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Dihydropyridine calcium channel blocker Pregnancy: SPC §4.6: Nifedipine should not be used during pregnancy unless the clinical condition of the woman requires treatment with nifedipine. In animal studies, nifedipine has been shown to produce embryotoxicity, foetotoxicity and teratogenicity. There are no adequate well controlled studies in pregnant women. From the clinical evidence available a specific prenatal risk has not been identified, although an increase in perinatal asphyxia, caesarean delivery, as well as prematurity and intrauterine growth retardation have been reported. It is unclear whether these reports are due to the underlying hypertension, its treatment, or to 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 either not indicated or have failed to be efficacious. Acute pulmonary oedema has been observed when calcium channel blockers, among others nifedipine, have been used as a tocolytic agent during pregnancy, especially in cases of multiple pregnancy (twins or more), with the intravenous route and/or concomitant use of beta-2 agonists. §4.4: Adalat LA should be reserved for women with severe hypertension who are unresponsive to standard therapy. Breast-feeding: nifedipine is excreted in breast milk; breastfed infants receive a small fraction of the maternal dose; limited clinical evidence suggests no specific safety concerns, but patients should be advised of signs of low blood pressure in the infant and to talk to their doctor if they have concerns.

Nifedipine (Modified-release)

Brand names: Adalat LA, Adipine MR, Coracten XL

Used in: Pre-eclampsia & Obstetric Emergencies

Modified-release nifedipine is an oral dihydropyridine calcium-channel blocker used for hypertension and for the prophylaxis of angina.

Adult dose

Dose: Hypertension (Adalat LA): initial 20 mg once daily in mild to moderate hypertension, 30 mg once daily in severe hypertension; increase according to individual requirements if necessary. Prophylaxis of chronic stable angina (monotherapy or with a beta-blocker): initial 30 mg once daily; increase according to individual requirements.
Route: Oral, prolonged-release tablet (Adalat LA) — swallow whole with a glass of water, with or without food; never bite, chew or break up; not with grapefruit juice
Frequency: Once daily, at approximately 24-hour intervals — same time each day, preferably in the morning
Max: 90 mg/day (SPC: 'up to a maximum of 90 mg once-daily', printed for both hypertension and angina prophylaxis)
SCOPE: these figures come from the Adalat LA SPC only (hypertension and chronic stable angina prophylaxis). Other modified-release brands named on this page (Adipine MR, Coracten XL) are separate licences with their own SPCs, which are NOT in the source bundle — do not apply these figures to them. Not for acute attacks of angina (§4.3). Treatment may be continued indefinitely. Switching: patients controlled on Adalat capsules or Adalat retard may be safely switched to Adalat LA; patients switched from other calcium antagonists (e.g. diltiazem, verapamil) should start at 30 mg Adalat LA once daily, with later titration as clinically warranted. Co-administration with CYP 3A4 inhibitors or inducers may result in the recommendation to adapt the nifedipine dose or not to use nifedipine at all (§4.2/§4.5). Elderly: no dose adaptation necessary above 65 years (pharmacokinetic data). Tablet shell: the outer membrane is not digested, so the whole tablet may be seen in the toilet or stools (§4.4). NOT COVERED: the Adalat LA SPC gives no posology for Raynaud's phenomenon, for immediate-release nifedipine or for tocolysis; no Raynaud's regimen is stated here because none is supported by the source.

Dose adjustments

Renal

SPC §4.2: 'Based on pharmacokinetic data, no dosage adjustment is required in patients with renal impairment.' §4.4 adds a caution: in dialysis patients with malignant hypertension and hypovolaemia, a marked decrease in blood pressure can occur.

Hepatic

No dose reduction is given for this product: SPC §4.3 lists hepatic impairment as a contraindication ('Owing to the duration of action of the formulation, Adalat LA should not be administered to patients with hepatic impairment'). §4.4 separately states: 'In patients with impaired liver function careful monitoring and, in severe cases, a dose reduction may be necessary.' The §4.3 contraindication governs for Adalat LA.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Known hypersensitivity to nifedipine, to other dihydropyridines (theoretical risk of cross-reactivity) or to any excipient
  • Cardiogenic shock
  • Clinically significant aortic stenosis
  • Unstable angina
  • During or within one month of a myocardial infarction
  • Treatment of acute attacks of angina
  • Secondary prevention of myocardial infarction
  • Hepatic impairment (owing to the duration of action of the formulation)
  • History of gastro-intestinal obstruction, oesophageal obstruction, or any degree of decreased lumen diameter of the gastro-intestinal tract
  • 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)
  • Safety in malignant hypertension has not been established

