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Why it's used

Nifedipine is used to treat high blood pressure. It is a prescription medicine. This medicine works by preventing the transport of calcium ions into the heart and other smooth muscles. This medicine results in the dilation of blood vessels, which decreases the blood pressure. Nifedipine is also used to prevent severe stable chest pain.
Nifedipine may also be taken in combination with other medicines to treat certain conditions as recommended by the doctor. Nifedipine is used together with Anti-Hypertensive to treat high blood pressure conditions.
Calcium Channel Blockers
Nifedipine belongs to a class of medicines called Calcium Channel Blockers. Calcium channel blockers treat a variety of conditions, such as high blood pressure, chest pain and symptoms of cold hands and feet (Raynaud's disease). These medicines relax blood vessels and thereby increase the supply of blood and oxygen to the heart.

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How to use

Read the directions on the product label, patient guide, or medicine guide provided by the medicine company or your pharmacist before starting to use Nifedipine. If you have any questions related to this medicine, ask your doctor or pharmacist. Eat this medicine as recommended by your doctor.
You should keep track of your blood pressure regularly. Share your results with the doctor and discuss if your blood pressure measurements are too low or too high. Your treatment plan may need changes.
Nifedipine is eaten without food. The use of Nifedipine in the presence of food may alter the rate of absorption of Nifedipine. Nifedipine should be swallowed whole on an empty stomach. Do not crush, chew or divide the tablet. Nifedipine is eaten usually in the morning.

Typical Dosage

The typical dose of Nifedipine is 30-60 mg once daily. The maximum adult dose of Nifedipine is 90 mg once daily in a day. Nifedipine is commonly used at the same time every day. This medicine is not known to be habit-forming.
To decrease the possibility of side-effects, you might be recommended to use the extended-release form of this medicine by your doctor. The extended-release medicine helps in maintaining a steady level of the medicine in your body for a longer period of time. Do not crush or chew the medicine, unless indicated on the package or by your doctor.

Talk to Your Doctor

Talk to your doctor if you develop new or worsening symptoms. Tell your doctor if chest pain, increased breathlessness, and swelling of the ankles. If you have issues with the health of your liver, a low dose of Nifedipine is required with careful monitoring. You should consult with your doctor before stopping the use of Nifedipine.
You may need to gradually decrease the dose of this medicine before stopping.

Use in Children

The safety and effectiveness of using Nifedipine in children has not been established. No safety and effectiveness data has been established for the use of Nifedipine in children.
Avoid grapefruit and grapefruit juice while using Nifedipine. Grapefruit and grapefruit juice increases the amount of Nifedipine in the bloodstream.

Storage

You should store Nifedipine below 30°C (86°F), away from moisture, and away from light. Store the medicine away from the reach of children and pets.
Medicines may be prescribed for uses other than those listed in the medicine guide. Do not use Nifedipine for conditions for which it was not prescribed. Do not give Nifedipine to other people who might have the same conditions or symptoms that you have. Self-medication may harm them.

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How to take Nifedipine

Your dose may depend on several personal factors. You should consult with your doctor to find out the dose that is best for you. The dose of Nifedipine depends on the following factors:
  • patient's health
  • the health of the patient's kidneys
  • response to treatment

Nifedipine Dosage

Dosage for high blood pressure

Adult
  • Initial: 20 mg once daily
  • Maximum: 90 mg once daily

Dosage for severe stable chest pain

Adult
  • Initial: 30 mg once daily
  • Maximum: 90 mg once daily

Minimum Age

18 years

Forms

Capsule
Strength: 5 mg, 10 mg, and 20 mg
Liquid Filled Capsule
Strength: 10 mg and 20 mg
Tablet
Strength: 10 mg, 20 mg, and 30 mg
Extended Release Tablet
Strength: 10 mg, 20 mg, 30 mg, 60 mg, and 90 mg
Film-Coated Tablet
Strength: 30 mg, 60 mg, and 90 mg
Film-Coated, Extended Release Tablet
Strength: 30 mg, 60 mg, and 90 mg

