Dihydropyridine calcium channel blocker
Updated · Methodology
First line
Hypertension during breastfeeding. 2020 and SEGO 2023 – drug of choice. RID 1.8–3.5%, no milk-supply effect. Also used for nipple vasospasm (Raynaud's of the nipple) in nursing mothers – 30 mg 1–2 times daily.
Sources
ICD-10: I10 · ICD-11: BA00
First line
Hypertension in pregnancy (SR form) and tocolysis in preterm labor (IR off-label). Per 222 (2020) and SEGO 2023, nifedipine SR is first-line alongside methyldopa and labetalol. SR dose 30–60 mg 1–2 times daily. IR not recommended for HTN due to reflex tachycardia and BP drop.
Sources
ICD-10: O13 · ICD-11: JA23
Blocks L-type calcium channels in vascular smooth muscle, relaxes arterioles, lowers peripheral resistance. Vascular-selective with weak myocardial effect. Immediate-release (IR – dangerous in hypertensive emergency due to rapid BP drop) and slow-release forms (SR, OROS – Adalat OROS, Procardia XL).
Safe (SR form). Use from 2nd trimester as indicated.
Compatible. Hale L2. RID 1.8–3.5%. No milk-supply effect.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Grapefruit juice inhibits CYP3A4 and cuts first-pass metabolism of nifedipine: levels rise and the effect lasts longer. Blood pressure can drop too far, with dizziness on standing, flushing, headache, fast heartbeat and ankle swelling. According to the Adalat Oros SmPC, after regular juice intake the effect persists for at least 3 days after the last glass. For this reason the SmPC says not to take grapefruit or grapefruit juice during treatment.
Source: AEMPS: Ficha técnica de Adalat Oros 30 mg comprimidos de liberación prolongada (nifedipino) (2021)
Verbatim lines from the interaction sections, in the language of the label
«Nifedipino Retard STADA no se administrará en combinación con rifampicina ya que la inducción enzimática de la misma reduce los niveles plasmáticos de nifedipino (ver sección 4.5).»AEMPS, section 4.3 · Open on CIMA
«Drug Interactions:: Nifedipine is metabolized by CYP3A4. Co-administration of nifedipine with phenytoin, an inducer of CYP3A4, lowers the systemic exposure to nifedipine by approximately 70%. Avoid…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: Digitalis: Administration of nifedipine with digoxin increased digoxin levels in nine of twelve normal volunteers. The average increase was 45%. Another investigator found no…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: Digitalis: Administration of nifedipine with digoxin increased digoxin levels in nine of twelve normal volunteers. The average increase was 45%. Another investigator found no…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: Nifedipine is metabolized by CYP3A4. Co-administration of nifedipine with phenytoin, an inducer of CYP3A4, lowers the systemic exposure to nifedipine by approximately 70%. Avoid…»FDA, section 7 · Open on DailyMed
«En caso de administración simultánea de nifedipino y betabloqueantes, debe vigilarse atentamente la situación del paciente, ya que en casos aislados se ha observado empeoramiento de una insuficiencia…»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions:: CYP3A inhibitors such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir may result in increased exposure to…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: CYP3A inhibitors such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir may result in increased exposure to…»FDA, section 7 · Open on DailyMed
«Digoxina: La administración simultánea de nifedipino y digoxina puede producir una disminución de la eliminación de la digoxina y, en consecuencia, un incremento de los niveles plasmáticos de ésta…»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions:: CYP3A inhibitors such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir may result in increased exposure to…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: CYP3A inhibitors such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir may result in increased exposure to…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: CYP3A inhibitors such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir may result in increased exposure to…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: CYP3A inhibitors such as fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, saquinavir, indinavir, and nelfinavir may result in increased exposure to…»FDA, section 7 · Open on DailyMed
«La fenitoina induce el sistema del citocromo P450 3A4. Cuando se administra concomitantemente con fenitoina, la biodisponibilidad del nifedipino se reduce y por tanto, su eficacia. Cuando se…»AEMPS, section 4.5 · Open on CIMA
«Quinidina: En casos de administración simultánea de nifedipino y quinidina se ha observado una disminución de los niveles plasmáticos de quinidina, que aumentan notablemente tras la supresión del…»AEMPS, section 4.5 · Open on CIMA
«Tacrolimus: Tacrolimus se metaboliza través del sistema del citocromo P450 3A4. Datos recientemente publicados muestran que la dosis de tacrolimus administrada simultáneamente con nifedipino pueden…»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions:: Coumarin Anticoagulants: There have been rare reports of increased prothrombin time in patients taking coumarin anticoagulants to whom nifedipine was administered. However, the…»FDA, section 7 · Open on DailyMed
