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Nifedipine 💊
Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure
💊 About: Always check the BNF link here
- 🔹 Belongs to the dihydropyridine class of calcium channel blockers (CCBs).
- 🩸 Acts as a peripheral vasodilator by relaxing vascular smooth muscle.
- 📌 Unlike verapamil/diltiazem, it has little effect on cardiac conduction → not used for arrhythmias.
🎯 Indications
- ❤️ Hypertension (especially effective in older patients and Afro-Caribbean origin per NICE guidance).
- 💓 Angina pectoris (stable and vasospastic).
- ❄️ Raynaud phenomenon – reduces vasospasm in fingers/toes.
- 🧾 Unlicensed/off-label: oesophageal spasm, preterm labour (tocolysis).
🔄 Interactions
- ⬇️ Potentiates hypotension when combined with other BP-lowering drugs (e.g. beta-blockers, ACE inhibitors).
- 🍊 Metabolised by CYP3A4 → levels may rise with grapefruit juice, macrolides, or azole antifungals.
- ❌ Avoid short-acting nifedipine in acute coronary syndrome → can cause reflex tachycardia and worsen ischaemia.
⚠️ Side Effects
- 🧠 Headache, flushing, dizziness.
- 🦵 Ankle oedema (common, dose-related).
- 💩 Constipation, malaise.
- ❤️ Rare but serious: bradycardia, AV block, worsening heart failure.
- 🩸 Gingival hyperplasia with prolonged use.
📊 Dose
- 💊 Hypertension: Extended-release 30–60 mg OD PO (max 120 mg/day). Long-acting nifedipine 40–80 mg OD.
- ❤️ Angina: 5–20 mg PO TDS (short-acting; use with caution).
- ❄️ Raynaud’s: 5–20 mg PO TDS.
- 🧾 Oesophageal spasm (off-label): 10 mg PO TDS.
📚 References
📝 Teaching Points
- 🔑 Preferred antihypertensive in Afro-Caribbean patients
- ⚠️ Avoid short-acting formulations in ischaemic heart disease due to risk of rebound tachycardia.
- 💧 Peripheral oedema is not due to salt/water retention but to arteriolar dilation → unresponsive to diuretics.
- 📌 Consider switching to another dihydropyridine (e.g. amlodipine) if ankle oedema intolerable.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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