Adult Dosing
Prinzmetal's or variant angina or chronic stable angina pectoris
- Usual: 10-20 mg PO tid
- Initial: 10 mg PO tid. Dose may be further increased to 20-30 mg tid or qid. (Max: 30 mg as single dose; 180 mg/day)
- Alt: 30-60 mg (ER) PO qd. Titrate: gradual increase at 7-14 day intervals. (Max: 90-120 mg/day)
Hypertension
- Start with 30 mg PO qd
- Maintenance dose: 30-90 mg PO qd (ER)
- Titrate: Adjustment at 7-14 day intervals based on tolerance and response (Max: 90 mg/day)
Autonomic Dysreflexia (Non-FDA Approved)
- 10 mg (immediate release) PO, bite and swallow
Pediatric Dosing
Hypertension [Not FDA approved]
- Hypertrophic cardiomyopathy: 0.6-0.9 mg/kg/day PO divided q6-8 hrs
Autonomic Dysreflexia (Non-FDA Approved)
- 0.25-0.5mg/kg PO q4-6 hrs; Max 10 mg/dose; 1-2 mg/kg/day
[Outline]
Nifedipine, Adalat CC, Afeditab CR, Nifediac CC
- Alone or in combination for treatment of hypertension
Nifedipine, Procardia, Procardia XL, Nifedical XL
- Management of vasospastic angina confirmed by classical pattern of angina at rest accompanied by ST segment elevation, angina or coronary artery spasm provoked by ergonovine, or angiographically demonstrated coronary artery spasm
- Management of chronic stable angina without evidence of vasospasm in patients who remain symptomatic despite adequate doses of beta blockers and/or organic nitrates or who cannot tolerate those agents
- Alone or in combination for treatment of hypertension
- Excessive and poorly tolerated hypotension has occurred during initial titration or at the time of subsequent upward dosage adjustment. Patients who have undergone coronary artery bypass surgery using high dose fentanyl anesthesia and those who are receiving concomitant beta blockers with nifedipine are more susceptible. If permitted, allow at least 36 hrs for nifedipine to be washed out of the body prior to surgery
- Increased frequency, duration and/or severity of angina or acute myocardial infarction has been reported in patients with severe obstructive coronary disease starting nifedipine or at the time of dosage titration
- Gradually taper dose of beta blocker as abrupt withdrawal syndrome with increased angina has occurred
- Patients with tight aortic stenosis are at greater risk of CHF
- Rare occasions of bezoars have occurred and may require surgical intervention
- Serious GI obstruction has occurred in patients requiring need for hospitalization and surgical intervention
- Alteration in GI anatomy, hypomotility disorders and use of concomitant medications (H2-histamine blockers, nonsteroidal anti-inflammatory drugs, laxatives, anticholinergic agents, and levothyroxine) are the risk factors associated with GI obstruction
- Carefully monitor blood pressure during the initial administration and titration of nifedipine. Closely monitor patients already taking medications that are known to lower blood pressure
- Mild-moderate peripheral edema has occurred in patients
- Take care to differentiate peripheral edema from the effects of increasing left ventricular dysfunction in patients whose angina or hypertension is complicated by congestive heart failure
- Rare, usually transient, but occasionally significant elevations of enzymes such as alkaline phosphatase, CPK, LDH, SGOT and SGPT have occurred. Cholestasis with or without jaundice and rare instances of allergic hepatitis have occurred
- Decrease in platelet aggregation and increase in bleeding time have occurred in nifedipine-treated patients
- Careful monitoring and dose reduction is necessary; consider initiating therapy with the lowest dose available in patients with cirrhosis
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- CHF
- Aortic stenosis
- Hypotension
- Anesthesia or surgery
- Concurrent or recent beta blocker
- GI stricture
- Geriatrics
Pregnancy Category:C
Breastfeeding: Low levels of nifedipine are excreted into breastmilk; however, no adverse effects have been reported among breastfed infants. This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776) and based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 5 January 2011). Manufacturer advises to use the drug during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Pricing data from www.DrugStore.com in U.S.A.
- Adalat CC 90 MG TB24 [Bottle] (SCHERING)
30 mg = $98.62
90 mg = $269.89 - Nifediac CC 90 MG TB24 [Bottle] (TEVA PHARMACEUTICALS USA)
30 mg = $61.99
90 mg = $171.96 - Afeditab CR 60 MG TB24 [Bottle] (WATSON LABS)
30 mg = $63.86
90 mg = $181.5 - NIFEdipine 60 MG TB24 [Bottle] (MYLAN)
90 mg = $129.96
270 mg = $339.93 - Adalat CC 30 MG TB24 [Bottle] (SCHERING)
30 mg = $54.99
90 mg = $140.97 - NIFEdipine 10 MG CAPS [Bottle] (ACTAVIS ELIZABETH)
90 mg = $80.99
180 mg = $148.98 - NIFEdipine 20 MG CAPS [Bottle] (ACTAVIS ELIZABETH)
90 mg = $165.99
270 mg = $482.99 - Procardia XL 60 MG TB24 [Bottle] (PFIZER U.S.)
30 mg = $135.99
90 mg = $389.96 - Adalat CC 60 MG TB24 [Bottle] (SCHERING)
30 mg = $83.99
90 mg = $251.97 - Procardia 10 MG CAPS [Bottle] (PFIZER U.S.)
90 mg = $115.38
270 mg = $328.67 - Procardia XL 90 MG TB24 [Bottle] (PFIZER U.S.)
30 mg = $145.86
90 mg = $416.73 - NIFEdipine 30 MG TB24 [Bottle] (MYLAN)
100 mg = $94.99
300 mg = $259.95 - Nifediac CC 60 MG TB24 [Bottle] (TEVA PHARMACEUTICALS USA)
30 mg = $49.99
90 mg = $125.96 - Afeditab CR 30 MG TB24 [Bottle] (WATSON LABS)
30 mg = $46.52
90 mg = $116.29 - Procardia XL 30 MG TB24 [Bottle] (PFIZER U.S.)
30 mg = $79.79
90 mg = $211.01
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
