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Medication Safety Issues
Sound-alike/look-alike issues:
NIFEdipine may be confused with niCARdipine, niMODipine, nisoldipine
Procardia XL® may be confused with Cartia XT®
International issues:
Nipin® [Italy and Singapore] may be confused with Nipent® which is a brand name for pentostatin in the U.S.
Pronunciation
(nye FED i peen)
U.S. Brand Names
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Management of chronic stable or vasospastic angina; treatment of hypertension (sustained release products only)
Use: Unlabeled/Investigational
Management of pulmonary hypertension, preterm labor, Raynaud's phenomenon
Pregnancy Risk Factor
C
Pregnancy Considerations
Adverse events were observed in animal reproduction studies. Nifedipine crosses the placenta. Use in pregnancy only when clearly needed and when the benefits outweigh the potential hazard to the fetus. Hypotension, IUGR reported. IUGR probably related to maternal hypertension. May be used for the treatment of preterm labor.
Lactation
Enters breast milk/not recommended (AAP considers "compatible")
Contraindications
Hypersensitivity to nifedipine or any component of the formulation; immediate release preparation for treatment of urgent or emergent hypertension; acute MI
Warnings/Precautions
Concerns related to adverse effects:
• Angina/MI: Increased angina and/or MI have occurred with initiation or dosage titration of dihydropyridine calcium channel blockers; use with caution in patients with obstructive coronary disease especially in the absence of concurrent beta-blockade.
• Hypotension/syncope: Symptomatic hypotension with or without syncope can rarely occur; blood pressure must be lowered at a rate appropriate for the patient's clinical condition. The use of immediate release nifedipine (sublingually or orally) in hypertensive emergencies and urgencies is neither safe nor effective. Serious adverse events (eg, death, cerebrovascular ischemia, syncope, stroke, acute myocardial infarction, and fetal distress) have been reported. Immediate release nifedipine should not be used for acute blood pressure reduction.
• Peripheral edema: The most common side effect is peripheral edema; occurs within 2-3 weeks of starting therapy.
• Reflex tachycardia: May occur with use.
Disease-related concerns:
• Aortic stenosis: Use with caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in myocardial ischemia.
• Heart failure (HF): Use with caution in patients with HF; may cause worsening of symptoms.
• Hepatic impairment: Use with caution in patients with hepatic impairment; may require lower starting dose.
• Hypertrophic cardiomyopathy (HCM) with outflow tract obstruction: Use with caution in patients with HCM and outflow tract obstruction since reduction in afterload may worsen symptoms associated with this condition.
Special populations:
• Elderly: The elderly may be more susceptible to adverse effects.
Dosage form specific issues:
• Extended release formulation: Consists of drug within a nondeformable matrix; following drug release/absorption, the matrix/shell is expelled in the stool. The use of nondeformable products in patients with known stricture/narrowing of the GI tract has been associated with symptoms of obstruction.
• Immediate release formulation: Immediate release formulations should not be used to manage essential hypertension, adequate studies to evaluate outcomes have not been conducted.
Other warnings/precautions:
• Surgery: Use with caution before major surgery. Cardiopulmonary bypass, intraoperative blood loss or vasodilating anesthesia may result in severe hypotension and/or increased fluid requirements. Consider withdrawing nifedipine (>36 hours) before surgery if possible.
• Withdrawal: Abrupt withdrawal may cause rebound angina in patients with CAD.
