Nifedipine

DEA Class; Rx

Common Brand Names; Procardia, Procardia XL, Adalat CC, Nifedical XL, Adalat, Afeditab CR, Nifediac CC

• Calcium Channel Blockers; 
• Calcium Channel Blockers, Dihydropyridine

Indicated for the treatment of variant angina (Prinzmetal angina) and chronic stable angina.

Hypersensitivity to nifedipine or other calcium-channel blockers

Cardiogenic shock

Concomitant administration with strong CYP3A4 inducers (eg, rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, St John’s wort) significantly reduces nifedipine efficacy

Immediate release preparation (sublingually or orally) for urgent or emergent hypertension

Adverse effects differ between short-acting (conventional) and extended-release formulations, with the conventional preparations having more serious adverse drug reactions in some cases

• Peripheral edema (10-30%)
• Dizziness (23-27%)
• Flushing (23-27%)
• Headache (10-23%)
• Heartburn (11%)
• Nausea (11%)
• Muscle cramps (8%)
• Mood change (7%)
• Nervousness (7%)
• Cough (6%)
• Dyspnea (6%)
• Palpitations (6%)
• Wheezing (6%)
• Hypotension, transient (5%)
• Urticaria (2%)
• Pruritus (2%)
• Constipation (<2%)
• Chest pain (<2%)

Use with caution in (≤4 weeks) myocardial infarction (MI), congestive heart failure (CHF), advanced aortic stenosis, peripheral edema, symptomatic hypotension, unstable angina, concurrent use of beta blockers, hepatic or renal impairment, persistent progressive dermatologic reactions, exacerbation of angina (during initiation of treatment, after a dose increase, or after withdrawal of beta blocker)

Short-acting nifedipine may be less safe than other calcium-channel blockers in management of angina, hypertension, or acute MI

Use cautiously in combination with quinidine

Conventional (short-acting) form not indicated for hypertension

Use extended-release form with caution in severe GI stenosis; rare reports of GI obstructive symptoms in patients with known strictures or without history of GI obstruction in association with ingestion of long-acting nifedipine; bezoars can occur in very rare cases and may necessitate surgical intervention

Extended-release form contains lactose; thus, patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption should not take this medicine

Cirrhosis: Clearance reduced and systemic exposure increased

CYP3A inhibitors (eg, ketoconazole, fluconazole, itraconazole clarithromycin, erythromycin, grapefruit, nefazodone, saquinavir, indinavir, nelfinavir, ritonavir) may inhibit nifedipine metabolism and result in increased exposure when coadministered

Strong CYP3A inducers (eg, rifampin, rifabutin, phenobarbital, phenytoin, carbamazepine, and St John’s wort) may enhance nifedipine metabolism and result in decreased exposure when coadministered

Avoid use in heart failure due to lack of benefit, and/or worse outcomes with calcium channel blockers in general

Use with caution in patients with hypertrophic cardiomyopathy and outflow tract obstruction; reduction in afterload may worsen symptoms associated with this condition

Avoid use of immediate release formulation in the elderly; may cause hypotension and risk precipitating myocardial ischemia

Pregnancy category: C

Lactation: Drug is distributed into breast milk; manufacturer suggests discontinuing drug or refraining from nursing (however, American Academy of Pediatrics states that drug is safe for nursing)