Official reprint from UpToDate®

www.uptodate.com ©2017 UpToDate®

Nifedipine: Drug information

Copyright 1978-2017 Lexicomp, Inc. All rights reserved.

(For additional information see "Nifedipine: Patient drug information" and see "Nifedipine: Pediatric drug
information")

For abbreviations and symbols that may be used in Lexicomp (show table)

Brand Names: US Adalat CC; Afeditab CR; Nifediac CC [DSC]; Nifedical XL [DSC]; Procardia; Procardia
XL

Brand Names: Canada Adalat XL; Apo-Nifed PA; Mylan-Nifedipine Extended Release; Nifedipine ER;
PMS-Nifedipine; PMS-Nifedipine ER

Pharmacologic Category Antianginal Agent; Antihypertensive; Calcium Channel Blocker; Calcium

Channel Blocker, Dihydropyridine

Dosing: Adult Dosage adjustments should occur at 7- to 14-day intervals to allow for adequate
assessment of new dose; however, if clinically indicated, titration may be done more rapidly with appropriate
monitoring; when switching from immediate-release to sustained-release formulations, use same total daily
dose.

Chronic stable or vasospastic angina: Oral:

Immediate release: Initial: 10 mg 3 times daily; usual dose: 10 to 20 mg 3 times daily; coronary
artery spasm may require up to 20 to 30 mg 3 to 4 times daily; single doses >30 mg and total daily
doses >120 mg are rarely needed; maximum: 180 mg daily; Note: Do not use for acute anginal
episodes; may precipitate myocardial infarction

Extended release: Initial: 30 or 60 mg once daily; titrate as clinically indicated. Doses >90 mg daily
should be used with caution and only if necessary (maximum: 120 mg daily)

Hypertension: Oral: Extended release: Initial: 30 or 60 mg once daily; usual dosage range (ASH/ISH
[Weber 2014]): 30 to 90 mg daily; maximum: 90 to 120 mg daily

Achalasia (off-label use): Sublingual: 10 to 30 mg administered 30 to 45 minutes before meals. Note:

Clinical response is short acting and use does not provide complete relief of symptoms; consider risks
before use (ACG [Vaezi 2013]).

Hypertension emergency in pregnancy (systolic BP ≥160 mm Hg or diastolic BP ≥110 mm Hg) (off-

label dose): Oral: Immediate release: 10 mg; may repeat with a 20 mg dose in 20 minutes if needed.
Also refer to administration protocols developed by the American College of Obstetricians and
 Gynecologists (ACOG 2015).

High altitude pulmonary edema (off-label use): Oral:

Prevention: ER: 30 mg every 12 hours starting the day before ascent and may be discontinued after
staying at the same elevation for 5 days or if descent initiated (WMS [Luks 2014]).

Treatment: ER: 30 mg every 12 hours (WMS [Luks 2014]).

Pulmonary hypertension (off-label use): Oral: Note: Guidelines recommend the sustained-release
formulation, which is not available in the US; dosing is provided empirically for the ER formulation.

ER: Initial: 60 mg once daily (initiate after demonstrating acute vasoreactivity); may increase
cautiously to 120 to 240 mg/day (ESC [Galie 2016]; Taichman 2014).

Raynaud's phenomenon (off-label use): Oral:

Extended release: Dosage range: 30 to 120 mg once daily (Thompson 2005; Wigley 2002)

Immediate release: 10 to 30 mg 3 times daily (Thompson 2005; Wigley 2002)

Ureteral calculi (distal) (off-label use): Oral: 10 to 30 mg 3 times daily for up to 4 weeks or until
expulsion of lower stones (Ye 2011; Zhang 2009)

Dosing: Pediatric
(For additional information see "Nifedipine: Pediatric drug information")

High altitude pulmonary edema (off-label use; Pollard, 2001): Oral: Note: Treatment with NIFEdipine is
only necessary if response to oxygen and/or descent is unsatisfactory; extended release preparation is
preferred, but with proper dose and frequency adjustment:

Immediate release: 0.5 mg/kg/dose (maximum: 20 mg/dose) every 8 hours

Hypertension (off-label use): Oral: Children 1 to 17 years: Extended release tablet: Initial: 0.2 to 0.5
mg/kg/day once daily or in 2 divided doses; maximum: 3 mg/kg/day up to 120 mg daily

Dosing: Geriatric Refer to adult dosing. In the management of hypertension, consider lower initial
doses and titrate to response (Aronow 2011).

Dosing: Renal Impairment There are no dosage adjustments provided in manufacturer's labeling
(has not been studied); the pharmacokinetics of nifedipine are not significantly influenced by the degree of
renal impairment (only trace amounts of unchanged drug are found in urine).

Hemodialysis: Supplemental dose is not necessary.

Peritoneal dialysis effects: Supplemental dose is not necessary.

Dosing: Hepatic Impairment There are no dosage adjustments provided in manufacturer's labeling
(has not been studied); use with caution. Clearance of nifedipine is reduced in cirrhotic patients, which may
lead to increased systemic exposure; monitor closely for adverse effects/toxicity and consider dose
adjustments.

Dosage Forms Excipient information presented when available (limited, particularly for generics);
consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Procardia: 10 mg

Generic: 10 mg, 20 mg

Tablet Extended Release 24 Hour, Oral:

Adalat CC: 30 mg [DSC]

Adalat CC: 30 mg [contains corn starch]

Adalat CC: 60 mg [DSC]

Adalat CC: 60 mg [contains corn starch]

Adalat CC: 90 mg [DSC]

Adalat CC: 90 mg [contains corn starch]

Afeditab CR: 30 mg, 60 mg

Nifediac CC: 30 mg [DSC], 60 mg [DSC]

Nifedical XL: 30 mg [DSC], 60 mg [DSC]

Procardia XL: 30 mg, 60 mg, 90 mg

Generic: 30 mg, 60 mg, 90 mg

Generic Equivalent Available (US) Yes

Administration
Immediate release: In general, may be administered with or without food.