Adverse Reactions
>10%:
Cardiovascular: Flushing (10% to 25%; extended release products 3% to 4%), peripheral edema (dose related 7% to 30%)
Central nervous system: Dizziness/lightheadedness/giddiness (10% to 27%), headache (10% to 23%)
Gastrointestinal: Nausea/heartburn (10% to 11%)
?1% to 10%:
Cardiovascular: Palpitation (?2% to 7%), transient hypotension (dose related 5%), CHF (2%)
Central nervous system: Nervousness/mood changes (?2% to 7%), fatigue (6%), shakiness (?2%), jitteriness (?2%), sleep disturbances (?2%), difficulties in balance (?2%), fever (?2%), chills (?2%)
Dermatologic: Dermatitis (?2%), pruritus (?2%), urticaria (?2%)
Endocrine & metabolic: Sexual difficulties (?2%)
Gastrointestinal: Diarrhea (?2%), constipation (?2%), cramps (?2%), flatulence (?2%), gingival hyperplasia (?10%)
Neuromuscular & skeletal: Muscle cramps/tremor (?2% to 8%), weakness (<3%), inflammation (?2%), joint stiffness (?2%)
Ocular: Blurred vision (?2%)
Respiratory: Cough/wheezing (6%), nasal congestion/sore throat (?2% to 6%), chest congestion (?2%), dyspnea (?2%)
Miscellaneous: Diaphoresis (?2%)
<1% (Limited to important or life-threatening): Agranulocytosis, allergic hepatitis, alopecia, anemia, aplastic anemia, angina, angioedema, arrhythmia, arthritis with positive ANA, bezoars (sustained-release preparations), cerebral ischemia, depression, EPS, dysosmia, erythema multiforme, erythromelalgia, epistaxis, exfoliative dermatitis, facial edema, gastroesophageal reflux, gynecomastia, hematuria, ischemia, leukopenia, memory dysfunction, migraine, myalgia, myoclonus, nocturia, paranoid syndrome, parotitis, periorbital edema, photosensitivity, polyuria, purpura, Stevens-Johnson syndrome, syncope, tachycardia, taste perversion, thrombocytopenia, tinnitus, transient blindness, ventricular arrhythmia
Reported with use of sublingual short-acting nifedipine: Cerebrovascular ischemia, syncope, heart block, stroke, sinus arrest, severe hypotension, acute MI, ECG changes, and fetal distress
Metabolism/Transport Effects
Substrate of CYP2D6 (minor), 3A4 (major); Inhibits CYP1A2 (moderate), 2C9 (weak), 2D6 (weak), 3A4 (weak)
Drug Interactions
Alcohol (Ethyl): May increase the serum concentration of NIFEdipine. Risk C: Monitor therapy
Alpha1-Blockers: May enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
Amifostine: Antihypertensives may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, antihypertensive medications should be withheld for 24 hours prior to amifostine administration. If antihypertensive therapy can not be withheld, amifostine should not be administered. Risk D: Consider therapy modification
Antifungal Agents (Azole Derivatives, Systemic): May decrease the metabolism of Calcium Channel Blockers. Risk D: Consider therapy modification
Antihypertensives: May enhance the hypotensive effect of other Antihypertensives. Risk C: Monitor therapy
Barbiturates: May increase the metabolism of Calcium Channel Blockers. Risk D: Consider therapy modification
Calcium Channel Blockers (Nondihydropyridine): May enhance the hypotensive effect of Calcium Channel Blockers (Dihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may decrease the metabolism of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor therapy
Calcium Salts: May diminish the therapeutic effect of Calcium Channel Blockers. Risk C: Monitor therapy
CarBAMazepine: May increase the metabolism of Calcium Channel Blockers (Dihydropyridine). Risk C: Monitor therapy
Cimetidine: May decrease the metabolism of Calcium Channel Blockers. Risk D: Consider therapy modification
Cisapride: May increase the serum concentration of NIFEdipine. Reported with sustained release nifedipine product. Risk C: Monitor therapy
Clopidogrel: Calcium Channel Blockers may diminish the therapeutic effect of Clopidogrel. Risk C: Monitor therapy
CycloSPORINE: May decrease the metabolism of Calcium Channel Blockers (Dihydropyridine). Nicardipine may likewise inhibit the metabolism of cyclosporine. Cyclosporine dosage adjustments might be needed. Risk C: Monitor therapy
CYP1A2 Substrates: CYP1A2 Inhibitors (Moderate) may decrease the metabolism of CYP1A2 Substrates. Risk C: Monitor therapy
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Fluconazole: May decrease the metabolism of Calcium Channel Blockers. Risk C: Monitor therapy
Grapefruit Juice: May increase the serum concentration of NIFEdipine. Risk X: Avoid combination
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Calcium Channel Blockers. Exceptions: Azithromycin; Dirithromycin [Off Market]; Spiramycin. Risk D: Consider therapy modification
Magnesium Salts: Calcium Channel Blockers may enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Risk C: Monitor therapy
MAO Inhibitors: May enhance the orthostatic effect of Orthostasis Producing Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Nafcillin: May increase the metabolism of Calcium Channel Blockers. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents (Nondepolarizing): Calcium Channel Blockers may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor therapy
Nitroprusside: Calcium Channel Blockers may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy
Pentoxifylline: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Phenytoin: Calcium Channel Blockers may decrease the metabolism of Phenytoin. Risk D: Consider therapy modification
Phosphodiesterase 5 Inhibitors: May enhance the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Protease Inhibitors: May decrease the metabolism of Calcium Channel Blockers (Dihydropyridine). Risk D: Consider therapy modification
QuiNIDine: Calcium Channel Blockers (Dihydropyridine) may decrease the serum concentration of QuiNIDine. Risk C: Monitor therapy
Quinupristin: May decrease the metabolism of Calcium Channel Blockers. Risk C: Monitor therapy
Rifamycin Derivatives: May increase the metabolism of Calcium Channel Blockers. This primarily affects oral forms of calcium channel blockers. Risk D: Consider therapy modification
RiTUXimab: Antihypertensives may enhance the hypotensive effect of RiTUXimab. Risk D: Consider therapy modification
Tacrolimus: Calcium Channel Blockers (Dihydropyridine) may increase the serum concentration of Tacrolimus. Risk C: Monitor therapy
VinCRIStine: NIFEdipine may decrease the excretion of VinCRIStine. Risk C: Monitor therapy
Yohimbine: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase CNS depression and may increase the effects of nifedipine). Monitor.
