Formulary
Nifedipine: Indications, Dosing, Side Effects and Interactions
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions...
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Nifedipine: Indications, Dosing, Side Effects and Interactions
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions...
Drug action
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may be diminished.
Indications and dose
**Raynaud's syndrome**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 5 mg 3 times a day, then adjusted according to response to 20 mg 3 times a day.
**Angina prophylaxis (not recommended)**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 5 mg 3 times a day, then adjusted according to response to 20 mg 3 times a day.
**Postponement of premature labour**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 20 mg, followed by 10-20 mg 3-4 times a day, adjusted according to uterine activity.
**Hiccup in palliative care**
- **Adult** (By Mouth Using Immediate-Release Medicines): 10 mg 3 times a day.
**Chronic anal fissure**
- **Adult** (By Rectum Using Ointment): Apply 2-3 times a day until pain stops. Max. duration of use 8 weeks, apply to anal canal, using 0.2%-0.5% topical preparation.
- **Adult** (By Mouth Using Modified-Release Medicines): 20 mg twice daily until pain stops. Max. duration of use 8 weeks.
**Hypertension,Angina prophylaxis**
- **Adult** (By Mouth): Initially 10 mg twice daily, adjusted according to response to 40 mg twice daily.
**Severe hypertension,Prophylaxis of angina**
- **Adult** (By Mouth): 30 mg once daily, increased if necessary up to 90 mg once daily.
**Hypertensive crisis, Acute angina in Kawasaki disease or progeria for nifedipine**
- **Child** (By mouth using immediate-release medicines): Initially 250-500 micrograms/kg (max. per dose 10 mg), then repeat once if necessary, may cause unpredictable and severe reduction of blood pressure-monitor closely following administration; if ineffective consider alternative treatment and seek specialist advice.
**Hypertension, Angina in Kawasaki disease or progeria for nifedipine**
- **Child 1 month-11 years** (By mouth using immediate-release medicines): 200-300 micrograms/kg 3 times a day, dose frequency depends on preparation used; maximum 3 mg/kg per day; maximum 90 mg per day.
- **Child 12-17 years** (By mouth using immediate-release medicines): 5-20 mg 3 times a day, dose frequency depends on preparation used; maximum 90 mg per day.
**Raynaud's syndrome for nifedipine**
- **Child 2-17 years** (By mouth using immediate-release medicines): 2.5-10 mg 2-4 times a day, start with low doses at night and increase gradually to avoid postural hypotension, dose frequency depends on preparation used.
**Persistent hyperinsulinaemic hypoglycaemia for nifedipine**
- **Neonate** (By mouth using immediate-release medicines): 100-200 micrograms/kg 4 times a day (max. per dose 600 micrograms/kg).
Cautions
For all calcium-channel blockers Elderly Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls). Cautions For nifedipine With systemic use Diabetes mellitus; elderly; heart failure; ischaemic pain; poor cardiac reserve; severe hypotension; short-acting formulations are not recommended for angina or long-term management of hypertension (their use may be associated with large variations in blood pressure and reflex tachycardia); significantly impaired left ventricular function (heart failure deterioration observed) Cautions, further information Systemic absorption following rectal use is unknown, therefore consider the possibility of cautions listed for systemic use. Ischaemic pain Manufacturer advises discontinue if ischaemic pain occurs or existing pain worsens shortly after initiating treatment. Cautions For Valni XL Cautions, further information Dose form not appropriate for use where there is a history of oesophageal or gastro-intestinal obstruction, decreased lumen diameter of the gastro-intestinal tract, inflammatory bowel disease, or ileostomy after proctocolectomy.
Contraindications
With systemic use Acute attacks of angina; cardiogenic shock; significant aortic stenosis; unstable angina; within 1 month of myocardial infarction Contra-indications, further information Systemic absorption following rectal use is unknown, therefore consider the possibility of contra-indications listed for systemic use.
Side effects
For all calcium-channel blockers Common or very common Abdominal pain; dizziness; drowsiness; fatigue; flushing; headache; hypotension; nausea; palpitations; peripheral oedema; skin reactions; tachycardia; vomiting Uncommon Angioedema; depression; erectile dysfunction; gingival hyperplasia; myalgia; paraesthesia; syncope Overdose Features of calcium-channel blocker poisoning include nausea, vomiting, dizziness, agitation, confusion, and coma in severe poisoning. Metabolic acidosis and hyperglycaemia may occur. In overdose, the dihydropyridine calcium-channel blockers cause severe hypotension secondary to profound peripheral vasodilatation. For details on the management of poisoning, see Calcium-channel blockers, under Emergency treatment of poisoning. Side-effects For nifedipine Common or very common Constipation; malaise; oedema; vasodilation Uncommon Allergic oedema; anxiety; chills; diarrhoea; dry mouth; epistaxis; gastrointestinal discomfort; gastrointestinal disorders; joint disorders; laryngeal oedema; migraine; muscle complaints; nasal congestion; pain; sleep disorders; tremor; urinary disorders; vertigo; vision disorders Rare or very rare Appetite decreased; burping; cardiovascular disorder; fever; hyperhidrosis; mood altered; sensation abnormal Frequency not known Agranulocytosis; bezoar; cerebral ischaemia; chest pain; dysphagia; dyspnoea; eye pain; gingival disorder; gynaecomastia (following long term use); hepatic disorders; hyperglycaemia; ischaemic heart disease; leucopenia; myasthenia gravis aggravated; photoallergic reaction; pulmonary oedema; telangiectasia; toxic epidermal necrolysis; weight decreased Side-effects, further information Systemic absorption following rectal use is unknown therefore consider the possibility of side-effects listed for oral use.
Interactions
**Other interactions (24):**
- Drugs that affect nifedipine Nifedipine is metabolised via the cytochrome P450 3A4 system, located both in the intestinal mucosa and in the liver.
- Drugs that are known to either inhibit or to induce this enzyme system may therefore alter the first pass (after oral administration) or the clearance of nifedipine (see Section 4.4).
- The extent as well as the duration of interactions should be taken into account when administering nifedipine together with the following drugs: Rifampicin: Rifampicin strongly induces the...
- Upon co-administration with rifampicin, the bioavailability of nifedipine is distinctly reduced and thus its efficacy weakened.
- Upon co-administration of known inhibitors of the cytochrome P450 3A4 system, the blood pressure should be monitored and, if necessary, a reduction in the nifedipine dose considered (see Sections...
- In the majority of these cases, no formal studies to assess the potential for a drug interaction between nifedipine and the drug(s) listed have been undertaken, thus far.
Pregnancy
With systemic use: May inhibit labour; manufacturer advises avoid before week 20, but risk to fetus should be balanced against risk of uncontrolled maternal hypertension. Use only if other treatment options are not indicated or have failed.
Breast feeding
With systemic use: Amount too small to be harmful but manufacturers advise avoid.
Hepatic impairment
For all calcium-channel blockers In general, manufacturers advise caution (risk of increased exposure). Hepatic impairment For nifedipine With oral use: For once-daily preparations, manufacturers advise dose form not appropriate (owing to the duration of action of the formulation). Dose adjustments With oral use: Manufacturer advises consider dose reduction in severe impairment.
Medicinal forms
Suspension,Tablet,Capsule,Capsule,Drops
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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