Missed Dose

Take the missed dose as soon as you remember and continue the regular dosing schedule after waiting for 12 hours before consuming the next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Nifedipine?
In case of overdose, close supervision of heart and respiratory function is recommended. Also, provide supportive care for low blood pressure such as placing legs in elevated position, use of calcium infusion, fluids and pressor agents. Stomach emptying should be performed by cleaning out the contents of the stomach or by using charcoal, a substance that absorbs poisons from the stomach. If the sufficient increase in blood pressure with calcium treatment is not achieved than provide treatment with noradrenaline or dopamine. The dose of these medicines should be adjusted based on the patient's response. Atropine is used to treat a slow heart rate. The Nifedipine should be removed from the body by blood purifying technique (called as, plasmapheresis).
Symptoms of an overdose of Nifedipine
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • accumulation of fluid in the lungs
  • cardiogenic shock
  • excessive acid in the blood (metabolic acidosis)
  • heart rhythm disturbances
  • high blood sugar levels
  • loss of consciousness
  • low blood pressure
  • low oxygen level in the tissue (hypoxia)
If you think you have overdosed on Nifedipine, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Nifedipine

Before you use Nifedipine, tell your doctor of your medical and health history including the following:
  • allergic to Nifedipine or other dihydropyridines
  • heart problems (cardiogenic shock)
  • high blood pressure
  • inflammation of the bowel or intestine (Crohn’s disease)
  • Liver disease
  • narrowing of an intestine
  • narrowing of the aortic heart valves
  • obstruction in the food pipe
  • patients with an artificial pouch (Kock pouch) constructed after surgical removal of a part of small intestine, rectum, or anus
  • patients with occurrence of heart attack in the last month
  • sudden episodes of an angina attack
  • use of Rifampicin
Before you use Nifedipine, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic to dihydropyridine.
Before having any surgery when using Nifedipine, tell your doctor and dentist about all the medicinal products you use including prescription and non-prescription medicines, and any herbal supplements.
The use of this medicine may change liver enzymes level. A temporary elevation in the liver enzymes such as alkaline phosphatase, creatine kinase, lactate dehydrogenase, aspartate aminotransferase (SGOT) and alanine transaminase (SGPT) has been seen in patients using this medicine.
The use of Nifedipine may change blood urea nitrogen. In patients with existing kidney disease, a reversible increase in the blood urea nitrogen may be seen while using this medicine.
The use of this medicine may change creatinine levels in the blood. In patients with existing kidney disease, a reversible increase in the creatinine level may be seen while using this medicine.

Alcohol

Limit the consumption of alcohol with Nifedipine. Drinking alcohol may cause dizziness, fainting, tiredness, and visual disturbance.

Use in Pregnancy

Nifedipine should be used in pregnancy only when required. There are no well-controlled studies on the use of Nifedipine is available for pregnant women. There are few reports of poor growth of fetus (intrauterine growth retardation), lack of oxygen at birth (perinatal asphyxia), surgical delivery of the baby (cesarean delivery) and preterm birth (prematurity) while using this medicine.

Use while Breastfeeding

Nifedipine is not safe for use in women who are breastfeeding. If you are breastfeeding, discuss with your doctor if you should either discontinue breastfeeding or stop using this medicine while breastfeeding. This medicine passes into the breastmilk. The mothers should not breastfeed their babies while consuming Nifedipine. After the consumption of immediate release formulations of Nifedipine, do not breastfeed the baby for 3 to 4 hours to reduce the risk of exposure of this medicine to the infant.

Impact on Fertility

Nifedipine may impact fertility in women. If you are trying to conceive, discuss with your doctor on the use of this medicine. The use of Nifedipine may cause a reversible change in the sperm's head section and decreases the ability of sperm to bind and fertilize an egg.

Seizures

Nifedipine can make you feel sleepy. Be careful while driving, using machinery, or doing any other activity that needs you to be alert. The consumption of alcohol with Nifedipine can make you feel more sleepy. Nifedipine may cause seizures in some people. Discuss with your doctor if you perform activities where a loss of consciousness may cause you or others harm.

Increased Risk

This medicine may increase your sensitivity to sunlight. If this happens, limit your time outdoors and do not tan to prevent sunburns. Cover your skin when you are outdoors or use a sunscreen. In case you get a sunburn, consult with your doctor.

