Dihydropyridine calcium-channel blocker Pregnancy: Nifedipine should not be used during pregnancy unless the clinical condition of the woman requires treatment with nifedipine. Animal studies have shown embryotoxicity, foetotoxicity and teratogenicity; there are no adequate well-controlled studies in pregnant women. Increases in perinatal asphyxia, caesarean delivery, prematurity and intrauterine growth retardation have been reported, though it is unclear whether these are due to the underlying hypertension, its treatment, or a specific drug effect. Any use in pregnancy requires a very careful individual risk-benefit assessment and should only be considered if all other treatment options are not indicated or have failed. Acute pulmonary oedema has been observed with calcium channel blockers including nifedipine used as a tocolytic, especially in multiple pregnancy, with the intravenous route and/or concomitant beta-2 agonists. Breast-feeding: nifedipine is excreted in breast milk but breastfed infants receive a small fraction of the maternal dose; advise patients on signs of low blood pressure in the infant. Fertility: calcium antagonists have been associated with reversible biochemical changes in the spermatozoa's head section in single in vitro fertilisation cases and should be considered a possible cause of repeated unexplained IVF failure in men.

Nifedipine

Brand names: Adalat, Coracten, Adipine

Used in: Pre-eclampsia & Obstetric Emergencies

Nifedipine is a dihydropyridine calcium-channel blocker used for hypertension, angina and Raynaud's phenomenon.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Mild to moderate hypertension: 20 mg once daily initially. Severe hypertension: 30 mg once daily initially. Prophylaxis of angina pectoris: 30 mg once daily initially. (Prolonged-release tablets — Adalat LA)

Route: Oral — prolonged-release tablets swallowed whole with a glass of water, with or without food

Frequency: Once daily, at approximately 24-hour intervals (same time each day, preferably during the morning)

Max: 90 mg once daily (both hypertension and angina prophylaxis)

Source: UK SPC (eMC) for Adalat LA 30 mg prolonged-release tablets, §4.2 (https://www.medicines.org.uk/emc/product/6180/smpc). The dosage can be increased according to individual requirements up to a maximum of 90 mg once daily. SWITCHING: patients whose hypertension or anginal symptoms are controlled on Adalat capsules or Adalat retard may be safely switched to Adalat LA; prophylactic anti-anginal efficacy is maintained when patients are switched from other calcium antagonists such as diltiazem or verapamil, and those patients should start at the recommended initial dose of 30 mg Adalat LA once daily with subsequent titration as clinically warranted. Co-administration with CYP3A4 inhibitors or CYP3A4 inducers may result in the recommendation to adapt the nifedipine dose or not to use nifedipine at all (see §4.5). DURATION: treatment may be continued indefinitely. ADMINISTRATION WARNING: the tablets must be swallowed whole — under no circumstances should they be bitten, chewed or broken up — and must not be taken with grapefruit juice. ELDERLY: based on pharmacokinetic data, no dose adaptation is necessary in people above 65 years. PAEDIATRIC (non-numeric, so no structured paedDose): 'The safety and efficacy of Adalat LA in children below 18 years has not been established.' COVERAGE NOTE: this SPC covers only hypertension and prophylaxis of angina pectoris. It contains NO tocolysis regimen — nifedipine used as a tocolytic appears in §4.6/§4.8 only as a safety warning (acute pulmonary oedema has been observed when calcium channel blockers including nifedipine have been used as a tocolytic during pregnancy, especially in multiple pregnancy, with the intravenous route and/or concomitant beta-2 agonists). Any tocolysis dosing must be sourced separately from an obstetric guideline. Immediate-release capsule and other modified-release brands have different regimens not covered by this source. For cross-reference only, the US label in this bundle (nifedipine extended-release tablets) states therapy for either hypertension or angina should be initiated with 30 or 60 mg once daily, titration over a 7 to 14 day period, and that titration to doses above 120 mg is not recommended — US figures differ from the UK SPC and must not be substituted for it.

