Nifedipine ER (GITS)
PROCARDIA XL
Pronunciation: nye-FED-i-peen
“kNife fed a penguin (“Proker” chips)”
What it isNifedipine GITS extended-release (PROCARDIA XL, 1989) blocks L-type calcium channels; hypertension and stable or vasospastic angina.
Why this oneThe once-daily osmotic tablet avoids the rapid peaks, reflex tachycardia and pressure swings of immediate-release nifedipine.
What limits itPeripheral edema often ends treatment; headache, flushing, and reflex tachycardia reflect vasodilation.
FDA-approved for
- hypertension (1989)
- chronic stable / vasospastic angina (1989)
Principal riskReflex tachycardia and peripheral edema
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypotension and reflex tachycardia; overdose can cause severe vasodilatory shock.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 30 or 60 mg QD | Individualized (titrate over 7–14 days) | Titration above 120 mg/day not recommended |
| Vasospastic angina | Adults | 30 or 60 mg QD | Individualized (titrate over 7–14 days) | Above 120 mg/day not recommended; doses >90 mg limited experience in angina — use with caution |
| Chronic stable (effort-associated) angina | Adults symptomatic despite or intolerant of beta blockers and/or nitrates | 30 or 60 mg QD | Individualized (titrate over 7–14 days) | Above 120 mg/day not recommended; doses >90 mg limited experience in angina — use with caution |
| Angina — switch from nifedipine capsules | Adults controlled on IR nifedipine capsules | Nearest equivalent total daily dose QD (e.g., 10 mg TID capsules → 30 mg QD) | Retitrate as clinically warranted | Above 120 mg/day not recommended |
Titration Generally over 7–14 days; may proceed faster (steady state on day 2) if symptoms warrant and patient assessed frequently
Renal No adjustment stated; PK not significantly influenced by renal impairment (rare reversible BUN/creatinine rises in chronic renal insufficiency)
Hepatic No specific dose given; cirrhosis prolongs half-life and raises bioavailability — use caution
Food slightly alters early absorption but not extent (no labeled empty-stomach requirement); GI obstruction/bezoar risk with strictures or GI narrowing
Instructions
- Swallow whole; do not bite, chew, divide, or crush
- Empty tablet shell may appear in stool (normal)
- Avoid grapefruit and grapefruit juice
- If discontinuing, decrease dosage gradually with close supervision
- Dispense the extended-release form as prescribed
- Sublingual nitroglycerin may be used for acute angina, particularly during titration
Available strengths
- ER tab 30, 60, 90 mg
Cautions
- Excessive hypotension (initial titration, with beta blockers, high-dose fentanyl CABG)
- Increased angina and/or myocardial infarction on starting or dose increase
- Beta blocker withdrawal — taper beta blocker first
- Congestive heart failure (risk greater with tight aortic stenosis)
- Gastrointestinal obstruction requiring surgery (bezoars)
- Gastrointestinal ulcers (tablet adherence)
- Dose-dependent peripheral edema
- CYP3A4 inducers (avoid, e.g., phenytoin) and inhibitors (monitor, consider lowest dose)
Adverse reactions
- Edema (dose related)
- Headache
- Fatigue
- Dizziness
- Constipation
- Nausea
Pregnancy Teratogenic and embryo-/fetotoxic in animals; no adequate human studies — use only if potential benefit justifies potential risk.
Lactation Nifedipine is transferred into breast milk; use during breast-feeding only if potential benefit justifies potential risk.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 30 mg | ER tab | 30 qd | $3.90 | offered |
| 60 mg | ER tab | 30 qd | $5.04 | offered |
| 90 mg | ER tab | 30 qd | $8.07 | offered |
Other forms: Nifedipine (PROCARDIA)
Open Nifedipine ER (GITS) in the interactive console ↗
Memory aids: interaction avatars
Open Nifedipine ER (GITS) in the interactive console ↗
Self-check
- What release system is used by PROCARDIA XL?
A once-daily osmotic tablet. - What adverse effect often ends nifedipine ER treatment?
Peripheral edema.