Nifedipine (Oral)

Nifedipine is used in the treatment of patients who are suffering from the chest pain that is caused by angina, and also from high blood pressure.

Overview

In the US, nifedipine is known under the following brand names:

  • Procardia XL
  • Procardia
  • Nifedical XL
  • Nifediac CC
  • Afeditab CR
  • Adalat CC

Nifedipine can be used in combination with certain other medicines or by itself to treat the severe chest pains that are caused by angina. The drug is also used in the treatment of hypertension (high blood pressure).

When the blood pressure becomes too high, it can place a greater workload on the arteries and the heart. In cases where hypertension has become chronic, damage can occur to the blood vessels in the heart, brain, and kidneys. This can result in serious complications, including heart attacks.

Nifedipine is one of a family of drugs called channel blockers. The medication works by relaxing the blood vessels. This has the effect of increasing the blood and oxygen supply to the heart, whilst easing its workload.

Nifedipine is a prescription only medicine and comes in various forms, including liquid-filled capsules, extended-release tablets, capsules, and tablets

Conditions treated

Type of medicine

  • Channel blocker
  • Tablets
  • Capsules

Side effects

In addition to the effects it is supposed to have, nifedipine can cause a few unwanted side effects. You may not experience any unwanted effects at all, but if you do, they may need further medical attention.

If you notice any of the following effects, you should check with your GP right away:

  • Yellow eyes and skin
  • Wheezing
  • Weakness
  • Waking at night to urinate
  • Vomiting of blood or matter that resembles coffee grounds
  • Vomiting
  • Vocal changes
  • Changes in vision
  • Stomach or upper right abdominal pains
  • Unexpected weight gain or loss
  • Unusual bruising or bleeding
  • Trembling, unsteadiness, or other problems with coordination or muscle control
  • Unconsciousness
  • Troubled breathing on exertion
  • Troubled breathing at rest
  • Shaking or trembling of the feet or hands
  • Tingling of the feet or hands
  • Tightness of the chest
  • Tenderness
  • Swollen, tender, glands in the neck
  • Swollen glands
  • Swellings around your eyes
  • Sweating
  • Stopping of heart
  • Ulcers, sores, or white spots in the mouth or on the lips
  • Sore throat
  • Sneezing
  • Bubbling, clicking, or rattling noises in the lungs
  • Skin rashes
  • Shortness of breath
  • Shivering
  • Sharp back pain under the ribs
  • Shakiness in the arms, legs, feet, or hands
  • Unsteady walk or shakiness
  • Severe unusual weakness or tiredness
  • Runny nose
  • Reddening in the whites of the eyes
  • Swelling or redness of the gums
  • Rapid weight gain
  • Swelling or puffiness around the eyes, eyelids, face, tongue, or lips
  • Red pinpoint spots on the skin
  • Pale skin
  • Painful or difficult urination
  • Pain or discomfort in the jaw, arms, neck, and back
  • Burning or pain while urinating
  • Pain in the genitals or groin
  • Pain
  • Noisy breathing
  • No pulse or blood pressure
  • Nervousness
  • Neck pain
  • Nausea
  • Nasal congestion
  • Muscle cramps
  • Light-colored stools
  • Hive-like swellings on eyelids, face, lips, throat, hands, legs, genitals, or feet
  • Itching
  • Irritation inside the mouth
  • Increased sweating
  • Hoarseness
  • Severe and throbbing headache
  • Headaches
  • General tiredness and weakness
  • Fever
  • Feeling unusually cold or warm
  • Rapid, pounding, irregular, or racing pulse or heartbeat
  • Eye pain
  • Extreme fatigue
  • Extra heartbeats
  • Ear congestion or pain in the ears
  • Dryness or soreness of throat
  • Dry mouth
  • Feeling dizzy, faint, or lightheaded when rising suddenly from a prone or seated position
  • Feeling dizzy or lightheaded
  • Dilated neck veins
  • Difficulty in swallowing
  • Rapid, difficult or noisy breathing, sometimes with wheezing
  • Labored breathing
  • Decreased urine output
  • Dark urine
  • Cough producing a pink frothy sputum
  • Cough
  • Cold sweats
  • Chills
  • Chest pain
  • Chest congestion
  • Changes in skin color
  • Body aches and pains
  • Blurred vision
  • Bluish color of lips, skin, and fingernails
  • Blood in the urine or stools
  • Blood in the eyes
  • Swelling or bloating of the arms, face, hands, feet, or lower legs
  • Bleeding gums
  • Tarry, black stools