Food: Nifedipine serum levels may be decreased if taken with food. Food may decrease the rate but not the extent of absorption of Procardia XL®. Increased therapeutic and vasodilator side effects, including severe hypotension and myocardial ischemia, may occur if nifedipine is taken by patients ingesting grapefruit.
Herb/Nutraceutical: St John's wort may decrease nifedipine levels. Avoid bayberry, blue cohosh, cayenne, ephedra, ginger, ginseng (American), kola, licorice (may worsen hypertension). Avoid black cohosh, California poppy, coleus, golden seal, hawthorn, mistletoe, periwinkle, quinine, shepherd's purse (may have increased antihypertensive effect).
Mechanism of Action
Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina; also reduces peripheral vascular resistance, producing a reduction in arterial blood pressure.
Pharmacodynamics/Kinetics
Onset of action: Immediate release: ~20 minutes
Protein binding (concentration dependent): 92% to 98%
Metabolism: Hepatic via CYP3A4 to inactive metabolites
Bioavailability: Capsule: 40% to 77%; Sustained release: 65% to 89% relative to immediate release capsules; bioavailability increased with significant hepatic disease
Half-life elimination: Adults: Healthy: 2-5 hours; Cirrhosis: 7 hours; Elderly: 7 hours (extended release tablet)
Excretion: Urine (60% to 80% as inactive metabolites); feces
Dosage
Oral:
Children 1-17 years: Hypertension: Extended release tablet: Initial: 0.25-0.5 mg/kg/day once daily or in 2 divided doses; maximum: 3 mg/kg/day up to 120 mg/day
Adults: Note: Dosage adjustments should occur at 7- to 14-day intervals, to allow for adequate assessment of new dose; when switching from immediate release to sustained release formulations, use same total daily dose.
Chronic stable or vasospastic angina:
Immediate release: Initial: 10 mg 3 times/day; usual dose: 10-20 mg 3 times/day; maximum: 180 mg/day; Note: Do not use for acute anginal episodes; may precipitate myocardial infarction
Extended release: Initial: 30 or 60 mg once daily; maximum: 120-180 mg/day
Hypertension: Extended release: Initial: 30 or 60 mg once daily; maximum: 90-120 mg/day
Pulmonary hypertension (unlabeled use; Galie, 2004): Extended release: Dosage range: 60-240 mg once daily
Raynaud's phenomenon (unlabeled use; Wigley, 2002): Extended release: Dosage range: 30-120 mg once daily
Hemodialysis: Supplemental dose is not necessary
Peritoneal dialysis effects: Supplemental dose is not necessary
Dosing adjustment in hepatic impairment: Reduce dose by 50% to 60% in patients with cirrhosis
Administration: Oral
Immediate release: In general, may be administered with or without food.
Extended release: Tablets should be swallowed whole; do not crush or chew.
Adalat® CC, Afeditab® CR, Nifediac CC®: Administer on an empty stomach (per manufacturer). Other extended release products may not have this recommendation; consult product labeling.
Monitoring Parameters
Heart rate, blood pressure, signs and symptoms of CHF, peripheral edema
Dietary Considerations
Avoid grapefruit juice with all products.
Immediate release: Capsule is rapidly absorbed orally if it is administered without food, but may result in vasodilator side effects; if flushing is problematic, administration with low-fat meals may decrease. In general, can take with or without food.
Extended release: Adalat® CC, Afeditab® CR, Nifediac CC®: Take on an empty stomach (manufacturer recommendation). Other extended release products may not have this recommendation; consult product labeling.
Patient Education
Do not take any new medication or OTC medications or herbal products during therapy without consulting prescriber. Take exactly as directed; do not alter dose without consulting prescriber. Do not crush or chew sustained release forms; swallow whole. Avoid caffeine, alcohol, and grapefruit juice. When used to manage angina, consult prescriber before increasing exercise routine (decreased angina does not mean it is safe to increase exercise). May cause orthostatic hypotension (change position slowly from sitting or lying to standing, or when climbing stairs); sore mouth (inspect gums for swelling or redness; use soft toothbrush, waxed dental floss, and frequent mouth rinses); dizziness, difficulties in balance, or fatigue (use caution when driving or engaging in tasks that require alertness until response to drug is known); or nausea or heartburn (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help). Report chest pain, palpitations, rapid heartbeat; swelling of extremities; muscle weakness or pain; respiratory difficulty; nervousness or mood change, rash; or vision changes. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant.