«Fármacos antiepilépticos que inducen el sistema del citocromo P450 3A4, como la fenitoina, carbamazepina y fenobarbital»AEMPS, section 4.5 · Open on CIMA
«antagonistas de los receptores de la angiotensina 1 (AT-1)»AEMPS, section 4.5 · Open on CIMA
«Antibióticos macrólidos (p. ej. eritromicina): La azitromicina aunque está relacionada estructuralmente con la clase de antibióticos macrólidos no inhibe el CYP3A4.»AEMPS, section 4.5 · Open on CIMA
«Fármacos antiepilépticos que inducen el sistema del citocromo P450 3A4, como la fenitoina, carbamazepina y fenobarbital»AEMPS, section 4.5 · Open on CIMA
«Cisaprida: La administración simultánea de cisaprida y nifedipino puede producir un aumento de las concentraciones plasmáticas de nifedipino.»AEMPS, section 4.5 · Open on CIMA
«Established and Other Potentially Significant Drug Interactions: felodipine, nifedipine, nicardipine, and verapamil ↑ calcium channel blocker Caution is warranted. Dose titration of the calcium…»FDA, section 7 · Open on DailyMed
«Combinaciones a usar con precaución: Antagonistas del calcio del tipo dihidropiridina como nifedipino, felodipino y amlodipino: El uso concomitante en pacientes con insuficiencia cardiaca pueda…»AEMPS, section 4.5 · Open on CIMA
«Established and Other Potentially Significant Interactions: Calcium Channel Blockers: e.g., amlodipine diltiazem felodipine nifedipine verapamil ↑ calcium channel blockers Clinical monitoring is…»FDA, section 7 · Open on DailyMed
«BLOQUEANTES DE LOS CANALES DE CALCIO: Amlodipino Diltiazem Felodipino Nicardipino Nifedipino Verapamilo»AEMPS, section 4.5 · Open on CIMA
«Established and Other Potentially Significant Drug Interactions: Calcium Channel Blockers : amlodipine, diltiazem, felodipine, nicardipine, nifedipine, verapamil calcium channel blockers Clinical…»FDA, section 7 · Open on DailyMed
«Established and Other Potentially Significant Drug Interactions: Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ calcium channel blocker When co-administered with efavirenz, dosage…»FDA, section 7 · Open on DailyMed
«Antagonistas de los canales de calcio: El isoenzima CYP3A4 está implicado en el metabolismo de algunos antagonistas de los canales de calcio (nifedipino, isradipino, amlodipino, verapamilo y…»AEMPS, section 4.5 · Open on CIMA
«Antihipertensivos como metildopa: Agentes bloqueadores de los canales de calcio (ej. diltiazem, nifedipino, verapamilo): e l uso concomitante de estos medicamentos puede aumentar el riesgo de…»AEMPS, section 4.5 · Open on CIMA
«Effects of Posaconazole on Other Drugs: Prevention or Management Verapamil, Diltiazem, Nifedipine, Nicardipine, Felodipine Monitor frequently for adverse reactions and toxicity with concomitant use…»FDA, section 7 · Open on DailyMed
«Established and Other Potentially Significant Drug Interactions: Calcium channel blockers: diltiazem, nifedipine, verapamil ↑ calcium channel blockers Caution is warranted and clinical monitoring of…»FDA, section 7 · Open on DailyMed
«Effects of Other Drugs on Tacrolimus: Mild or Moderate CYP3A Inhibitors: Clotrimazole, antibiotics (e.g., erythromycin, fluconazole), calcium channel blockers (e.g., verapamil, diltiazem, nifedipine…»FDA, section 7 · Open on DailyMed
«La terapia concomitante con dihidropiridinas (por ejemplo, nifedipino) puede aumentar el riesgo de hipotensión y se puede producir insuficiencia cardíaca en pacientes que la presenten de forma…»AEMPS, section 4.5 · Open on CIMA
«hidroclorotiazida, warfarina, digoxina, anticonceptivos orales, (etinilestradiol/AEMPS, section 4.5 · Open on CIMA
«Número de veces que cambia la exposición con ciclosporina: La administración conjunta de nifedipino con ciclosporina puede producir un incremento en la proporción de hiperplasia gingival, comparado…»AEMPS, section 4.5 · Open on CIMA
«DRUG INTERACTIONS: Nifedipine Nifedipine: Nifedipine is a substrate for CYP3A. Clarithromycin and other macrolides are known to inhibit CYP3A. There is potential of CYP3A-mediated interaction between…»FDA, section 7 · Open on DailyMed
«Se han realizado diversos ensayos clínicos en los que se administró clopidogrel junto con otros medicamentos para investigar el potencial de interacción farmacocinético y farmacodinámico. No se…»AEMPS, section 4.5 · Open on CIMA
«Los agentes antagonistas de los canales del calcio pueden bien incrementar o bien no alterar los niveles de digoxina en suero. Verapamilo, felodipino y tiapamilo incrementan los niveles de digoxina…»AEMPS, section 4.5 · Open on CIMA
«Pharmacokinetic Drug Interactions: Nifedipine 45% NA»FDA, section 7 · Open on DailyMed
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Nifedipine is evaluated for the following indications with varying evidence strength: Hypertension in pregnancy (evidence tier A), Hypertension during breastfeeding (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Nifedipine (≥ 1 in 100): Lower-limb edema (10–30%), Headache, Flushing, Palpitations, Constipation. See the Safety section for uncommon and serious reactions.
Safe (SR form). Use from 2nd trimester as indicated.
Compatible. Hale L2. RID 1.8–3.5%. No milk-supply effect.
Nifedipine is contraindicated in: Hypersensitivity; Cardiogenic shock; Severe aortic stenosis; Acute MI in first 1–3 months; Severe hepatic impairment. Full list in the Safety section.
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