Extended release: Tablets should be swallowed whole; do not crush, split, or chew.

Adalat CC, Afeditab CR, Nifediac CC: Administer on an empty stomach (per manufacturer). Other
extended release products may not have this recommendation; consult product labeling.

Use Management of chronic stable or vasospastic angina; treatment of hypertension (ER products only)

Guideline recommendations:

Hypertension:
 The 2014 guideline for the management of high blood pressure in adults (JNC 8) recommends
initiation of pharmacologic treatment to lower blood pressure for the following patients (JNC 8
[James, 2013]):

• Patients ≥60 years with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood
pressure (DBP) ≥90 mm Hg.

• Patients <60 years with SBP ≥140 mm Hg or DBP ≥90 mm Hg.

• Patients ≥18 years with diabetes with SBP ≥140 mm Hg or DBP ≥90 mm Hg.

• Patients ≥18 years with chronic kidney disease (CKD) with SBP ≥140 mm Hg or DBP ≥90
mm Hg.

Chronic kidney disease (CKD) and hypertension: In patients with chronic kidney disease (CKD),
regardless of race or diabetes status, the use of an ACE inhibitor (ACEI) or angiotensin
receptor blocker (ARB) as initial therapy is recommended to improve kidney outcomes. In the
general nonblack population (without CKD) including those with diabetes, initial
antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker,
ACEI, or ARB. In the general black population (without CKD) including those with diabetes,
initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium
channel blocker instead of an ACEI or ARB.

Diabetes and hypertension: The American Diabetes Association (ADA) guidelines suggest that
for patients with hypertension and diabetes without albuminuria, any of the 4 classes of blood
pressure medications (eg, ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics,
dihydropyridine calcium channel blockers) may be used and have shown beneficial
cardiovascular outcomes (ADA 2017a).

Use: Off-Label
Achalasia; High altitude pulmonary edema (prevention and treatment); Hypertensive emergency in
pregnancy; Preterm labor; Pulmonary hypertension; Raynaud phenomenon; Ureteral calculi (distal)

Medication Safety Issues

Sound-alike/look-alike issues:

NIFEdipine may be confused with niCARdipine, niMODipine, nisoldipine

Procardia XL may be confused with Cartia XT

Geriatric Patients: High-Risk Medication:

Beers Criteria: Nifedipine (immediate release) is identified as a potentially inappropriate medication

to be avoided in patients 65 years and older (independent of diagnosis or condition) due to its
potential to cause hypotension and risk for precipitating myocardial ischemia (Beers Criteria [AGS
 2015]).

Pharmacy Quality Alliance (PQA): Nifedipine (immediate release) is identified as a high-risk

medication in patients 65 years and older on the PQA’s, Use of High-Risk Medications in the Elderly
(HRM) performance measure, a safety measure used by the Centers for Medicare and Medicaid
Services (CMS) for Medicare plans.

International issues:

Depin [India] may be confused with Depen brand name for penicillamine [US]; Depon brand name
for acetaminophen [Greece]; Dipen brand name for diltiazem [Greece]

Nipin [Italy and Singapore] may be confused with Nipent brand name for pentostatin [US, Canada,
and multiple international markets]

Adverse Reactions
>10%:

Cardiovascular: Flushing (10% to 25%; extended release: 3% to 4%), peripheral edema (7% to 30%)

Central nervous system: Dizziness (10% to 27%), headache (10% to 23%)

Gastrointestinal: Heartburn (≤11%), nausea (≤11%)

1% to 10%:

Cardiovascular: Palpitations (≤7%), transient hypotension (5%), cardiac failure (2%)

Central nervous system: Mood changes (≤7%), nervousness (≤7%), fatigue (6%), chills (≤2%),
disturbed sleep (≤2%), equilibrium disturbance (≤2%), jitteriness (≤2%), shakiness (≤2%)

Dermatologic: Dermatitis (≤2%), diaphoresis (≤2%), pruritus (≤2%), urticaria (≤2%)

Gastrointestinal: Gingival hyperplasia (≤10%), sore throat (≤6%), abdominal cramps (≤2%),
constipation (≤2%), diarrhea (≤2%), flatulence (≤2%)

Genitourinary: Sexual difficulty (≤2%)

Neuromuscular & skeletal: Muscle cramps (≤8%), tremor (≤8%), weakness (<3%), joint stiffness
(≤2%)

Ophthalmic: Blurred vision (≤2%)

Respiratory: Cough (≤6%), nasal congestion (≤6%), wheezing (≤6%), chest congestion (≤2%),
dyspnea (≤2%)

Miscellaneous: Fever (≤2%), inflammation (≤2%)

<1%, postmarketing, and/or case reports: Acute generalized exanthematous pustulosis,

agranulocytosis, alopecia, altered sense of smell, anemia, aplastic anemia, angina pectoris,
 angioedema, arthritis (with positive ANA), bezoar formation, cardiac arrhythmia, cerebral ischemia,
depression, dysgeusia, epistaxis, extrapyramidal reaction, erectile dysfunction, erythema multiforme,
erythromelalgia, exfoliative dermatitis, facial edema, gastroesophageal reflux disease, gastrointestinal
obstruction, gastrointestinal ulcer, gynecomastia, hematuria, hepatitis (allergic), ischemia, leukopenia,
malignant neoplasm of lip (Friedman 2012), memory impairment, migraine, myalgia, myoclonus,
nocturia, paranoia, parotitis, periorbital edema, polyuria, purpura, skin photosensitivity, Stevens-Johnson
syndrome, syncope, tachycardia, thrombocytopenia, tinnitus, toxic epidermal necrolysis, transient
blindness, ventricular arrhythmia

Contraindications
Hypersensitivity to nifedipine or any component of the formulation

Note: Considered contraindicated in patients with ST-elevation myocardial infarction (STEMI)

(ACCF/AHA [O'Gara 2013]); avoid use (Elkayam 1990; Yancy 2013).