Some of the side effects that are experienced by people using nifedipine disappear without the need for further treatment, as your body gets used to the new medicine. Your GP may also be able to suggest ways in which you can prevent or reduce many of these unwanted effects. Check with your GP if any of the effects listed below fail to resolve within a week or so of starting your course of nifedipine or if they are especially troublesome:

  • Unable to sleep
  • Trouble concentrating
  • Tiredness
  • Swelling of the breasts or breast soreness in both men and women
  • Stuffy nose
  • Stomach upset, discomfort, or pain
  • Sneezing
  • Sleepiness or unusual feelings of drowsiness
  • Severe sunburn
  • Scaly skin
  • Reddening or other skin discoloration
  • Reddening of the neck, face, arms, and sometimes of the upper chest
  • Red, swollen skin
  • Passing urine more frequently than usual
  • Passing gas more often than usual
  • Pain or burning in the throat
  • Pain in the chest under the sternum
  • Nervousness
  • Muscle tension, tightness, or stiffness
  • Muscle pains or weakness
  • Mood swings
  • Lower back or side pains
  • Loss of energy or strength
  • Loss of interest or pleasure
  • Loss of body heat
  • Loss of libido or of sexual performance
  • Leg cramps or pains
  • Lack or loss of strength
  • Lack of appetite
  • Joint stiffness
  • Pain, itching, redness, tenderness, swelling, or warmth of the skin
  • Irritability
  • Increased sensitivity to sunlight
  • Increased need to urinate
  • Inability to obtain or maintain an erection
  • Heartburn
  • Thinning hair or hair loss
  • General feeling of illness or discomfort
  • Full feeling
  • Feeling sad or empty
  • Indigestion
  • Feeling of constant movement of self or surroundings
  • Fear or nervousness
  • Excessive muscle tone
  • Excessive gas in stomach or intestines
  • Feelings of discouragement
  • Difficulty in moving
  • Constipation
  • Diarrhea
  • Cracks in the skin
  • Crawling, burning, itching, prickling, numbness, tingling, or "pins and needles" sensations
  • Bloody nose
  • Belching
  • Knee, ankle, or big toe joint pain
  • Acid or sour stomach
  • Abnormal ejaculation

This list of side effects that can be caused by nifedipine may not affect all patients who use this medicine and it is not exhaustive. If you notice any other effects that are not mentioned in this guide, you should check with your GP.

Dosage

The treatment regimen that you are prescribed to treat hypertension may also include changes in diet and weight control, as well as the use of nifedipine. Your doctor may recommend reducing the amount of salt in your diet. However, always ask your GP's advice if you are thinking of making radical changes to your diet.

The majority of patients who suffer from hypertension are not aware that they have the condition, and many feel completely normal. For this reason, it is very important that you take your dose of nifedipine exactly as you have been directed to. Keep all appointments with your GP, even though you may feel perfectly well.

Nifedipine will not provide a cure for your condition, but it will help in controlling it. In order to keep your blood pressure under control, you must continue to take nifedipine, possibly for the rest of your life. You should be aware that uncontrolled hypertension can damage your blood vessels in the heart, brain, and kidneys, leading to serious health conditions such as heart attack and kidney disease.

You must swallow nifedipine tablets whole, without chewing, breaking, or crushing them. If possible, take the extended-release tablets on an empty stomach. You may notice that the tablets pass into your stool. This is normal and only occurs once your body has absorbed the medication.

Your dose of nifedipine will probably not be the same as for other patients. You must stick to your GP's orders or the product label's directions when taking nifedipine. The information that follows is based on the average for this drug. If your dose is not the same as this, do not alter it without prior authority from your GP.

The size of your doses, their frequency, and the duration of your course of treatment with nifedipine will depend on the medical condition for which you are being treated.

Capsules to treat hypertension or chest pain:

  • Adults: Initially, take 10 mg three times daily. Your GP may adjust your dose if necessary.
  • Children: The use and dose rate of this medicine will be determined by your child's GP.

Extended-release tablets to treat hypertension or chest pain:

  • Adults: Initially, take 30 mg or 60 mg once daily. Your GP may adjust your dose if necessary. Note that the total dose does not usually exceed 90 mg once daily.
  • Children: The use and dose rate of this medicine will be determined by your child's GP.

