Can nifedipine extended‑release 90 mg be given twice daily?

Nifedipine ER 90 mg Should Be Given Once Daily, Not Twice Daily

Nifedipine extended-release 90 mg is designed for once-daily administration and should not be split into twice-daily dosing. 1

FDA-Approved Dosing Schedule

• The FDA label explicitly states that nifedipine extended-release tablets should be administered once daily on an empty stomach 1
• The usual maintenance dose range is 30-60 mg once daily, with titration up to 90 mg once daily permitted 1
• Doses above 90 mg daily are not recommended by the FDA 1

Guideline-Based Recommendations

• The ACC/AHA guidelines specify nifedipine LA (long-acting) at 30-90 mg once daily as the standard dosing frequency for hypertension 2
• Multiple clinical guidelines consistently recommend extended-release nifedipine be dosed once daily to maintain stable therapeutic plasma concentrations over 24 hours 3, 4
• The extended-release formulation is specifically engineered to maintain therapeutic blood levels for approximately 24 hours with single daily dosing 3

Why Not Twice Daily?

• Formulation design: Extended-release nifedipine tablets are designed as intact delivery systems that must be swallowed whole and cannot be divided 1
• Pharmacokinetic profile: The ER formulation provides controlled drug release over 24 hours, making twice-daily dosing unnecessary and potentially leading to inappropriate peak-trough variations 3
• Clinical evidence: Studies demonstrate that once-daily ER formulations provide superior persistence and compliance compared to twice-daily formulations, with patients on once-daily dosing showing 1.3 times better persistence 5

Important Clinical Caveats

• If blood pressure control is inadequate at 90 mg once daily, consider adding a second antihypertensive agent from a different class rather than splitting the dose or exceeding 90 mg 2, 1
• Never confuse formulations: Immediate-release nifedipine requires multiple daily doses but should be avoided entirely due to safety concerns unless given with beta-blockade 3, 4
• Slow-release (retard) formulations that require twice-daily dosing are different products than the extended-release 24-hour formulation 6, 5

Practical Algorithm

1. Start: Nifedipine ER 30 mg once daily 1
2. Titrate: Increase to 60 mg once daily after 7-14 days if needed 1
3. Maximum monotherapy: 90 mg once daily 1
4. If inadequate control: Add second agent (ACE inhibitor, ARB, or thiazide diuretic) rather than exceeding 90 mg or splitting doses 2