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Nifedipine

Classification

Dihydropyridine calcium channel blocker

Indications

CCP: Hypertensive emergency

CCP: Angina

Contraindications

Hypersensitivity
Children < 6 years of age
Severe hypotension
Cardiovascular shock
Breast-feeding
Pregnancy or women of childbearing potential.
Ileostomy after proctocolectomy
moderate or severe hepatic impairment
Severe gastrointestinal obstructive disorders
Concomitant use with rifampicin

Adult dosages

CCP: Angina

10 mg PO q 8 hr

CCP: Hypertensive Emergency

30-60 mg (extended release) PO od

Pediatric Considerations And Dosing

CCP: Hypertensive emergency

0.25-0.5 mg/kg/day (extended release) PO in 1 or 2 daily doses. Not to exceed 120 mg/day

Mechanism Of Action

Nifedipine is a calcium channel blocker. Thus, it inhibits transmembrane influx of extracellular calcium ions across myocardial and vascular smooth muscle cell membranes without changing serum calcium concentrations. This results in inhibition of cardiac and vascular smooth muscle contraction, thereby dilating the main coronary and systemic arteries.

Pharmacokinetics

Onset: 20- 30 minutes

Duration: 8- 24 hours

Peak plasma time: 30-120 minutes

Half-life: 2-5 hours

Adverse Effects

Peripheral edema
Dizziness
Headache
Heartburn
Nausea
Muscle cramps
Mood changes
Nervousness
Cough
Dyspnea
Palpitations
Wheezing
Hypotension
Pruritus
Urticaria
Constipation
Chest pain

Warning And Precautions

Use with extreme caution in patients with severe aortic stenosis, as it may reduce coronary perfusion resulting in myocardial ischemia.
Alterations in GI anatomy (eg, severe GI narrowing, history of GI cancer, obstruction, bowel resection, gastric bypass, vertical banded gastroplasty) and underlying hypomotility disorders have led to bezoar formation with extended-release forms.
The American College of Cardiology/American Heart Association heart failure guidelines recommend avoiding use in patients with heart failure.
Use with caution in patients with hepatic impairment.
Hypertrophic cardiomyopathy (HCM) with outflow tract obstruction: Use with caution in patients with HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition.
The use of nondeformable products in patients with known stricture/narrowing of the GI tract (eg, severe gastrointestinal narrowing, colon cancer, obstruction, bowel resection, gastric bypass, vertical banded gastroplasty) has been associated with symptoms of obstruction.
Immediate release formulations should not be used to manage primary hypertension.
Abrupt withdrawal may cause rebound angina in patients with coronary artery disease.
Nifedipine crosses the placenta and an increase in perinatal asphyxia, cesarean delivery, prematurity, and delays in intrauterine growth have been reported following maternal use.

Drug Interactions

Everolimus
Pimozide
Abametapir
Afatinib
Amlodipine
Apalutamide
Dihydroergotamine
Edoxaban
Ergotamine
Erythromycin
Fosphenytoin
Idelalisib
Ivosidenib
Lofexidine
Lonafamib
Lovastatin
Nefazodone
Phenytoin
Pirfenidone
Pomalidomide
Ranolazine
Riociguat
Silodosin
Simvastatin
Sirolimus
Tolvaptan
Tucatinib
Venetoclax
Voxelotor