Nifedipine Side-effects

The following side-effects may commonly occur when using Nifedipine. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
Rarely, the use of Nifedipine may cause the following side-effects:
The following severe side-effects may also occur when using Nifedipine:
  • Symptoms: a severe reduction in the number of white blood cells enlarged lymph nodes
  • central nervous system disorders
  • stomach and intestinal disorders
    Symptoms: diarrhea, difficulty swallowing, inflammation of the oesophagus (esophagitis), stomach and intestinal bleeding, increased levels of the enzyme gamma-glutamyl transferase (GGT increased), gum bleeding, vomiting, intestinal obstruction intestinal ulcer
  • Symptoms: shortness of breath (dyspnea), abnormal lung sounds (rales), inflammation of the pharynx (pharyngitis), high pitched breathing sound (stridor) presence of excess fluid in the lungs
  • heart and blood vessel disorders
    Symptoms: rapid or irregular heartbeat, low heart rate, heart attack (cardiac arrest), abnormal heart beat (extrasystole), low blood pressure, low blood pressure when suddenly standing from a sitting position cutaneous angiectases
  • Symptoms: high levels of uric acid in the blood (gout) high blood sugar (hyperglycaemia)
  • liver disorder
    Symptoms: yellow discoloration of the skin (jaundice)
  • kidney disorder
    Symptoms: kidney stone
  • severe skin reactions
    Symptoms: swelling of the lower layer of the skin, rash, drug induced severe allergic reaction increased skin sensitivity to the sunlight
  • eye disorder
    Symptoms: pink eye (conjunctivitis), eye bleeding (eye hemorrhage) blurred vision
Your doctor has prescribed this medicine because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious cases of side-effects. This page does not contain a complete list of all possible side-effects.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Low blood pressure

The patients who underwent bypass surgery (coronary artery bypass surgery) using a high dose of fentanyl anesthesia or other narcotics are at increased risk while using this medicine. Also, the patients using beta-blockers in combination with Nifedipine are at increased risk. Such patients may suffer from severely low blood pressure. Before using Nifedipine with fentanyl anesthesia, the doctor should remain aware of the occurrence of such adverse event. In such case, sufficient time (minimum 36 hours) should be given to the patient to wash out the Nifedipine before the surgery.

Chest pain (angina) or heart attack

The patients who are facing the severe condition of reduced blood flow to the heart (obstructive coronary artery disease) are at increased risk while using this medicine. Such patients may suffer from increased severity, frequency and duration of chest pain (angina) or heart attack by starting the use of Nifedipine or while increasing its dose.

Withdrawal of beta-blockers

The patients who suddenly discontinue the use of beta-blockers before using this medicine are at increased risk. Such patients may get a withdrawal syndrome such as enhanced chest pain (angina) which may be related to sensitivity to catecholamines. Do not discontinue the use of a beta-blocker suddenly. A reduction in the dose is recommended to prevent the occurrence of withdrawal syndrome.

Heart failure

The patients suffering from narrowing of the heart valve (aortic stenosis) are at increased risk while using this medicine. These patients may suffer from heart failure.The use of Nifedipine will be not beneficial in such patients due to reduced blood flow across the aortic valve.

Stomach and intestinal obstruction

The patients using Nifedipine tablet are at increased risk. The outer membrane of Nifedipine is not digested and appears as a complete tablet in the patient's stool. It is advised to take care of the patient while using this medicine, due to the increased chances of the occurrence of obstructive symptoms or accumulation of undigested material (bezoars). Surgical treatment may be needed to treat bezoars.

Use with antihypertensive agents

The patients using Nifedipine with beta-blocking drugs and other antihypertensive agents are at increased risk. The use of Nifedipine with beta-blocking drugs and other antihypertensive agents may cause an additive effect resulting in a sudden fall in the blood pressure. The possibility of occurrence of such events must be borne in mind before using these medicines together.

Patients with heart disorders

The patients with heart disorders such as reduced heart's ability to pump blood according to the need of the body. Such patients may suffer from worsening of heart failure. Nifedipine should be used with caution in such patients.

Patients suffering from diabetes

The patients suffering from diabetes are at increased risk while using this medicine. Such patients may require some adjustments for the control of diabetes while using Nifedipine.

Changes in the blood pressure

The patients with excessively high blood pressure causing organ damage and decreased blood volume (hypovolaemia) are at increased risk while using this medicine. Such patients may suffer from low blood pressure.

