Nifedipine 90mg ER (cc) Tablets
It is used to treat some types of chest pain (angina).It is used to treat high blood pressure.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihypertensive, Antianginal
Pharmacologic Class
Calcium Channel Blocker, Dihydropyridine
Pregnancy Category
Category C
FDA Approved
Dec 1981
DEA Schedule
Not Controlled
Overview
What is this medicine?
Nifedipine is a medication used to treat high blood pressure (hypertension) and chest pain (angina). It belongs to a class of drugs called calcium channel blockers. It works by relaxing blood vessels, which helps blood flow more easily and lowers blood pressure, and also helps more oxygen reach the heart.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely.
When taking your medication, swallow the tablets or capsules whole. Do not chew, break, or crush them, as this can affect how the medication works.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better. Stopping your medication abruptly without consulting your doctor can increase your risk of side effects. If you need to stop taking your medication, your doctor will advise you on how to gradually reduce the dosage to minimize potential side effects.
Some medications should be taken with food, while others should be taken on an empty stomach. If you're unsure about the best way to take your medication, consult with your pharmacist for guidance.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature, protected from light and moisture. Avoid storing your medication in a bathroom, as the humidity and temperature fluctuations can affect its potency. Keep all medications in a secure location, out of the reach of children and pets.
When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by your pharmacist or healthcare provider. Instead, check with your pharmacist for guidance on the best disposal method. Many communities have drug take-back programs that provide a safe and environmentally responsible way to dispose of unwanted medications.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely.
When taking your medication, swallow the tablets or capsules whole. Do not chew, break, or crush them, as this can affect how the medication works.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better. Stopping your medication abruptly without consulting your doctor can increase your risk of side effects. If you need to stop taking your medication, your doctor will advise you on how to gradually reduce the dosage to minimize potential side effects.
Some medications should be taken with food, while others should be taken on an empty stomach. If you're unsure about the best way to take your medication, consult with your pharmacist for guidance.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature, protected from light and moisture. Avoid storing your medication in a bathroom, as the humidity and temperature fluctuations can affect its potency. Keep all medications in a secure location, out of the reach of children and pets.
When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless specifically instructed to do so by your pharmacist or healthcare provider. Instead, check with your pharmacist for guidance on the best disposal method. Many communities have drug take-back programs that provide a safe and environmentally responsible way to dispose of unwanted medications.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take the tablet whole; do not chew, crush, or divide it.
- Take at the same time each day, preferably with a meal.
- Avoid grapefruit and grapefruit juice while taking this medication, as it can increase the drug's effects and side effects.
- Limit alcohol consumption, as it can increase the blood pressure-lowering effect.
- Maintain a healthy diet (low in sodium, saturated fat), regular exercise, and manage stress to help control blood pressure.
- Do not stop taking this medication suddenly without consulting your doctor, as it can worsen your condition.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
30-90 mg orally once daily
Dose Range:
30 - 120 mg
Condition-Specific Dosing:
hypertension:
Initial: 30-60 mg orally once daily; titrate over 7-14 days as needed, up to 90-120 mg once daily. Max: 120 mg/day.
chronic_stable_angina:
Initial: 30-60 mg orally once daily; titrate over 7-14 days as needed, up to 90-120 mg once daily. Max: 120 mg/day.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No dosage adjustment generally required.
Moderate:
No dosage adjustment generally required.
Severe:
No dosage adjustment generally required, but monitor for exaggerated effects.
Dialysis:
Not dialyzable. No dosage adjustment required.
Hepatic Impairment:
Mild:
Consider lower initial dose and careful titration.
Moderate:
Consider lower initial dose (e.g., 30 mg once daily) and careful titration. Monitor for exaggerated effects.
Severe:
Use with caution. Consider lower initial dose (e.g., 30 mg once daily) and careful titration. Monitor closely for adverse effects.
