Nifedipine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Hypertension

Initial dose:
Extended release tablets: 30 to 60 mg orally once a day

Dosage can be increased gradually every 7 to 14 days.

Maximum dose:
Adalat (R) CC: 90 mg/day
Procardia XL (R): 120 mg/day

Usual Adult Dose for Migraine Prophylaxis

Initial dose:
Extended release tablets: 30 mg orally once a day
Immediate release capsules: 10 mg orally 3 times a day

Usual Adult Dose for Angina Pectoris Prophylaxis

Initial dose:
Extended release tablets: 30 to 60 mg orally once a day
Immediate release capsules: 10 mg orally 3 times a day

Dosage can be increased gradually every 7 to 14 days.

Maintenance dose:
Immediate release capsules: 10 to 30 mg orally 3 to 4 times a day

Maximum dose:
Extended release tablets:
Adalat (R) CC: 90 mg/day
Procardia XL (R): 120 mg/day

Immediate release capsules: 180 mg/day

Usual Adult Dose for Congestive Heart Failure

Initial dose:
Procardia XL (R): 30 to 60 mg orally once a day
Adalat (R) CC: 30 mg orally once a day

Usual Adult Dose for Premature Labor

The tocolytic properties of nifedipine have been evaluated in several studies. Doses used in these studies have ranged from 10 to 40 mg as an initial "one time" dose. Subsequent dosages have ranged from 10 to 20 mg every 6 to 8 hours as needed and tolerated to delay delivery.

Immediate release capsules are not approved by the FDA for the treatment of premature labor. In addition, their use in patients with hypertension is not recommended because of data that have revealed evidence of increased risk of adverse cardiovascular events associated with the use of short-acting nifedipine in patients with hypertension. Elderly patients with coronary artery disease may be at particular risk (unlikely to pertain to pregnant women).

Usual Pediatric Dose for Hypertensive Emergency

Children:
Immediate release capsules: 0.25 to 0.5 mg/kg/dose (maximum 10 mg/dose) repeated every 4 to 6 hours if necessary
Maximum dose: 1 to 2 mg/kg/day

Initial doses less than or equal to 0.25 mg/kg/dose may result in a less dramatic decrease in blood pressure and be safer than larger initial doses. Some centers use initial doses of 0.1 mg/kg/dose.

Usual Pediatric Dose for Hypertension

Extended release tablets:
Children: 0.25 to 0.5 mg/kg/day in 1 to 2 divided doses; dose should be titrated to effect
Maximum dose: 3 mg/kg/day up to 120 mg/day (or 180 mg/day in some centers)

Adolescents:
Initial dose: 30 mg orally once a day

Usual Pediatric Dose for Hypertrophic Cardiomyopathy

Children: 0.6 to 0.9 mg/kg/24 hours in 3 to 4 divided doses

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Cirrhotic patients: Careful monitoring and dose reduction may be needed. Initiating therapy with the lowest available dose should be considered.

Precautions

Nifedipine is contraindicated in cases of cardiogenic shock. Coadministration with strong CYP450 inducers (e.g., rifampin) is also contraindicated as the effectiveness of nifedipine tablets could be significantly reduced.

Immediate release nifedipine capsules should not be used for the acute reduction of blood pressure or the control of essential hypertension. Immediate release capsules should not be used within the first week or two following myocardial infarction and should be avoided in the setting of acute coronary syndrome (when infarction may be imminent).

Although in most patients the hypotensive effect of nifedipine is modest and well tolerated, occasional patients have had excessive and poorly tolerated hypotension. These responses have usually occurred during initial titration or at the time of subsequent upward dosage adjustment, and may be more likely in patients on concomitant beta-blockers.

In patients treated with immediate release nifedipine where coronary artery bypass surgery using high dose fentanyl anesthesia is considered, the physician should be aware of the possibility of severe hypotension and/or increased fluid volume requirements. If the patient's condition permits, sufficient time (at least 36 hours) should be allowed for nifedipine to be washed out of the body prior to surgery.

Rarely, patients, particularly those with severe obstructive coronary artery disease, have developed well-documented increased frequency, duration, and/or severity of angina or acute myocardial infarction on starting nifedipine or at the time of dosage increase.

Because nifedipine decreases peripheral vascular resistance, careful monitoring of blood pressure during the initial administration and titration of nifedipine is suggested. Close observation is especially recommended for patients already taking medications that are known to lower blood pressure.

Due to the possibility of an excessive drop in blood pressure which could harm the mother and fetus, blood pressure must be carefully monitored in pregnant women when administering nifedipine in combination with intravenous magnesium sulfate.

Adalat (R) CC contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption should not use this product.

Safety and efficacy have not been fully established in pediatric patients (less than 18 years of age).

Dialysis

Nifedipine is not removed by hemodialysis or peritoneal dialysis. A supplemental dose is not necessary.

Other Comments

Coadministration of nifedipine with grapefruit juice results in a doubling in nifedipine AUC and Cmax with no change in half-life. The increased plasma concentrations most likely result from inhibition of CYP450 3A4 related first-pass metabolism. Grapefruit and grapefruit juice should be avoided while taking nifedipine.

Patients may benefit by switching from high-dose short acting products to sustained release. The use of nifedipine sublingually by puncturing capsules and administering the drug solution is not recommended due to rare cases of serious adverse events.

Extended release tablets should be swallowed whole and should not be chewed, divided, or crushed.

Adalat (R) CC should be administered on an empty stomach.

Due to the nonabsorbable shell of Procardia XL (R), patients may notice the empty tablet in their stools.

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