Patients undergoing barium contrast x-ray

The patients undergoing barium contrast x-ray are at increased risk while using this medicine. Such patients are at risk of giving a false -positive reaction to test which is used for examination of the stomach and intestinal tract (barium contrast x-ray test). Tell the doctor before undergoing this test while using Nifedipine.

Interactions with Nifedipine

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Nifedipine. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

CYP3A inhibitors

Nifedipine may interact with CYP3A inhibitors (ketoconazole, itraconazole, and fluconazole), which are used to treat fungal infections. When these drugs are used in combination with Nifedipine, the exposure to Nifedipine gets increased. In this case, dose adjustment and careful monitoring of blood pressure may be required. When using Nifedipine with these medicines, a low starting dose of Nifedipine should be used. A patient should avoid using grapefruit while using Nifedipine.

Strong CYP3A inducers

There may be an interaction of Nifedipine with strong CYP3A inducers (phenobarbital, carbamazepine, and phenytoin), which are used to treat seizures. When Nifedipine is used with these drugs, the effectiveness of Nifedipine has been found to be decreased. It is advised that Nifedipine should not be used in combination with these medicines.

Antiarrhythmic drugs

Nifedipine interacts with quinidine, which is used to treat irregular heartbeat. Use of Nifedipine with quinidine may lead to a decrease in the level of quinidine and an increase in the level of Nifedipine in the blood. The dose adjustment of Nifedipine and appropriate monitoring of heart rate or blood pressure is recommended while using quinidine with Nifedipine.

Calcium channel blockers

Special instructions need to be followed while taking this medicine along with diltiazem and verapamil, which are used to treat high blood pressure and chest pain. When Nifedipine is used in combination with these drugs, it may increase the level of Nifedipine in the blood. In this case, the dose of Nifedipine should be reduced. Caution must be followed, and blood pressure should also be monitored.

Beta-blockers

Your doctor's guidelines may need to be followed while taking this medicine along with timolol, which is used to treat glaucoma. When using Nifedipine with beta-blockers, patients with heart diseases may see an increased risk of congestive heart failure, severe low blood pressure or exacerbation of angina. Careful monitoring and proper dose adjustment of Nifedipine is advised in these patients.

Digitalis

Nifedipine may interact with digoxin, which is used to treat irregular heartbeat and heart failure. If the Nifedipine and digoxin are used together, the level of digoxin gets increased in the blood. It is advised to monitor the digoxin levels when starting, adjusting and discontinuing Nifedipine. If required, the dose of glycoside should be reduced.

Antibacterial drugs

There may be an interaction of Nifedipine with quinupristin/dalfopristin, which are used to treat bacterial infection. When Nifedipine is used in combination with these drugs, it may lead to an increase in the level of Nifedipine in the blood. In such cases, proper monitoring of blood pressure and the dose reduction of Nifedipine should be considered.

Immunosuppressive drugs

Nifedipine interacts with tacrolimus, which is used to treat a skin condition called eczema. Use of Nifedipine with tacrolimus may lead to an increase in the level of tacrolimus in the blood. In this case, the amount of tacrolimus in the blood should be monitored, and the dose of tacrolimus must be reduced.

Glucose-lowering drugs

Special instructions need to be followed while taking this medicine along with metformin and acarbose, which are used to control high blood sugar level. The use of Nifedipine with glucose-lowering drugs may enhance the absorption, excretion and amount of metformin in the blood. Nifedipine produces high blood sugar level. While using acarbose with Nifedipine, the monitoring of blood glucose level and dose adjustment of Nifedipine is recommended.

Alpha-adrenergic blocker

Your doctor's guidelines may need to be followed while taking this medicine along with doxazosin, which is used to treat high blood pressure. The use of Nifedipine with doxazosin may increase the level of Nifedipine in the blood and lower the blood pressure. Appropriate monitoring of blood pressure and dose adjustment of Nifedipine is recommended in such patients.

Anticoagulants

Nifedipine may interact with coumarin, which is used to prevent blood clotting. Patients taking Nifedipine with coumarin may experience an increase in the blood clotting time.

Antihypertensive drugs

There may be an interaction of Nifedipine with diuretics, PDE5 inhibitors, alpha-methyldopa, these drugs are used to treat high blood pressure. When these drugs are used in combination with Nifedipine may increase the blood lowering effect of diuretics, PDE5 inhibitors, alpha-methyldopa.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Nifedipine is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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