due to superior safety profile and more consistent plasma concentrations. 3, 2

• Maximum dose: 120 mg/day for hypertension in pediatric patients (ages 6-17 years) 1
• Maximum dose: 180 mg/day for angina management in adults 2
• Maximum dose: 180 mg/day for Raynaud's phenomenon after titration from initial doses of 30-60 mg daily 4
• Dosing is typically once daily (QD) or twice daily (BID) 1

Immediate-Release Formulations (Avoid)

Immediate-release nifedipine should be avoided due to significant safety concerns, including dose-related increases in mortality in patients with coronary artery disease. 3

• The American Heart Association recommends against administering immediate-release nifedipine to patients with acute coronary syndromes, especially without beta-blocker therapy 3
• Short-acting dihydropyridine calcium channel antagonists should be avoided per the American College of Cardiology 3
• Rapid blood pressure reduction with immediate-release nifedipine can lead to cerebrovascular ischemia, stroke, acute myocardial infarction, and conduction disturbances 3
• If immediate-release nifedipine must be used in pregnancy (low-resource settings only), it should be avoided except when other drugs are unavailable, and never combined with magnesium sulfate due to risk of uncontrolled hypotension and fetal compromise 1

Pediatric Dosing

• Maximum dose: 3 mg/kg/day up to 120 mg/day for extended-release nifedipine in children 1
• For pediatric pulmonary hypertension: starting dose 0.1-0.2 mg/kg orally 3 times daily, with dose range of 2-3 mg/kg/day and maximum adult dose of 180 mg/day 2
• The American Academy of Pediatrics recommends considering amlodipine over nifedipine for calcium channel blocker therapy in pediatric patients, starting at 2.5 mg daily 3

Critical Safety Considerations

Nifedipine capsules (immediate-release) should no longer be prescribed due to safety concerns with rapid blood pressure drops. 2

• Sublingual or intravenous administration can cause precipitous blood pressure reduction leading to myocardial infarction or fetal distress in pregnancy 2
• All calcium channel blockers, including nifedipine, should be avoided in patients with severe left ventricular dysfunction or pulmonary edema 2
• Nifedipine is contraindicated in patients with advanced aortic stenosis 2

Dose Titration Strategy

• Start at 30 mg daily and titrate upward based on response, allowing at least 4 weeks between dose adjustments to observe full therapeutic effect 2
• Most hypertensive patients require combination therapy; use submaximal doses of two drugs rather than maximal doses of a single drug to achieve larger blood pressure responses with fewer side effects 2
• Common adverse effects include hypotension, dizziness, flushing, nausea, constipation, and peripheral edema, which are dose-dependent and more common at higher doses 2, 4