Canadian labeling: Additional contraindications (not in US labeling): Severe hypotension; cardiovascular

shock; breast-feeding; pregnancy or women of childbearing potential. Note: SOGC and ACOG guidelines
recommend nifedipine as a preferred agent for maternal hypertension (ACOG 2013; SOGC [Magee
2014]). Extended release only: Hypersensitivity to other dihydropyridine calcium antagonists; Kock
pouch (ileostomy after proctocolectomy); moderate or severe hepatic impairment; severe
gastrointestinal obstructive disorders

Warnings/Precautions
Concerns related to adverse effects:

• Angina/MI: Increased angina and/or MI have occurred with initiation or dosage titration of
dihydropyridine calcium channel blockers. Reflex tachycardia may occur resulting in angina and/or
MI in patients with obstructive coronary disease, especially in the absence of concurrent beta-
blockade. In patients with unstable angina/non-STEMI, the use of immediate-release nifedipine is
not recommended except with concomitant beta-blockade (ACCF/AHA [Anderson, 2013]).

• Hypotension/syncope: Symptomatic hypotension with or without syncope can rarely occur; blood
pressure must be lowered at a rate appropriate for the patient's clinical condition. The use of
immediate release nifedipine (sublingually or orally) in hypertensive emergencies and urgencies
is neither safe nor effective. Serious adverse events (eg, death, cerebrovascular ischemia,
syncope, stroke, acute myocardial infarction, and fetal distress) have been reported. Immediate
release nifedipine should not be used for acute blood pressure reduction.

• Peripheral edema: The most common side effect is peripheral edema; occurs within 2-3 weeks of
starting therapy.

Disease-related concerns:

• Aortic stenosis: Use with extreme caution in patients with severe aortic stenosis; may reduce
coronary perfusion resulting in myocardial ischemia.
 • Gastrointestinal strictures: Alterations in gastrointestinal anatomy (eg, severe gastrointestinal
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.

• Heart failure (HF): The ACCF/AHA heart failure guidelines recommend to avoid use in patients
with heart failure due to lack of benefit and/or worse outcomes with calcium channel blockers in
general (Yancy, 2013).

• Hepatic impairment: Use with caution in patients with hepatic impairment. Clearance of nifedipine
is reduced in cirrhotic patients leading to increased systemic exposure; monitor closely for adverse
effects/toxicity and consider dose adjustments.

• 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.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency
adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug
interactions database for more detailed information.

Dosage form specific issues:

• Extended release formulation: Consists of drug within a nondeformable matrix; following drug
release/absorption, the matrix/shell is expelled in the stool. 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 (pharmacobezoar).

• Immediate release formulation: Immediate release formulations should not be used to manage
primary hypertension, adequate studies to evaluate outcomes have not been conducted.

• Lactose: Adalat CC tablets contain lactose; do not use with galactose intolerance, Lapp lactase
deficiency, or glucose-galactose malabsorption syndromes.

Other warnings/precautions:

• Surgery: Use with caution before major surgery. Cardiopulmonary bypass, intraoperative blood
loss or vasodilating anesthesia may result in severe hypotension and/or increased fluid
requirements. Consider withdrawing nifedipine (>36 hours) before surgery if possible.

• Withdrawal: Abrupt withdrawal may cause rebound angina in patients with CAD.

Metabolism/Transport Effects Substrate of CYP2D6 (minor), CYP3A4 (major); Note: Assignment

of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits
BCRP/ABCG2, CYP2C9 (weak)
Drug Interactions

(For additional information: Launch drug interactions program)

Alcohol (Ethyl): May increase the serum concentration of NIFEdipine. Risk C: Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Alpha1-Blockers: May enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor
therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine.
Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications
should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy
cannot be withheld, amifostine should not be administered. Risk D: Consider therapy modification

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor
therapy

Antifungal Agents (Azole Derivatives, Systemic): May enhance the adverse/toxic effect of Calcium
Channel Blockers. Specifically, itraconazole may enhance the negative inotropic effects of verapamil or
diltiazem. Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Calcium
Channel Blockers. Fluconazole and isavuconazonium likely exert weaker effects than other azoles and
are addressed in separate monographs. Management: Concurrent use of felodipine or nisoldipine with
itraconazole is specifically contraindicated. Frequent monitoring is warranted with any such
combination; calcium channel blocker dose reductions may be required. Exceptions: Fluconazole;
Isavuconazonium Sulfate. Risk D: Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the
hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk
C: Monitor therapy

Atosiban: Calcium Channel Blockers may enhance the adverse/toxic effect of Atosiban. Specifically,
there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor therapy

Barbiturates: May increase the metabolism of Calcium Channel Blockers. Management: Monitor for
decreased therapeutic effects of calcium channel blockers with concomitant barbiturate therapy.
Calcium channel blocker dose adjustments may be necessary. Nimodipine Canadian labeling
contraindicates concomitant use with phenobarbital. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy
Beta-Blockers: NIFEdipine may enhance the hypotensive effect of Beta-Blockers. NIFEdipine may
enhance the negative inotropic effect of Beta-Blockers. Risk C: Monitor therapy

