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CARDIOVASCULAR SYSTEM › CALCIUM CHANNEL BLOCKERS › SELECTIVE CALCIUM CHANNEL BLOCKERS WITH MAINLY VASCULAR EFFECTS › Dihydropyridine derivatives
nifedipine, combinations
C08CA55
Forms & Strengths
- Extended-release tablets: 20 mg, 30 mg, 60 mg, 90 mg
Adult Dosing
- Hypertension: Initial 30 mg to 60 mg once daily extended-release; adjust every 7 to 14 days; maximum 90 mg once daily
- Angina pectoris: Initial 30 mg to 60 mg once daily extended-release; maximum 90 mg once daily
Pediatric Dosing
- Safety and efficacy not established in pediatric patients
Indications
- Management of hypertension
- Management of chronic stable angina pectoris
- Vasospastic (Prinzmetal's) angina
Mechanism of Action
- Inhibits transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle
- Dilates main coronary arteries and arterioles, improving myocardial oxygen delivery
- Decreases total peripheral resistance, reducing blood pressure and myocardial oxygen demand
Contraindications
- Hypersensitivity to nifedipine or other dihydropyridines
- Concomitant use with strong CYP3A4 inducers (e.g., rifampin)
- Immediate-release formulation for acute hypertension or pain relief due to severe hypotension risk
- Cardiogenic shock
Adverse Reactions
- Peripheral edema
- Headache
- Dizziness
- Flushing
- Palpitations
- Fatigue
- Nausea
- Hypotension
Drug Interactions
- CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) increase nifedipine plasma concentrations and toxicity risk
- CYP3A4 inducers (e.g., rifampin, phenytoin) significantly decrease nifedipine efficacy
- Beta-blockers may rarely precipitate heart failure or severe hypotension
- Fentanyl anesthesia can cause severe hypotension
- Grapefruit juice inhibits intestinal CYP3A4, increasing nifedipine exposure
Curated Content: Needs Vetting Before Put to Clinical Use