Nifedipine
PROCARDIA
What it isL-type calcium-channel-blocking vasodilator; hypertension, angina, Raynaud phenomenon, and off-label tocolysis.
Why this oneExtended-release nifedipine is a preferred oral antihypertensive in pregnancy and also treats Raynaud vasospasm.
What limits itImmediate-release use can provoke reflex tachycardia and ischemia; edema and CYP3A4 interactions remain common problems.
FDA-approved for
- angina (1981)
- hypertension (~1985)
Off-label
- Raynaud phenomenon
- high-altitude illness
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | adult | 30 or 60 mg QD | individualized QD | 120 mg/day |
| Angina | adult | 30 or 60 mg QD | up to 90 mg QD | 120 mg/day |
Titration Titrate over 7–14 days (may proceed faster if warranted; steady state by day 2)
Renal Undefined
Hepatic Undefined
Instructions
- Swallow whole; do not bite or divide
- Avoid grapefruit juice
- If discontinuing, taper gradually under physician supervision
- Sublingual nitroglycerin may be used for acute angina
Cautions
- Excessive hypotension
- GI obstruction/bezoar and tablet adherence with ulceration (rare)
- Caution in congestive heart failure
- Exfoliative/bullous skin reactions (rare)
Adverse reactions
- Edema (dose-related)
- Headache
- Flushing
- Dizziness
- Asthenia
- Palpitations
- Nausea
Pregnancy Animal teratogenicity; use during pregnancy only if potential benefit justifies risk; no adequate human studies
Lactation Undefined
NO BOXED WARNINGS
Principal riskReflex tachycardia and peripheral edema
Cost, est. cash$5–$150/month
Generic entry1990
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypotension and reflex tachycardia; overdose can cause severe vasodilatory shock.
Mechanism of action: Nifedipine ballicule
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