Bosentan: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk
C: Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance
the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C:
Monitor therapy

Calcium Channel Blockers (Nondihydropyridine): Calcium Channel Blockers (Dihydropyridine) may

enhance the hypotensive effect of Calcium Channel Blockers (Nondihydropyridine). Calcium Channel
Blockers (Nondihydropyridine) may increase the serum concentration of Calcium Channel Blockers
(Dihydropyridine). Risk C: Monitor therapy

Calcium Salts: May diminish the therapeutic effect of Calcium Channel Blockers. Risk C: Monitor therapy

Cimetidine: May increase the serum concentration of Calcium Channel Blockers. Management:
Consider alternatives to cimetidine. If no suitable alternative exists, monitor for increased effects of
calcium channel blockers following cimetidine initiation/dose increase, and decreased effects following
cimetidine discontinuation/dose decrease. Risk D: Consider therapy modification

Cisapride: May increase the serum concentration of NIFEdipine. Reported with sustained release
nifedipine product. Risk C: Monitor therapy

Clopidogrel: Calcium Channel Blockers may diminish the therapeutic effect of Clopidogrel. Risk C:
Monitor therapy

Conivaptan: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Risk X: Avoid combination

CycloSPORINE (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase the serum
concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum
concentration of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk
with Inducers). Risk C: Monitor therapy

CYP3A4 Inducers (Strong): May decrease the serum concentration of NIFEdipine. Risk X: Avoid
combination

CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates (High risk with
Inhibitors). Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates (High risk with
Inhibitors). Risk D: Consider therapy modification

Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot
be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Risk D:
Consider therapy modification

Dapoxetine: May enhance the orthostatic hypotensive effect of Calcium Channel Blockers. Risk C:
Monitor therapy

Dasatinib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk
C: Monitor therapy

Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Digoxin: NIFEdipine may increase the serum concentration of Digoxin. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk
C: Monitor therapy

Efavirenz: May decrease the serum concentration of Calcium Channel Blockers. Risk C: Monitor therapy

Fluconazole: May increase the serum concentration of Calcium Channel Blockers. Risk C: Monitor
therapy

FLUoxetine: May enhance the adverse/toxic effect of NIFEdipine. Risk C: Monitor therapy

Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Risk C: Monitor therapy

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with
Inhibitors). Risk X: Avoid combination

Grapefruit Juice: May increase the serum concentration of NIFEdipine. Risk X: Avoid combination

Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive Agents.
Risk C: Monitor therapy

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering
Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect
of Hypotension-Associated Agents. Risk C: Monitor therapy

Idelalisib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk
X: Avoid combination

Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Risk C:
Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C:
Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Calcium Channel Blockers. Management:
Consider using a noninteracting macrolide. Felodipine Canadian labeling specifically recommends
avoiding its use in combination with clarithromycin. Exceptions: Azithromycin (Systemic); Fidaxomicin;
Roxithromycin; Spiramycin. Risk D: Consider therapy modification

Magnesium Salts: Calcium Channel Blockers may enhance the adverse/toxic effect of Magnesium
Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C:
Monitor therapy

Melatonin: May diminish the antihypertensive effect of Calcium Channel Blockers (Dihydropyridine).
Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor
therapy

MiFEPRIStone: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Management: Minimize doses of CYP3A4 substrates, and monitor for increased
concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine,
dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus. Risk D:
Consider therapy modification

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Nafcillin: May decrease the serum concentration of NIFEdipine. Risk D: Consider therapy modification

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Netupitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Risk C: Monitor therapy

Neuromuscular-Blocking Agents (Nondepolarizing): Calcium Channel Blockers may enhance the

neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor
therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.
Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management:
Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to
obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy
modification
Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

Phenytoin: NIFEdipine may increase the serum concentration of Phenytoin. Phenytoin may decrease the
serum concentration of NIFEdipine. Risk X: Avoid combination

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk
C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering
Agents. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk
C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor
therapy

QuiNIDine: Calcium Channel Blockers (Dihydropyridine) may decrease the serum concentration of
QuiNIDine. Calcium Channel Blockers (Dihydropyridine) may increase the serum concentration of
QuiNIDine. QuiNIDine may increase the serum concentration of Calcium Channel Blockers
(Dihydropyridine). Risk C: Monitor therapy

Sarilumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Risk
C: Monitor therapy

Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Risk C: Monitor therapy

Simeprevir: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Risk C: Monitor therapy

St John's Wort: May decrease the serum concentration of NIFEdipine. Risk X: Avoid combination

Stiripentol: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow
therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any
CYP3A4 substrate used with stiripentol requires closer monitoring. Risk D: Consider therapy
modification

Tacrolimus (Systemic): Calcium Channel Blockers (Dihydropyridine) may increase the serum
concentration of Tacrolimus (Systemic). Risk C: Monitor therapy

Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Risk C: Monitor therapy

VinCRIStine: NIFEdipine may increase the serum concentration of VinCRIStine. Risk C: Monitor therapy
 VinCRIStine (Liposomal): NIFEdipine may increase the serum concentration of VinCRIStine (Liposomal).
Risk C: Monitor therapy

Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor
therapy

Food Interactions Nifedipine serum levels may be decreased if taken with food. Food may decrease
the rate but not the extent of absorption of Procardia XL. Increased nifedipine concentrations resulting in
therapeutic and vasodilator side effects, including severe hypotension and myocardial ischemia, may occur
if nifedipine is taken by patients ingesting grapefruit. Management: Avoid grapefruit/grapefruit juice.