Pharmacology
Mechanism of Action
Nifedipine is a dihydropyridine calcium channel blocker that inhibits the transmembrane influx of calcium ions into cardiac muscle and vascular smooth muscle cells. This inhibition leads to coronary and peripheral arterial vasodilation, reducing peripheral vascular resistance and blood pressure, and increasing coronary blood flow. It has minimal effect on cardiac contractility and conduction at therapeutic doses.
Pharmacokinetics
Absorption:
Bioavailability:
45-70% (for ER formulations, absorption is slower and more sustained)
Tmax:
6-12 hours (for ER formulations)
FoodEffect:
Food may delay absorption but does not significantly affect the extent of absorption for ER formulations. Administer consistently with or without food.
Distribution:
Vd:
0.77-1.7 L/kg
ProteinBinding:
92-98%
CnssPenetration:
Limited
Elimination:
HalfLife:
Approximately 2-5 hours (for immediate release); 6-11 hours (for extended release due to formulation)
Clearance:
Approximately 0.5-1 L/kg/hr
ExcretionRoute:
Mainly renal (60-80% as inactive metabolites), fecal (15-20%)
Unchanged:
<1%
Pharmacodynamics
OnsetOfAction:
Approximately 6 hours (for ER formulations)
PeakEffect:
6-12 hours (for ER formulations)
DurationOfAction:
24 hours (for ER formulations)
Confidence:
Medium
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
New or worsening chest pain
Abnormal heartbeat
Mood changes
Shortness of breath, sudden weight gain, or swelling in the arms or legs
Muscle pain or cramping
Shakiness
Severe constipation or stomach pain, which may be signs of a serious bowel problem
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness, tiredness, or weakness
Headache
Flushing
Heartburn
Upset stomach
Feeling nervous and excitable
For some brands, you may notice the tablet shell in your stool, which is normal and not a cause for concern
Reporting Side Effects
If you have questions or concerns about side effects, talk to your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Remember, this is not an exhaustive list of possible side effects. If you have any questions, contact your doctor for medical advice.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
New or worsening chest pain
Abnormal heartbeat
Mood changes
Shortness of breath, sudden weight gain, or swelling in the arms or legs
Muscle pain or cramping
Shakiness
Severe constipation or stomach pain, which may be signs of a serious bowel problem
Black, tarry, or bloody stools
Vomiting blood or coffee ground-like material
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness, tiredness, or weakness
Headache
Flushing
Heartburn
Upset stomach
Feeling nervous and excitable
For some brands, you may notice the tablet shell in your stool, which is normal and not a cause for concern
Reporting Side Effects
If you have questions or concerns about side effects, talk to your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Remember, this is not an exhaustive list of possible side effects. If you have any questions, contact your doctor for medical advice.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting (signs of low blood pressure)
- Swelling in the ankles, feet, or hands (peripheral edema)
- Unusual or severe headache
- Chest pain that is new or worsening
- Shortness of breath
- Rapid or irregular heartbeat
- Signs of liver problems (e.g., yellowing of skin/eyes, dark urine, persistent nausea/vomiting)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have been diagnosed with intolerance to certain sugars, including lactose, glucose, or galactose. Some formulations of this medication may contain lactose.
If you have recently experienced a heart attack.
If you are taking any medications, including prescription and over-the-counter (OTC) drugs, natural products, or vitamins, that may interact with this medication. Specifically, certain medications used to treat HIV, infections, seizures, and other conditions should not be taken with this drug. However, this is not an exhaustive list of all potential interacting medications.
To ensure your safety, it is crucial to provide your doctor and pharmacist with a comprehensive list of all your medications, including prescription and OTC drugs, natural products, and vitamins, as well as any health problems you are experiencing. This will enable them to verify that it is safe for you to take this medication in conjunction with your other medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have been diagnosed with intolerance to certain sugars, including lactose, glucose, or galactose. Some formulations of this medication may contain lactose.
If you have recently experienced a heart attack.