If you omit one of your doses of nifedipine, take it immediately if possible. If your next dose is nearly due, omit the one you missed and return to your usual schedule. Do not take twice the prescribed dose.

Interactions

Drug interactions

There are some drugs that should never be used together. In other instances, two different medicines can be used at the same time, even though an interaction will probably take place. Under these circumstances, your GP may change the dose rate or suggest other precautions that you could take.

While you are using nifedipine, you must tell your GP if you are using any of the drugs that are mentioned below. These drugs have been included in this guide based on their relative significance in this context and the list is not necessarily exhaustive.

It is not recommended that you use nifedipine with any of the following drugs, but this may be necessary in some circumstances. If you are prescribed both drugs together, your GP may adjust the dose or frequency of use of one or both of them:

  • Voriconazole
  • Topiramate
  • Thiopental
  • Telithromycin
  • Telaprevir
  • St John's Wort
  • Secobarbital
  • Saquinavir
  • Rufinamide
  • Ritonavir
  • Rifapentine
  • Rifampin
  • Rifabutin
  • Primidone
  • Prednisone
  • Posaconazole
  • Pioglitazone
  • Phenytoin
  • Phenobarbital
  • Pentobarbital
  • Oxcarbazepine
  • Nevirapine
  • Nelfinavir
  • Nefazodone
  • Nafcillin
  • Modafinil
  • Mibefradil
  • Methohexital
  • Mephobarbital
  • Lopinavir
  • Lacosamide
  • Ketoconazole
  • Itraconazole
  • Idelalisib
  • Fosphenytoin
  • Fentanyl
  • Etravirine
  • Enzalutamide
  • Efavirenz
  • Digoxin
  • Dexamethasone
  • Dantrolene
  • Conivaptan
  • Cobicistat
  • Clopidogrel
  • Clobazam
  • Clarithromycin
  • Ceritinib
  • Carbamazepine
  • Butalbital
  • Butabarbital
  • Bosentan
  • Boceprevir
  • Atazanavir
  • Armodafinil
  • Aprobarbital
  • Amobarbital
  • Amiodarone

It is not recommended that you use nifedipine with any of the following drugs, as this could increase side effects. If you are prescribed both drugs together, your GP may adjust the dose or frequency of use of one or both of the drugs:

  • Vincristine Sulfate Liposome
  • Vincristine
  • Tacrolimus
  • Quinupristin
  • Quinidine
  • Micafungin
  • Magnesium
  • Indinavir
  • Ginseng
  • Ginkgo
  • Doxazosin
  • Dalfopristin
  • Cimetidine

Other interactions

Some drugs should not be taken while eating food or certain types of foods, as this could cause an interaction. Similarly, using alcohol or tobacco with some drugs can cause unwanted interactions. You should discuss your use of particular food groups, tobacco and alcohol with your GP before using nifedipine.

In the case of nifedipine, you should note that drinking grapefruit juice can increase the risk of certain side effects. If consuming grapefruit is unavoidable, ask your GP for instructions on how to manage any interactions that may occur.

Medical interactions

Some medical conditions may affect how nifedipine works and its use could make certain conditions worse. Be sure to discuss your medical history fully with your GP and mention any health conditions that you have, especially the following:

Using nifedipine with any of the following conditions could increase the risk of serious side effects:

  • Hypotension (low blood pressure)
  • Heart attack
  • Coronary artery disease
  • Congestive heart failure
  • Severe bowel blockage
  • Aortic stenosis (narrowing of a valve in your heart)

Nifedipine must not be used in patients who have suffered cardiogenic shock.

The extended-release tablet form of nifedipine should not be given to people with any of the following conditions. These tablets contain lactose, and could cause a serious allergic reaction in these patients:

  • Galactose intolerance (a rare hereditary condition)
  • Glucose-galactose malabsorption (a rare hereditary condition)
  • Lapp lactase deficiency (unusual hereditary illness)

Patients with kidney problems, including cirrhosis, should use nifedipine with caution. The effects of the drug may be exacerbated due to the slower removal of the drug from the patient's body.

