What is the dosing for Nifedipine (Adalat) Extended Release (XL)?

From the Guidelines

Nifedipine XL should be dosed at 30 to 180 mg orally once daily, with the specific dose titrated based on the patient's blood pressure response and clinical condition, as indicated in the guidelines 1. The dosing of Nifedipine XL is crucial for managing hypertension and other cardiovascular conditions.

• The medication is typically started at a dose of 30 mg once daily for most adults.
• The dose can be adjusted up to 60 mg or 90 mg once daily based on the patient's blood pressure response.
• For elderly patients or those with hepatic impairment, it is advisable to start at a lower dose of 30 mg.
• Nifedipine XL should be taken at the same time each day, swallowed whole without crushing or chewing, and can be taken with or without food.
• The medication works by blocking calcium channels in vascular smooth muscle and cardiac cells, causing vasodilation and reducing peripheral resistance, which lowers blood pressure.
• Patients should be monitored for common side effects including peripheral edema, headache, flushing, and dizziness.
• Blood pressure should be checked regularly to ensure adequate response, and dose adjustments should be made at intervals of 7-14 days to allow the medication to reach steady state.
• Abrupt discontinuation should be avoided as it may lead to rebound hypertension, as noted in the guidelines 1. Key considerations for the use of Nifedipine XL include:
• The potential for hypotension, dizziness, flushing, nausea, constipation, and edema as side effects.
• The importance of avoiding rapid-release, short-acting dihydropyridines like nifedipine in the absence of concomitant beta blockade due to increased adverse potential 1.
• The need to avoid verapamil and diltiazem in patients with pulmonary edema or evidence of severe LV dysfunction 1.

From the FDA Drug Label

The bioavailability of nifedipine from nifedipine extended-release tablets relative to immediate release tablets is in the range of 84%-89%. After ingestion of nifedipine extended-release tablets under fasting conditions, plasma concentrations peak at about 2. 5-5 hours with a second small peak or shoulder evident at approximately 6-12 hours post dose. When nifedipine extended-release tablets are administered as multiples of 30 mg tablets over a dose range of 30 mg to 90 mg, the area under the curve (AUC) is dose proportional; however, the peak plasma concentration for the 90 mg dose given as 3 x 30 mg is 29% greater than predicted from the 30 mg and 60 mg doses Two 30 mg nifedipine extended-release tablets may be interchanged with a 60 mg nifedipine extended-release tablet. Three 30 mg nifedipine extended-release tablets, however, result in substantially higher Cmax values than those after a single 90 mg nifedipine extended-release tablet. Once daily dosing of nifedipine extended-release tablets under fasting conditions results in decreased fluctuations in the plasma concentration of nifedipine when compared to t.i. d. dosing with immediate release nifedipine capsules.

The dosing for Nifedipine XL is as follows:

• Dose range: 30 mg to 90 mg
• Administration: Once daily
• Interchangeability: Two 30 mg tablets can be interchanged with a 60 mg tablet, but three 30 mg tablets should not be interchanged with a 90 mg tablet due to substantially higher Cmax values 2
• Peak plasma concentration: 2.5-5 hours with a second small peak or shoulder at approximately 6-12 hours post dose
• Bioavailability: 84%-89% relative to immediate release tablets 2

From the Research

Nifedipine XL Dosing

• Nifedipine XL, a long-acting formulation, is used to manage essential hypertension and angina 3.
• The initial dose of nifedipine XL can be 30 mg once daily, which can be increased to 60 mg once daily if blood pressure is not adequately controlled 4.
• Nifedipine XL has been shown to be effective in reducing blood pressure, with a mean decrease in systolic blood pressure of 28.5 mmHg and diastolic blood pressure of 16.4 mmHg 4.
• The efficacy and safety of nifedipine XL are comparable to other calcium channel blockers, such as amlodipine 4, 5.
• However, nifedipine XL may cause peripheral edema, particularly when used at high doses or in combination with other medications 6, 7.
• Combining nifedipine XL with renin-angiotensin system blockers or diuretics may reduce the risk of peripheral edema 6.
• Long-acting nifedipine formulations, such as nifedipine XL, offer therapeutic advantages beyond hypertension management, including efficacy in treating comorbid conditions like chronic kidney disease and diabetes 3.