Pregnancy Risk Factor C (show table)

Pregnancy Implications
Adverse events were observed in animal reproduction studies. Nifedipine crosses the placenta and small
amounts can be detected in the urine of newborn infants (Manninen 1991; Silberschmidt 2008). An increase
in perinatal asphyxia, cesarean delivery, prematurity, and intrauterine growth retardation have been reported
following maternal use. Untreated chronic maternal hypertension is also associated with adverse events in
the fetus, infant, and mother. If treatment for chronic hypertension during pregnancy is needed, nifedipine is
one of the preferred agents (ACOG 2013; SOGC [Magee 2014]). Nifedipine is also recommended for the
management of acute onset, severe hypertension (systolic BP ≥160 mm Hg or diastolic BP ≥110 mm Hg)
with preeclampsia or eclampsia in pregnant and postpartum women (ACOG 2015; Magee 2014).

Nifedipine has also been evaluated for the treatment of preterm labor. Tocolytics may be used for the short-
term (48 hour) prolongation of pregnancy to allow for the administration of antenatal steroids and should
not be used prior to fetal viability or when the risks of use to the fetus or mother are greater than the risk of
preterm birth (ACOG 171 2016). Nifedipine is ineffective for maintenance tocolytic therapy (ACOG 171 2016;
Roos 2013).

Breast-Feeding Considerations
Nifedipine is excreted into breast milk.

The relative infant dose (RID) of nifedipine is 0.27% to 3.2% when calculated using the highest breast
milk concentration located and compared to an infant therapeutic dose of 0.25 to 3 mg/kg/day. In
general, breastfeeding is considered acceptable when the RID is <10%; when an RID is >25%
breastfeeding should generally be avoided (Anderson 2016; Ito 2000). Using the highest milk
concentration (53.35 ng/mL), the estimated daily infant dose via breast milk is 8 mcg/kg/day. This milk
concentration was obtained following maternal administration of oral nifedipine 30 mg three times daily
(Ehrenkrantz 1989).

Milk concentrations reached a peak within 1 hour of maternal administration of immediate release
capsules (Ehrenkrantz 1989; Penny 1989). The half-life of nifedipine in breast milk has been reported to
be ~3 hours (Ehrenkrantz 1989).

The use of nifedipine in breastfeeding women for the treatment of Raynaud phenomenon has been
 described in case reports and case series; no adverse events were noted in the infants exposed to
nifedipine via breast milk (Anderson 2004; Barrett 2013; Garrison 2002; Page 2006; Wu 2012).
According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy
should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and
benefits of treatment to the mother.

The Academy of Breastfeeding Medicine recommends the use of nifedipine for the treatment of
Raynaud phenomenon of the nipple in breastfeeding mothers (Berens 2016).

Dietary Considerations Avoid grapefruit juice with all products.

Immediate release: Capsule is rapidly absorbed orally if it is administered without food, but may result
in vasodilator side effects; if flushing is problematic, administration with low-fat meals may decrease. In
general, can take with or without food.

Extended release: Adalat CC, Afeditab CR, Nifediac CC: Take on an empty stomach (manufacturer's
labeling). Other extended release products may not have this recommendation; consult product
labeling.

Monitoring Parameters Heart rate, blood pressure, signs and symptoms of CHF, peripheral edema

Reference Range
Hypertension: The 2014 guideline for the management of high blood pressure in adults (Eighth Joint
National Committee [JNC 8]):

• Patients ≥60 years: Goal of therapy is SBP <150 mm Hg and DBP <90 mm Hg.

• Patients <60 years: Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years with diabetes: Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years with chronic kidney disease (CKD): Goal of therapy is SBP <140 mm Hg and
DBP <90 mm Hg.

Diabetes and hypertension: The American Diabetes Association (ADA) guidelines (ADA 2017a; ADA
2017b):

• Patients ≥18 to ≤65 years: Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 to ≤65 years and at high risk of cardiovascular disease: Goal of therapy is SBP <130
mm Hg and DBP <80 mm Hg (if can be achieved without undue treatment burden).

• Patients ≥65 years (healthy or complex/intermediate health): Goal of therapy is SBP <140 mm Hg
and DBP <90 mm Hg.

• Patients ≥65 years (very complex/poor health): Goal of therapy is SBP <150 mm Hg and DBP <90
mm Hg.
Mechanism of Action Inhibits calcium ion from entering the “slow channels” or select voltage-
sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of
coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in
patients with vasospastic angina; also reduces peripheral vascular resistance, producing a reduction in
arterial blood pressure.

Pharmacodynamics/Kinetics
Onset of action: Immediate release: ~20 minutes

Protein binding (concentration dependent): 92% to 98%; Note: Protein-binding may be significantly
decreased in patients with renal or hepatic impairment

Metabolism: Hepatic via CYP3A4 to inactive metabolites

Bioavailability: Capsule: 40% to 77%; ER: 65% to 89% relative to immediate release capsules;
bioavailability increased with significant hepatic disease

Half-life elimination: Adults: Healthy: 2 to 5 hours; Cirrhosis: 7 hours; Elderly: 7 hours (extended release
tablet)

Excretion: Urine (60% to 80% as inactive metabolites); feces

Pricing: US
Capsules (NIFEdipine Oral)

10 mg (100): $106.84

20 mg (100): $230.26

Capsules (Procardia Oral)

10 mg (100): $301.12

Tablet, 24-hour (Adalat CC Oral)

30 mg (100): $213.19

60 mg (100): $358.33

90 mg (100): $419.89

Tablet, 24-hour (Afeditab CR Oral)

30 mg (100): $125.79

60 mg (100): $224.07

Tablet, 24-hour (NIFEdipine ER Oral)

 30 mg (100): $139.40

60 mg (100): $248.32

90 mg (100): $302.84

Tablet, 24-hour (NIFEdipine ER Osmotic Release Oral)

30 mg (100): $132.45

60 mg (100): $229.15

90 mg (100): $256.15

Tablet, 24-hour (Procardia XL Oral)

30 mg (100): $679.49

60 mg (100): $1175.84

90 mg (100): $1356.66

Disclaimer: The pricing data provide a representative AWP and/or AAWP price from a single manufacturer
of the brand and/or generic product, respectively. The pricing data should be used for benchmarking
purposes only, and as such should not be used to set or adjudicate any prices for reimbursement or
purchasing functions. Pricing data is updated monthly.