Dose adjustments

Renal

Based on pharmacokinetic data, no dosage adjustment is required in patients with renal impairment. (Note: in dialysis patients with malignant hypertension and hypovolaemia a distinct fall in blood pressure can occur as a result of vasodilation — §4.8.)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE & ADMINISTRATION Dosage must be adjusted according to each patient’s needs. Therapy for either hypertension or angina should be initiated with 30 or 60 mg once daily. Nifedipine Extended-Release Tablets USP should be swallowed whole and should not be bitten or divided. In general, titration should proceed over a 7 to 14 day period so that the physician can fully assess the response to each dose level and monitor blood pressure before proceeding to higher doses. Since steady-state plasma levels are achieved on the second day of dosing, titration may proceed more rapidly, if symptoms so warrant, provided the patient is assessed frequently. Titration to doses above 120 mg are not …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2019-06-06. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Known hypersensitivity to nifedipine, to other dihydropyridines (theoretical risk of cross-reactivity), or to any of the excipients
Cardiogenic shock, clinically significant aortic stenosis, unstable angina, or during or within one month of a myocardial infarction
Treatment of acute attacks of angina; also not for secondary prevention of myocardial infarction (and safety in malignant hypertension has not been established)
Hepatic impairment (owing to the duration of action of the prolonged-release formulation)
History of gastro-intestinal obstruction, oesophageal obstruction, or any degree of decreased lumen diameter of the gastro-intestinal tract; must not be used in patients with a Kock pouch (ileostomy after proctocolectomy)
Inflammatory bowel disease or Crohn's disease
Concomitant rifampicin (effective plasma levels of nifedipine may not be achieved owing to enzyme induction)

Side effects

Oedema including peripheral oedema (9.9%) and vasodilatation — common
Headache (3.9%) — common; dizziness, vertigo, migraine, tremor, par-/dysaesthesia, hypoaesthesia and somnolence — uncommon
Constipation — common; gastrointestinal and abdominal pain, nausea, dyspepsia, flatulence, dry mouth, gingival hyperplasia — uncommon; bezoar, dysphagia, intestinal obstruction, intestinal ulcer, vomiting and gastro-oesophageal sphincter insufficiency — rare
Tachycardia and palpitations — uncommon; chest pain (angina pectoris) — uncommon; hypotension and syncope — uncommon
Allergic reaction, allergic oedema/angioedema (including laryngeal oedema, which may be life-threatening), pruritus, urticaria and rash — uncommon; anaphylactic/anaphylactoid reaction — rare
Agranulocytosis and leucopenia (frequency not known); transient increase in liver enzymes — uncommon; jaundice — rare; toxic epidermal necrolysis and photosensitivity allergic reaction (frequency not known); pulmonary oedema reported when used as a tocolytic during pregnancy

Interactions

eMC §4.5 was NOT retrieved in this bundle — the items below come from §4.2 and §4.3 of the same SPC; the full §4.5 must be checked
Rifampicin — contraindicated; effective plasma levels of nifedipine may not be achieved owing to enzyme induction (§4.3)
CYP3A4 inhibitors or CYP3A4 inducers — co-administration may result in the recommendation to adapt the nifedipine dose or not to use nifedipine at all (§4.2)
Grapefruit juice — must not be taken with nifedipine (§4.2)

Clinical monograph

How it works

It is vascular-selective, blocking L-type calcium channels in arterial smooth muscle to cause vasodilatation and lower blood pressure with little direct effect on the heart rate.

Prescribing in practice

Use a modified-release preparation; immediate-release short-acting nifedipine can cause reflex tachycardia and abrupt hypotension and is not recommended for long-term blood-pressure control.
Common dose-related effects include ankle oedema, flushing and headache.
Modified-release products are brand-specific, so prescribe and dispense by brand.

Monitoring

Monitor blood pressure and review for vasodilatory side effects such as ankle swelling.

Counselling the patient

Take the modified-release tablets whole and do not crush or chew them.
Report marked ankle swelling, flushing or persistent headache.

Evidence & guidelines

A guideline-recommended dihydropyridine option for hypertension and angina in UK practice (NICE NG136).

Reference: NICE NG136/NG133/NG25; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

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