If you are taking any medications, including prescription and over-the-counter (OTC) drugs, natural products, or vitamins, that may interact with this medication. Specifically, certain medications used to treat HIV, infections, seizures, and other conditions should not be taken with this drug. However, this is not an exhaustive list of all potential interacting medications.
To ensure your safety, it is crucial to provide your doctor and pharmacist with a comprehensive list of all your medications, including prescription and OTC drugs, natural products, and vitamins, as well as any health problems you are experiencing. This will enable them to verify that it is safe for you to take this medication in conjunction with your other medications and health conditions. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
When starting this medication, be cautious when performing tasks that require your full attention, such as driving, until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.
Although rare, this medication can cause new or worsening chest pain, potentially leading to a heart attack, especially in individuals with severe heart blood vessel disease. Discuss your risk with your doctor.
Regularly monitor your blood pressure as directed by your healthcare provider. Additionally, undergo blood tests as scheduled by your doctor and discuss the results with them.
Avoid consuming grapefruit and grapefruit juice while taking this medication. If you have high blood pressure, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Be aware that a long-acting form of this medication has been associated with severe stomach and bowel problems, including blockages and ulcers, which may require hospitalization. Discuss these potential risks with your doctor.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.
When starting this medication, be cautious when performing tasks that require your full attention, such as driving, until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.
Although rare, this medication can cause new or worsening chest pain, potentially leading to a heart attack, especially in individuals with severe heart blood vessel disease. Discuss your risk with your doctor.
Regularly monitor your blood pressure as directed by your healthcare provider. Additionally, undergo blood tests as scheduled by your doctor and discuss the results with them.
Avoid consuming grapefruit and grapefruit juice while taking this medication. If you have high blood pressure, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Be aware that a long-acting form of this medication has been associated with severe stomach and bowel problems, including blockages and ulcers, which may require hospitalization. Discuss these potential risks with your doctor.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the potential benefits and risks to you and your baby.
Overdose Information
Overdose Symptoms:
- Profound hypotension (very low blood pressure)
- Bradycardia (slow heart rate)
- Tachycardia (fast heart rate)
- Dizziness, lightheadedness, fainting
- Flushing
- Hyperglycemia (high blood sugar)
- Metabolic acidosis
- Cardiogenic shock with pulmonary edema
What to Do:
Call 911 or Poison Control (1-800-222-1222) immediately. Management is supportive and symptomatic, including gastric lavage, activated charcoal, IV fluids, vasopressors (e.g., norepinephrine), calcium gluconate, atropine, and glucagon as needed.
Drug Interactions
Major Interactions
- Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, nefazodone) - may significantly increase nifedipine levels, leading to hypotension and edema.
- Rifampin - strong CYP3A4 inducer, may significantly decrease nifedipine levels, leading to loss of efficacy.
Moderate Interactions
- Other CYP3A4 inhibitors (e.g., erythromycin, fluconazole, diltiazem, verapamil, grapefruit juice) - may increase nifedipine levels.
- CYP3A4 inducers (e.g., phenytoin, carbamazepine, phenobarbital, St. John's Wort) - may decrease nifedipine levels.
- Beta-blockers - may cause additive negative inotropic and chronotropic effects, though generally well-tolerated with dihydropyridines. Monitor for bradycardia or heart failure exacerbation.
- Digoxin - may increase digoxin levels.
- Quinidine - may decrease quinidine levels.
- Theophylline - may increase theophylline levels.
- Cimetidine - may increase nifedipine levels.
- Magnesium sulfate (parenteral) - increased risk of hypotension and neuromuscular blockade.
Minor Interactions
- NSAIDs - may reduce antihypertensive effect.
- Alpha-blockers - additive hypotensive effects.
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Heart Rate (HR)
Rationale: To establish baseline and monitor for reflex tachycardia or bradycardia (if co-administered with other agents).
Timing: Prior to initiation
Liver Function Tests (LFTs)
Rationale: Nifedipine is extensively metabolized by the liver; baseline assessment is prudent, especially in patients with suspected hepatic impairment.