Brand Names: International Adalat (AE, AR, AT, BE, BF, BH, BJ, BR, CH, CI, CL, CR, CZ, DE, DK, DO,
EE, EG, ES, ET, FI, GB, GH, GM, GN, GR, GT, HK, HN, HR, HU, ID, IE, IT, JO, JP, KE, KR, KW, LR, LU, MA, ML, MR,
MT, MU, MW, MX, MY, NE, NG, NI, NO, PA, PE, PH, PK, PL, PT, QA, RU, SA, SC, SD, SE, SL, SN, SV, TN, TR, TZ,
UA, UG, UY, VE, VN, ZA, ZM, ZW); Adalat 10 (AU); Adalat 20 (AU); Adalat CR (BG, CH, CY, GR, JP, RO, TH);
Adalat Crono (IT); Adalat GITS (CN, HK); Adalat GITS 30 (PH); Adalat L (JP); Adalat LA (BH, ET, GB, KW, LB,
LK, MT, MY, SG); Adalat LP (FR); Adalat Oros (AU, BB, BM, BR, BS, BZ, CL, CO, DK, EC, EE, ES, FI, GY, ID, IS, JM,
KR, LU, NL, NO, NZ, PE, PR, PY, SE, SI, SR, TT, TW, UY, VE); Adalat Retard (AE, AT, BF, BH, BJ, CI, CL, CR, CZ,
DE, EG, ES, ET, GB, GH, GM, GN, GR, GT, HK, HN, ID, IQ, IR, JO, KE, KW, LR, LU, LY, MA, ML, MR, MT, MU, MW,
MY, NE, NG, NI, OM, PA, PE, PH, PL, PY, QA, SA, SC, SD, SL, SN, SV, SY, TN, TZ, UG, YE, ZM, ZW); Adalate (FR);
Addos XR (AU); Adefin (AU); Adefin XL (AU); Adifen SR (MY); Adipine XL (GB); Alonix-S (TW); Altapres (PH);
Ampine (BD); Anifa (LK); Aprical (DE, LU); Atanaal Softcap (TW); Calcibloc (PH); Calcibloc OD (PH); Calcicor
(ET); Calcigard (IN, SG, TH); Calcigard Retard (ZW); Cardifen (ZA); Cardiiopine (AE); Chronadalate LP (FR);
Citilat (IT); Coracten (AE, BH, CY, DE, EG, GB, IQ, IR, JO, KW, LB, LY, OM, SA, SY, YE); Coral (IT); Cordaflex (BG,
HU, VN); Cordilat (MX); Cordipen (SG); Cordipen Retard (SG); Cordipin (HK, HR); Cordipin Retard (HR);
Cordipin XL (HR, LV); Corinfar (HU, LV); Corinfar Retard (LV); Corotrend (DE); Depin (IN); Depin-E Retard (TH);
Dignokonstant (DE); Dipinkor (ID); Duranifin (DE); Ecodipin (CH); Epilat (QA); Fenamon (AE, BF, BH, BJ, CI, CY,
EG, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, MY, NE, NG, OM, SA, SC, SD, SL, SN,
SY, TN, TZ, UG, YE, ZM, ZW); Glopir (GR); Hexadilat (DK); Huma-Nifedin (HU); Jutadilat (DE); Kin Ran (CN);
Kordypin (UA); Kordypin XL (UA); Myogard (AE, BH, CY, EG, IN, IQ, IR, JO, KW, LB, LY, OM, SA, SY, YE); Nedipin
(TW); Nelapine (PH); Nepin SR (LK); Nicardia (TH); Nicardia CD (TH); Nicardia Retard (TH); Nicardia XL (LK);
Nidipin (HU); Nifa (BD); Nifadil (HR); Nifangin (FI); Nifar (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU,
MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW); Nifar-GB (MX); Nifdemin (FI); Nifebene (AT); Nifecap (BD);
Nifecard (AE, AT, BH, HR, JO, SA); Nifecard XL (SG); Nifecor (DE); Nifedepat (DE); Nifedicor (IT); Nifedigel
(MX); NIfedilat (ZA); Nifedilong (IL); Nifedin (IT); Nifedine (IN); Nifedipin (HR); Nifedipin AL (HU); Nifedipin
Pharmavit (HU); Nifedipin Stada (LU); Nifedipin-ratiopharm (LU); Nifedipresc MR (GB); Nifedix SR (KR);
Nifehexal (LU, VN); Nifelan (EC); Nifelat (AR, ET, HK, MT, SG, TH, ZW); Nifelat Q (TR); Nifelat R (ZW); Nifelat-Q
(TH); Nifensar (PE); Nifensar Retard (PE); Niferon CR (KR); Nifeslow (LU); Nifestad (PH); Nifezzard (MX);
Nificard (CY, EG, IQ, IR, KW, LB, LY, OM, QA, SY, YE); Nifin (BD); Nifipen (AE, BH, CY, EG, IQ, IR, JO, KW, LB, LY,
OM, QA, SA, SY, YE); Nipen (BD); Noviken LP (MX); Nyefax (AU); Nyefax Retard (NZ); Odipin (PH); Orix (GR);
Osmo-Adalat (IL); Pidilat (DE); Pressolat (IL); Sepamit (JP); Servidipine (MY); Slow-Nifine (LU); Unidipin (HU,
LU); Zenusin (AE, BF, BH, BJ, CI, CY, EG, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW,
NE, NG, OM, QA, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZM, ZW)

Use of UpToDate is subject to the Subscription and License Agreement.