Side effects

  • Common: oedema including peripheral oedema (9.9% in the trial database) and headache (3.9%); constipation; vasodilatation; feeling unwell
  • Common (others): gastrointestinal and abdominal pain, nausea, dyspepsia, flatulence, dry mouth; vertigo, migraine, dizziness, tremor; visual disturbances; palpitations; unspecific pain; muscle cramps, joint swelling; nosebleed, nasal congestion; polyuria, dysuria; erectile dysfunction
  • Uncommon: allergic reaction, allergic oedema/angioedema (including larynx oedema, which may result in a life-threatening outcome), pruritus, urticaria, rash; anxiety reactions, sleep disorders; hyperglycaemia; par-/dysaesthesia; tachycardia; hypotension, syncope; dyspnoea; transient increase in liver enzymes; erythema; chest pain (angina pectoris)
  • Rare: agranulocytosis, leucopenia; hypoaesthesia, somnolence; gingival hyperplasia; jaundice
  • Not known (post-marketing): anaphylactic/anaphylactoid reaction, depression, bezoar, dysphagia, intestinal obstruction, intestinal ulcer, vomiting, gastroesophageal sphincter insufficiency, toxic epidermal necrolysis, photosensitivity allergic reaction, palpable purpura, arthralgia, myalgia, pulmonary oedema (reported when used as a tocolytic during pregnancy), eye pain, chills

Interactions

  • Rifampicin: strongly induces CYP 3A4, distinctly reduces nifedipine bioavailability — contraindicated
  • CYP 3A4 inhibitors (macrolide antibiotics e.g. erythromycin, anti-HIV protease inhibitors e.g. ritonavir, azole antimycotics e.g. ketoconazole, fluoxetine, nefazodone, quinupristin/dalfopristin, cisapride, valproic acid, cimetidine, diltiazem) increase nifedipine exposure — monitor blood pressure and consider reducing the nifedipine dose
  • CYP 3A4 inducers (phenytoin, carbamazepine, phenobarbital) decrease nifedipine exposure — monitor clinical response and consider increasing the dose; reconsider a reduction when the inducer is stopped
  • Grapefruit juice: Adalat LA should not be taken with grapefruit juice
  • Other antihypertensives and beta-blockers: additive blood pressure lowering (postural hypotension); with beta-blockers monitor carefully as deterioration of heart failure is known in isolated cases
  • Digoxin: reduced digoxin clearance and raised plasma digoxin level — check for symptoms of digoxin overdosage
  • IV magnesium sulfate: monitor blood pressure carefully, owing to the possibility of an excessive fall in blood pressure that could harm both mother and foetus

Monitoring

  • Blood pressure — with particular care in hypotension or severe hypotension (systolic below 90 mm Hg), with CYP 3A4 inhibitors, with beta-blockers or other antihypertensives, and with IV magnesium sulfate in pregnancy
  • Liver function in patients with impaired liver function (§4.4: careful monitoring) — noting that hepatic impairment is a §4.3 contraindication for this formulation
  • Diabetic control — diabetic patients may require adjustment of their control
  • Obstructive gastrointestinal symptoms — bezoars can occur in very rare cases and may require surgical intervention
  • Heart failure — use with caution where cardiac reserve is poor; deterioration of heart failure has occasionally been observed
  • Signs of digoxin overdosage if co-prescribed with digoxin

Clinical monograph

How it works

It blocks L-type calcium channels in vascular smooth muscle, producing arterial vasodilatation that lowers peripheral resistance and blood pressure with relatively little effect on cardiac conduction.

Prescribing in practice

  • Prescribe and dispense by brand and do not interchange formulations, because modified-release products are not equivalent and swapping can cause loss of control or excessive effect.
  • Avoid immediate-release nifedipine in acute coronary syndromes, as rapid vasodilatation can cause reflex tachycardia and worsening ischaemia.
  • Common vasodilator effects include ankle oedema, flushing and headache, and grapefruit juice can raise drug levels.

Monitoring

Monitor blood pressure and heart rate and review for peripheral oedema and adequacy of angina control.

Counselling the patient

  • Swallow modified-release tablets whole and avoid grapefruit juice.
  • Ankle swelling, flushing or headache may occur; report troublesome symptoms.

Evidence & guidelines

A long-established antihypertensive and antianginal supported by clinical trials and recommended within NICE hypertension and angina guidance.

Reference: NICE CG127 Hypertension; ESC Hypertension Guidelines 2023; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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