Timing: Prior to initiation (if clinically indicated)
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly, especially during dose titration and periodically thereafter (e.g., weekly during titration, then monthly to quarterly)
Target: <130/80 mmHg (or individualized target)
Action Threshold: Persistent BP above target, or symptomatic hypotension (e.g., dizziness, syncope)
Heart Rate (HR)
Frequency: Regularly, especially during dose titration and periodically thereafter
Target: 60-100 bpm (or individualized target)
Action Threshold: Persistent bradycardia (<50 bpm) or significant tachycardia (>100 bpm) with symptoms
Peripheral Edema
Frequency: Regularly, especially during dose titration and periodically thereafter
Target: Absence of significant edema
Action Threshold: Development or worsening of significant lower extremity edema
Symptoms of Angina (if applicable)
Frequency: Regularly
Target: Reduction or elimination of angina episodes
Action Threshold: Persistent or worsening angina
Symptom Monitoring
- Headache
- Dizziness
- Flushing
- Palpitations
- Peripheral edema (swelling of ankles/feet)
- Fatigue
- Nausea
- Gastroesophageal reflux symptoms
Special Patient Groups
Pregnancy
Nifedipine is Pregnancy Category C. Studies in animals have shown adverse effects on the fetus. There are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is sometimes used off-label for preterm labor or severe preeclampsia.
Trimester-Specific Risks:
First Trimester:
Potential for teratogenicity observed in animal studies (skeletal abnormalities, digital anomalies). Human data are limited but generally do not show a consistent pattern of major malformations.
Second Trimester:
Generally considered safer than in the first trimester if clinically indicated for maternal conditions (e.g., severe hypertension).
Third Trimester:
May cause maternal hypotension, reflex tachycardia, and potential for uteroplacental hypoperfusion. Can inhibit uterine contractions, though this is the basis for its use in preterm labor. Neonatal adverse effects (e.g., hypotension, bradycardia) have been reported with maternal use near term.
Lactation
Nifedipine is excreted into breast milk in small amounts. The American Academy of Pediatrics considers it compatible with breastfeeding. Monitor the infant for potential adverse effects such as lethargy, poor feeding, or hypotension, though these are rare.
Infant Risk:
Low risk. Monitor for signs of hypotension or sedation in the infant.
Pediatric Use
Safety and efficacy of nifedipine extended-release in pediatric patients have not been established. Use is generally not recommended.
Geriatric Use
Use with caution in elderly patients, as they may be more sensitive to the hypotensive effects and may have reduced hepatic clearance. Consider starting at the lower end of the dosing range and titrate slowly. Monitor blood pressure and for signs of peripheral edema more closely.
Clinical Information
Clinical Pearls
- Nifedipine ER (e.g., Adalat CC, Procardia XL) should be taken once daily and swallowed whole; do not crush, chew, or divide.
- Avoid grapefruit juice due to significant CYP3A4 interaction, which can lead to increased nifedipine levels and adverse effects.
- Peripheral edema (ankle swelling) is a common dose-dependent side effect, often managed by dose reduction or addition of an ACE inhibitor/ARB.
- Immediate-release nifedipine should generally be avoided for acute blood pressure reduction due to rapid onset and potential for reflex tachycardia and ischemic events.
- Patients should be advised to report any new or worsening chest pain, dizziness, or swelling.
- Can cause gingival hyperplasia with long-term use; good oral hygiene is important.
Alternative Therapies
- Other dihydropyridine calcium channel blockers (e.g., amlodipine, felodipine, isradipine, nicardipine)
- Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem - for angina or hypertension with rate control needs)
- ACE inhibitors (e.g., lisinopril, enalapril)
- Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
- Thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone)
- Beta-blockers (e.g., metoprolol, carvedilol - for angina or hypertension with heart rate control needs)
Cost & Coverage
Average Cost:
$30 - $150 per 30 tablets (90mg ER)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (for generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more details. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider for clarification. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide information about the medication taken, the amount, and the time it happened.