REFERENCES

1. Adalat CC (nifedipine extended release tablet) [prescribing information]. Pine Brook, NJ: Almatica Pharma Inc.; May 2016.
2. Adalat XL (nifedipine extended release tablet) [product monograph]. Mississauga, Ontario, Canada: Bayer Inc.; July 2016.
3. American College of Obstetricians and Gynecologists (ACOG). Committee opinion no. 623: emergent therapy for acute-
onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol. 2015;125(2):521-525. doi:
10.1097/01.AOG.0000460762.59152.d7. [PubMed 25611642]
4. American College Of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 171: Management of Preterm Labor.
Obstet Gynecol. 2016;128(4):e155-e164. doi: 10.1097/AOG.0000000000001711. [PubMed 27661654]
5. American College of Obstetricians and Gynecologists (ACOG); Task Force on Hypertension in Pregnancy. Hypertension in
pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy.
Obstet Gynecol. 2013;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88. [PubMed 24150027]
6. American Diabetes Association (ADA). 9. Cardiovascular disease and risk management. Diabetes Care. 2017a;40(suppl
1):S75-S87. [PubMed 27979896]
7. American Diabetes Association (ADA). 11. Older adults. Diabetes Care. 2017b;40(suppl 1):S99–S104. [PubMed 27979898]
8. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers
Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227-2246.
doi:10.1111/jgs.13702. [PubMed 26446832]
9. Anderson JE, Held N, Wright K. Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding.
Pediatrics. 2004;113(4):e360-364. [PubMed 15060268]
10. Anderson JL, Adams CD, Antman EM, et al; American College of Cardiology Foundation/American Heart Association Task
Force on Practice Guidelines. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the
management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of
Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(23):e663-
e828. doi: 10.1161/CIR.0b013e31828478ac. [PubMed 23630129]10.1161/CIR.0b013e31828478ac
11. Aronow WS, Fleg JL, Pepine CJ, et al, “ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A
Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents,”
Circulation, 2011, 123(21):2434-506. [PubMed 21518977]
12. Barrett ME, Heller MM, Stone HF, et al, "Raynaud Phenomenon of the Nipple in Breastfeeding Mothers: An Underdiagnosed
Cause of Nipple Pain," JAMA Dermatol, 2013, 149(3):300-6. [PubMed 23682366]
13. Bärtsch P, Maggiorini M, Ritter M, Noti C, Vock P, Oelz O. Prevention of high-altitude pulmonary edema by nifedipine. N
Engl J Med. 1991;325(18):1284-1289. [PubMed 1922223]
14. Berens P, Eglash A, Malloy M, Steube AM. ABM clinical protocol #26: persistent pain with breastfeeding. Breastfeed Med.
2016;11(2):46-53. [PubMed 26881962]
15. Deen-Duggins L, Fry HR, Clay JR, et al, “Nifedipine-Associated Gingival Overgrowth: A Survey of the Literature and Report of
Four Cases,” Quintessence Int, 1996, 27(3):163-70. [PubMed 9063228 ]
16. Deshwal R, Iqbal M, Basnet S. Nifedipine for the treatment of high altitude pulmonary edema. Wilderness Environ Med.
2012;23(1):7-10. doi:10.1016/j.wem.2011.10.003. [PubMed 22441082]
17. Ehrenkranz RA, Ackerman BA, and Hulse JD, "Nifedipine Transfer Into Human Milk," J Pediatr, 1989, 114(3):478-80.
[PubMed 2921695]
18. Elkayam U, Amin J, Mehra A, Vasquez J, Weber L, Rahimtoola SH. A prospective, randomized, double-blind, crossover
study to compare the efficacy and safety of chronic nifedipine therapy with that of isosorbide dinitrate and their
combination in the treatment of chronic congestive heart failure. Circulation. 1990;82(6):1954-1961. [PubMed 2242521]
19. Fihn SD, Gardin JM, Abrams J, et al, “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and
Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians,
American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular
Angiography and Interventions, and Society of Thoracic Surgeons,” Circulation, 2012, 126(25):3097-137. [PubMed
23166211]
20. Friedman GD, Asgari MM, Warton EM, et al, "Antihypertensive Drugs and Lip Cancer in Non-Hispanic Whites," Arch Intern
Med, 2012, 6:1-6. [PubMed 22869299]
21. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and
treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi:
10.1210/jc.2015-4061. [PubMed 26934393]
22. Furberg Cd, Psaty BM, and Meyer JV, “Nifedipine: Dose-Related Increase in Mortality in Patients With Coronary Heart
Disease,” Circulation, 1995, 92(5):1326-31. [PubMed 7648682]
23. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary
hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society
of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and
Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J.
2016;37(1):67-119. doi:10.1093/eurheartj/ehv317. [PubMed 15589643]
24. Garrison CP. Nipple vasospasms, Raynaud's syndrome, and nifedipine. J Hum Lact. 2002;18(4):382-385. [PubMed
12449056]
25. Go AS, Bauman M, King SM, et al. An effective approach to high blood pressure control: a science advisory from the
