What are the recommended dosing regimens of nifedipine (immediate‑release and extended‑release) for adults and children?

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Last updated: February 16, 2026 • View editorial policy

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Nifedipine Dosing Recommendations

For adults with hypertension or angina, use extended-release nifedipine 30-90 mg once daily as first-line, with titration up to 180 mg daily for angina if needed; avoid immediate-release formulations unless combined with beta-blockers due to serious cardiovascular risks. 1

Adult Dosing by Indication

Hypertension

  • Start at 30 mg once daily of extended-release formulation and titrate upward based on response 1
  • Allow at least 4 weeks between dose adjustments to observe full therapeutic effect 1
  • Maximum dose: 120 mg daily for standard hypertension management 1
  • For resistant hypertension, doses up to 180 mg daily may be used 1
  • Most patients require combination therapy; use submaximal doses of two drugs rather than maximal doses of a single agent to minimize side effects 1

Angina

  • Extended-release: 30-180 mg once daily (preferred formulation) 1, 2
  • Immediate-release: 30-90 mg daily divided into multiple doses, only with concomitant beta-blockade 1, 2
  • Higher doses up to 180 mg daily may be required for adequate angina control 1

Critical Safety Warning for Immediate-Release Formulations

Immediate-release nifedipine capsules should not be prescribed due to safety concerns with precipitous blood pressure drops that can cause myocardial infarction. 1 The American College of Cardiology explicitly contraindicates immediate-release nifedipine for unstable angina/NSTEMI unless given with beta-blockade 1, 3, 2. Sublingual or rapid administration can cause uncontrolled hypotension leading to end-organ damage 1.

Pediatric Dosing

Hypertension (Ages 6-17 Years)

  • Extended-release: up to 120 mg per day (approximately 3 mg/kg/day) 1
  • Administer once daily or twice daily to maintain consistent plasma concentrations 1

Pulmonary Hypertension

  • Starting dose: 0.1-0.2 mg/kg orally three times daily 1
  • Dose range: 2-3 mg/kg/day 1
  • Maximum: 180 mg/day (adult dose ceiling) 1
  • Note: Only 10-15% of pediatric patients with pulmonary arterial hypertension will have a positive acute vasoreactive response to calcium channel blockers 1

Special Population Considerations

Elderly Patients

  • Initiate at 30 mg once daily of extended-release formulation 1
  • Monitor closely for hypotension, dizziness, and falls due to decreased baroreceptor response 1
  • Dihydropyridine calcium antagonists like nifedipine are particularly indicated for isolated systolic hypertension in the elderly 1

Pregnancy

  • Avoid immediate-release nifedipine unless no alternative antihypertensive agents are available 1
  • Never combine with magnesium sulfate due to risk of uncontrolled hypotension and fetal compromise 1
  • Methyldopa remains first-line for hypertension in pregnancy 1
  • If nifedipine is used, therapeutic doses range from 10-30 mg orally every 6-8 hours 4

Patients with Cardiac Dysfunction

  • Avoid all calcium channel blockers in severe left ventricular dysfunction or pulmonary edema 1, 2
  • Contraindicated in advanced aortic stenosis 1
  • For mild left ventricular dysfunction, amlodipine and felodipine are better tolerated than nifedipine 2

Formulation-Specific Considerations

Extended-Release vs Immediate-Release

  • Extended-release maintains therapeutic levels for approximately 24 hours with once-daily dosing, providing more consistent plasma concentrations and better adherence 1
  • Immediate-release requires multiple daily doses; 120 mg liquid would need division throughout the day to approximate steady levels of a single 120 mg XL tablet 1
  • Pharmacokinetic differences between ER formulations can include 20-25% differences in drug exposure, which may impact blood pressure control when switching formulations 3, 2

For Patients Unable to Swallow Tablets

  • Consider alternative calcium channel blockers available in liquid formulations rather than immediate-release nifedipine liquid 1

Combination Therapy

  • Nifedipine combines effectively with beta-blockers or ACE inhibitors for enhanced blood pressure control 1
  • Combination therapy allows use of submaximal doses with larger blood pressure responses and fewer side effects 1

Common Pitfalls to Avoid

  • Never use immediate-release nifedipine for acute hypertensive emergencies; use intravenous nicardipine instead 1
  • Do not use sublingual administration due to unpredictable and potentially dangerous blood pressure drops 1
  • Avoid switching between extended-release formulations without monitoring, as bioavailability differences may affect control 3, 2
  • Do not exceed 180 mg daily for any indication 1

Expected Side Effects (Dose-Related)

  • Peripheral edema, headache, flushing, dizziness, hypotension, nausea, and constipation are common vasodilatory effects 1, 2
  • Extended-release nifedipine may cause slightly more edema than amlodipine 1
  • Monitor for orthostatic hypotension, particularly in elderly patients 1

References

1
Guideline

Nifedipine Dosing Guidelines for Hypertension and Angina

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Nifedipine Treatment Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Nifedipine ER Formulation Considerations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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