nifedipine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
nifedipine: clinical details
Prescribing considerations
- Confirm the exact modified-release product because licensed indications, release profiles and administration instructions differ.
- Not suitable for terminating an acute angina episode.
- Use caution with hypotension, poor cardiac reserve or heart failure, diabetes, dialysis with hypovolaemia and hepatic impairment.
- Review CYP3A4 inhibitors, inducers, grapefruit exposure and additive cardiovascular medicines.
- Check formulation-specific gastrointestinal and excipient warnings.
Contraindications and cautions
- Product-specific contraindications commonly include hypersensitivity to nifedipine or other dihydropyridines, cardiogenic shock, clinically significant aortic stenosis, unstable angina and recent myocardial infarction.
- Rifampicin co-administration is contraindicated.
- Some selected formulations additionally contraindicate acute porphyria, Kock pouch, gastrointestinal obstruction or narrowing, inflammatory bowel disease, hepatic impairment, pregnancy or breastfeeding. Check the exact SmPC.
Monitoring
- Blood pressure and symptoms of excessive hypotension, particularly after initiation, switching or interacting medicines.
- Peripheral oedema, worsening angina and features of heart failure.
- Clinical response when CYP3A4 inducers or inhibitors are started or stopped.
- Liver impairment and diabetic control where relevant.
- Digoxin or tacrolimus concentrations when clinically indicated.
Clinical pharmacology
A vascular-selective 1,4-dihydropyridine L-type calcium-channel antagonist. Arterial vasodilation reduces peripheral resistance and afterload, while coronary vasodilation can improve myocardial perfusion. It is metabolised in the gut wall and liver through CYP3A4.
Formulation and product differences
- Modified-release products have different release characteristics and instructions; continuity of the intended product or brand reduces inadvertent switching.
- Some prolonged-release tablets use an osmotic delivery system; an empty tablet shell may appear in the stool.
- Coracten XL is a hard prolonged-release capsule containing minitablets.
- Nifedipress MR and Dexipress MR are film-coated modified-release tablets that must not be crushed, chewed, divided or dissolved.
nifedipine preparations and strengths
Capsule
Route: Oral
Strengths: 10 mg, 20 mg, 60 mg
Modified-release tablet
Route: Oral
Strengths: 10 mg, 20 mg, 30 mg
nifedipine interactions
Nifedipine is extensively affected by CYP3A4 interactions and can add to the effects of other cardiovascular medicines.
Rifampicin
Strongly reduces nifedipine exposure and is contraindicated with the selected products.
Macrolide antibiotics, azole antifungals and HIV protease inhibitors
May increase nifedipine exposure and the risk of low blood pressure or other adverse effects.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.