American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention
[published online November 15, 2013]. Hypertension. [PubMed 24243703]
26. Goundry B, Bell L, Langtree M, et al, "Diagnosis and Management of Raynaud's Phenomenon," BMJ, 2012, 344:e289.
[PubMed 22315243]
27. Grossman E, Messerli FH, Grodzicki T, et al, “Should a Moratorium Be Placed on Sublingual Nifedipine Capsules Given for
Hypertensive Emergencies and Pseudoemergencies?” JAMA, 1996, 276(16):1328-31. [PubMed 8861992]
28. Harel-Raviv M, Eckler M, Lalani K, et al, “Nifedipine-Induced Gingival Hyperplasia. A Comprehensive Review and Analysis,”
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 79(6):715-22. [PubMed 7621029 ]
29. Ishikawa K, Nakai S, Takenaka T, et al, “Short-Acting Nifedipine and Diltiazem Do Not Reduce the Incidence of Cardiac
Events in Patients With Healed Myocardial Infarction. Secondary Prevention Group,” Circulation, 1997, 95(10):2368-73.
[PubMed 9170398]
30. Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
31. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults:
Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) [published online December
18, 2013]. JAMA. [PubMed 24352797]
32. Luks AM, McIntosh SE, Grissom CK, et al; Wilderness Medical Society. Wilderness Medical Society practice guidelines for
the prevention and treatment of acute altitude illness: 2014 update. Wilderness Environ Med. 2014;25(4 suppl):S4-S14.
 doi:10.1016/j.wem.2014.06.017. [PubMed 25498261]
33. Magee LA, Pels A, Helewa M, et al; Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation,
and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can.
2014;36(5):416-441. [PubMed 24927294]
34. Manninen AK and Juhakoski A, "Nifedipine Concentrations in Maternal and Umbilical Serum, Amniotic Fluid, Breast Milk
and Urine of Mothers and Offspring," Int J Clin Pharmacol Res, 1991, 11(5):231-6. [PubMed 1814844]
35. Messerli FH, Kowey P, and Grodzicki T, “Sublingual Nifedipine for Hypertensive Emergencies,” Lancet, 1991,
338(8771):881. [PubMed 1681227]
36. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents,
“The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,”
Pediatrics, 2004, 114(2 Suppl):555-76. [PubMed 15286277]
37. Nery EB, Edson RG, Lee KK, et al, “Prevalence of Nifedipine-Induced Gingival Hyperplasia,” J Periodontol, 1995, 66(7):572-8.
[PubMed 7562349 ]
38. Nifedipine [product monograph]. Vaughan, Ontario, Canada: AA Pharma Inc; June 2010.
39. Nishikawa SJ, Tada H, Hamasaki A, et al, “Nifedipine-Induced Gingival Hyperplasia: A Clinical and In Vitro Study,” J
Periodontol, 1991, 62(1):30-5. [PubMed 2002429 ]
40. Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart
Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on
Practice Guidelines. Circulation. 2014;129(23):2440-92. doi: 10.1161/CIR.0000000000000029. [PubMed 24589852]
41. Oelz O, Maggiorini M, Ritter M, et al. Prevention and treatment of high altitude pulmonary edema by a calcium channel
blocker. Int J Sports Med. 1992;13(suppl 1):S65-S68. [PubMed 1483797]
42. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial
infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice
Guidelines [published correction appears in Circulation. 2013;128(25):e481.] Circulation. 2013;127(4):e362-e425. [PubMed
23247304]
43. Page SM, McKenna DS. Vasospasm of the nipple presenting as painful lactation. Obstet Gynecol. 2006;108(3 Pt 2):806-
808. [PubMed 17018510]
44. Penny WJ and Lewis MJ, "Nifedipine Is Excreted in Human Milk," Eur J Clin Pharmacol, 1989, 36(4):427-8. [PubMed
2737237]
45. Pollard AJ, Niermeyer S, Barry P, et al, “Children at High Altitude: An International Consensus Statement by an Ad Hoc
Committee of the International Society for Mountain Medicine, March 12, 2001,” High Alt Med Biol, 2001, 2(3):389-403.
[PubMed 11682018]
46. Poole-Wilson PA, Lubsen J, Kirwan BA, et al, “Effect of Long-Acting Nifedipine on Mortality and Cardiovascular Morbidity in
Patients with Stable Angina Requiring Treatment (Action Trial): Randomized Controlled Trial,” Lancet, 2004,
364(9437):849-57. [PubMed 15351192]
47. Prisant LM and Spaulding VC, “Antihypertensive Pharmacobezoar,” J Clin Hypertens (Greenwich), 2006, 8(4):296-8.
[PubMed 16596036]
48. Procardia (nifedipine) [prescribing information]. New York, NY: Pfizer; no date 2014.
49. Procardia XL (nifedipine) [prescribing information]. New York, NY: Pfizer; January 2015.
50. Psaty BM, Heckbert SR, Koepsell TD, et al, “The Risk of Myocardial Infarction Associated With Antihypertensive Therapies,”
JAMA, 1995, 274(8):620-5. [PubMed 7637142]
51. Raynaud's Treatment Study Investigators. Comparison of Sustained-Release Nifedipine and Temperature Biofeedback for
Treatment of Primary Raynaud Phenomenon. Results From a Randomized Clinical Trial With 1-Year Follow-Up. Arch Intern
Med, 2000, 160(8):1101-8. [PubMed 10789602]
52. Rich S, Kaufmann E, Levy PS. The effect of high doses of calcium-channel blockers on survival in primary pulmonary
hypertension. N Engl J Med. 1992;327(2):76-81. [PubMed 1603139]