nifedipine

(nye fed' i peen)

Adalat, Adalat CC, Adalat XL (CAN), Apo-Nifed (CAN), Gen-Nifedipine
(CAN), Nifedical XL, Novo-Nifedin (CAN), Procardia, Procardia XL

Pregnancy Category C

Drug classes
Calcium channel-blocker
Antianginal
Antihypertensive

Therapeutic actions
Inhibits the movement of calcium ions across the membranes of cardiac and arterial
muscle cells; inhibition of transmembrane calcium flow results in the depression of
impulse formation in specialized cardiac pacemaker cells, in slowing of the velocity of
conduction of the cardiac impulse, in the depression of myocardial contractility, and in
the dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead
to decreased cardiac work, decreased cardiac energy consumption, and increased delivery
of oxygen to myocardial cells.

Indications
• Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina)
• Chronic stable angina (effort-associated angina)
• Sustained-release preparation only: Treatment of hypertension
• Orphan drug use: Treatment of interstitial cystitis

Contraindications and cautions

• Contraindicated with allergy to nifedipine.
• Use cautiously with lactation, pregnancy.

Available forms
ER tablets—30, 60, 90 mg; capsules—10, 20 mg

Dosages
ADULTS
Initial dose, 10 mg tid PO. Maintenance range, 10–20 mg tid. Higher doses (20–30 mg
tid–qid) may be required, depending on patient response. Adjust over 7–14 days. More
than 180 mg/day is not recommended.
Sustained-release
30–60 mg PO once daily. Adjust over 7–14 days. Usual maximum dose is 90–
120 mg/day.

Pharmacokinetics
Route Onset Peak
Oral 20 min 30 min
SR 20 min 2.5–6 hr
Metabolism: Hepatic; T1/2: 2–5 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
• CNS: Dizziness, light-headedness, headache, asthenia, fatigue, nervousness,
sleep disturbances, blurred vision
• CV: Peripheral edema, angina, hypotension, arrhythmias, AV block, asystole
• Dermatologic: Flushing, rash, dermatitis, pruritus, urticaria
• GI: Nausea, diarrhea, constipation, cramps, flatulence, hepatic injury
• Other: Nasal congestion, cough, fever, chills, shortness of breath, muscle cramps,
joint stiffness, sexual difficulties

Interactions
Drug-drug
• Increased effects with cimetidine

Nursing considerations
Assessment
• History: Allergy to nifedipine; pregnancy; lactation
• Physical: Skin lesions, color, edema; orientation, reflexes; P, BP, baseline ECG,
peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation,
normal GI output; liver function tests

Interventions
• Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being
adjusted to therapeutic dose; the dosage may be increased more rapidly in
hospitalized patients under close supervision. Do not exceed 30 mg/dose
increases.
• Ensure that patients do not chew or divide sustained-release tablets.
• Taper dosage of beta-blockers before nifedipine therapy.
• Protect drug from light and moisture.

Teaching points
• Do not chew, cut, or crush sustained-release tablets. Swallow whole.
• These side effects may occur: Nausea, vomiting (eat frequent small meals);
dizziness, light-headedness, vertigo (avoid driving, operating dangerous
machinery; take special precautions to avoid falling); muscle cramps, joint
stiffness, sweating, sexual difficulties (reversible).
• Report irregular heartbeat, shortness of breath, swelling of the hands or feet,
pronounced dizziness, constipation.

Adverse effects in Italic are most common; those in Bold are life-threatening.