Makindo Medical Notes

💊 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

• Nifedipine – BNF
• NICE CKS – Hypertension

📝 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.