Warnings

When you decide to use nifedipine, you should first weigh the risks against the benefits of doing so. It is advisable to make this decision based on discussions with your GP. In the case of nifedipine, the following factors should be taken in to account:

Be sure to tell your GP if you have ever suffered from any strange or unexpected reactions to nifedipine or to any other prescription drugs. Also mention any known allergies that you have to over the counter products, including vitamin supplements, herbal remedies, and diet pills. Check the product label carefully and check the ingredients. This is especially important if you are allergic to food dyes, preservatives, certain food groups, or animal by-products.

There have been no definitive studies carried out into the effects of this drug in children. If you have concerns about this aspect of your child's treatment, check with your GP.

To date, there have been no specific studies performed into the use of nifedipine in elderly patients. However, it is considered that geriatric patients are more likely to have age-related health problems relating to the heart, kidneys, or liver. The dose of this medicine may need to be adjusted accordingly in these cases.

There is no evidence to indicate that using nifedipine to treat women during pregnancy presents any undue risk to the fetus. However, if this applies in your case, you may wish to discuss the possible risks of using this drug with your GP before agreeing to treatment with it.

Similarly, there is nothing to suggest that using nifedipine while breastfeeding is likely to harm your nursing infant. However, you may decide to stop breastfeeding while you are taking this medication, to be on the safe side. For more advice on alternative feeding solutions for your child, check with your GP or midwife.

Throughout the course of your treatment with nifedipine, you must attend your GP clinic for regular check-ups. These visits are necessary to ensure that the drug is working as expected and to be sure that you are not suffering any unwanted effects.

Make sure that your GP is aware of all the drugs that you are currently using, especially the following:

  • St John's Wort
  • Rifampin
  • Rifabutin
  • Phenytoin
  • Phenobarbital
  • Carbamazepine

You may experience lightheadedness, fainting fits, and dizzy spells, particularly when you stand up after lying or sitting down for a while. You are more likely to suffer these effects when you first begin using nifedipine or if the dose is increased.

Nifedipine can cause edema in some people. You must mention it to your GP right away if you notice any of the following signs:

  • Swelling or bloating of the arms, face, hands, feet, or lower legs
  • Tingling in the feet or hands
  • Unusual weight loss or gain

You should not stop using nifedipine unless you have spoken to your GP first. If you are told to stop using the drug, your GP will probably advise that you do so gradually before you stop using it completely.

You must tell your doctor or dentist that you are using nifedipine. It may be necessary for you to stop using this drug a few days prior to undergoing any medical tests or surgical procedures. Note that this medicine can affect the outcome of some diagnostic tests.

Grapefruit and grapefruit juice can cause the effects of nifedipine to be increased by causing the levels of the drug in your body to rise. Do not drink grapefruit juice or eat grapefruit while you are using this drug.

You must not use any other medication, including prescription drugs, over the counter products, herbal remedies, diet pills, or vitamin supplements while you are using nifedipine without checking with your treating physician first.

Storage

Your prescription of nifedipine should be stored in a closed container in a place where it cannot be reached by pets or children. Keep the medicine away from sources of heat and out of direct sunlight.

Do not freeze the medicine. Keep it at room temperature.

Do not keep or use nifedipine that has gone out-of-date or keep any that is no longer required. Dispose of unused drugs responsibly and safely. Do not throw tablets or capsules out with your trash where they could be found and eaten by children or pets.

Ask your pharmacist or GP for advice on how to dispose of unused or unwanted nifedipine.

Summary

Nifedipine is a prescription only drug that belongs to a group of medicines called channel blockers. The medication is used in the treatment of angina and hypertension, either by itself or in combination with other suitable drugs.

The medicine works by relaxing the blood vessels to improve blood flow to the heart. Although nifedipine cannot cure your condition, it can be extremely effective in reducing and controlling the symptoms. This is especially important in patients with high blood pressure, as this condition can cause serious damage to the blood vessels that supply the kidney, heart, and brain if it is allowed to go untreated for a long time.

This drug can cause a number of side effects and also interacts adversely with many other medicines. Talk to your GP about your medical history before you begin using nifedipine.

Throughout the course of your treatment with nifedipine, you will be required to attend appointments with your GP for check-ups. These appointments are necessary to ensure that the medication is having the desired effect and is not causing any side effects.

You may have to take nifedipine for the rest of your life in order to maintain its effects and control your condition. Do not stop taking the drug without first discussing this with your GP, even if you think that you are much better. Stopping this medication too quickly can cause dangerous side effects.