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Dihydropyridine calcium channel blocker Pregnancy: Can be used in second/third trimester for hypertension. Avoid in first trimester.

Nifedipine (Modified-release)

Brand names: Adalat LA, Adipine MR, Coracten XL

Adult dose

Dose: 30–60 mg modified-release once daily; range 20–90 mg/day
Route: Oral (MR formulation — swallow whole)
Frequency: Once daily (LA) or twice daily (SR)
Max: 90 mg/day
Hypertension: 30 mg OD (LA), increase to 60–90 mg. Angina: 30–60 mg OD. Raynaud's phenomenon: 10–20 mg TDS (immediate-release) or 30 mg OD (MR). Avoid short-acting formulations for HTN/angina (reflex tachycardia, excess MI risk).

Paediatric dose

Dose: 0.25 mg/kg
Route: Oral
Frequency: Three times daily
Max: 3 mg/kg/day
Hypertensive emergency (acute): 0.25–0.5 mg/kg immediate-release (unlicensed route; swallow, do not crush for sublingual use). Specialist guidance required. Modified-release not suitable for children (swallowing difficulty).

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Reduce dose in severe hepatic impairment.

Paediatric weight-based calculator

Hypertensive emergency (acute): 0.25–0.5 mg/kg immediate-release (unlicensed route; swallow, do not crush for sublingual use). Specialist guidance required. Modified-release not suitable for children (swallowing difficulty).

Clinical pearls

  • Modified-release ONLY for hypertension and angina — never use short-acting for these indications
  • Peripheral oedema responds to dose reduction or switch to amlodipine
  • Grapefruit juice increases nifedipine bioavailability — avoid
  • First-line for Raynaud's phenomenon (reduces peripheral vasospasm)
  • Amlodipine preferred for hypertension in most guidelines (longer half-life, smoother)

Contraindications

  • Cardiogenic shock
  • Significant aortic stenosis
  • Acute MI within 4 weeks
  • Short-acting formulation for angina or hypertension (excess MI risk)

Side effects

  • Peripheral oedema (common — capillary leak)
  • Flushing
  • Headache
  • Reflex tachycardia (especially short-acting)
  • Hypotension
  • Gingival hyperplasia (prolonged use)
  • Constipation

Interactions

  • CYP3A4 inhibitors (grapefruit juice, erythromycin) — increase nifedipine levels
  • CYP3A4 inducers (rifampicin) — reduce nifedipine levels
  • Beta-blockers — additive negative inotropic effect
  • Antihypertensives — additive hypotension

Monitoring

  • Blood pressure
  • Heart rate
  • Oedema
  • LFTs (prolonged use)

Reference: BNFc; BNF; NICE CG127 Hypertension; ESC Hypertension Guidelines 2023. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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