Geriatric Considerations
Elderly may experience a greater hypotensive response. Theoretically, constipation may be more of a problem in elderly patients. The half-life of nifedipine is extended in elderly patients (6.7 hours) as compared to younger subjects (3.8 hours).
Additional Information
When measuring smaller doses from the liquid-filled capsules, consider the following concentrations (for Procardia®) 10 mg capsule = 10 mg/0.34 mL; 20 mg capsule = 20 mg/0.45 mL; may be used preoperative to treat hypertensive urgency.
Considerable attention has been directed to potential increases in mortality and morbidity when short-acting nifedipine is used in treating hypertension. The rapid reduction in blood pressure may precipitate adverse cardiovascular events.
Short-acting nifedipine should not be used for acute anginal episodes since this may precipitate myocardial infarction. Extended-release formulations are preferred for the management of chronic or vasospastic angina (Poole-Wilson, 2004).
Equivalency of extended release formulation (Adalat® CC): The manufacturer states that it is acceptable to interchange two 30 mg tablets with one 60 mg tablet to effectively deliver a 60 mg dose. However, it is not recommended to substitute one 90 mg tablet with three 30 mg tablets, since the resulting Cmax is 29% higher compared to giving the single 90 mg tablet.
Anesthesia and Critical Care Concerns/Other Considerations
Evidence-Based Information: Considerable attention has been directed to potential increases in mortality and morbidity when short-acting nifedipine is used in treating hypertension. The rapid reduction in blood pressure may precipitate adverse cardiovascular events.
Short-acting nifedipine should not be used for acute anginal episodes since this may precipitate myocardial infarction. Extended-release formulations are preferred for the management of chronic or vasospastic angina (Poole-Wilson, 2004).
Cardiovascular Considerations
Considerable attention has been directed to potential increases in mortality and morbidity when short-acting nifedipine is used in treating hypertension. The rapid reduction in blood pressure may precipitate adverse cardiovascular events.
Short-acting nifedipine should not be used for acute anginal episodes since this may precipitate myocardial infarction. Extended-release formulations are preferred for the management of chronic or vasospastic angina (Poole-Wilson, 2004).
In the treatment of unstable angina/non-ST-segment elevation MI, a nondihydropyridine calcium antagonist (diltiazem or verapamil) may be considered in patients with continuing or frequently recurring ischemia when beta-blockers are contraindicated (Class I). Oral long-acting calcium antagonists may also be considered in addition to beta-blockers and nitrates (Class IIa).
Dental Health: Effects on Dental Treatment
Nifedipine has been reported to cause 10% incidence of gingival hyperplasia; effects from 30-100 mg/day have appeared after 1-9 months. Discontinuance results in complete disappearance or marked regression of symptoms; symptoms will reappear upon remedication. Marked regression occurs after 1 week and complete disappearance of symptoms has occurred within 15 days. If a gingivectomy is performed and use of the drug is continued or resumed, hyperplasia usually will recur. The success of the gingivectomy usually requires that the medication be discontinued or that a switch to a noncalcium channel blocker be made. If for some reason nifedipine cannot be discontinued, hyperplasia has not recurred after gingivectomy when extensive plaque control was performed. If nifedipine is changed to another class of cardiovascular agent, the gingival hyperplasia will probably regress and resolve. Switching to another calcium channel blocker may result in continued hyperplasia.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Dizziness is common; may cause nervousness, sedation, or mood changes
Mental Health: Effects on Psychiatric Treatment
May cause leukopenia; use caution with clozapine and carbamazepine; concurrent use with propranolol may increase AV nodal effects; barbiturates may decrease effects of nifedipine
Nursing: Physical Assessment/Monitoring
Use caution in severe aortic stenosis or severe hepatic impairment. Assess potential for interactions with other pharmacological agents or herbal products patient is taking that may increase risk of hypotension and toxicity. Assess therapeutic effectiveness (according to purpose for use) and adverse reactions (eg, hypotension, peripheral edema, gastrointestinal upset, CNS changes) when starting, adjusting dose, or discontinuing. Teach patient proper use, possible side effects/appropriate interventions (eg, orthostatic precautions), and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, softgel: 10 mg, 20 mg
Procardia®: 10 mg
Tablet, extended release: 30 mg, 60 mg, 90 mg
Adalat® CC, Procardia XL®: 30 mg, 60 mg, 90 mg
Afeditab® CR, Nifedical XL®: 30 mg, 60 mg
Nifediac CC®: 30 mg, 60 mg, 90 mg [90 mg tablet contains tartrazine]
Pricing: U.S. (www.drugstore.com)
Capsules (NIFEdipine)
10 mg (90): $72.69
20 mg (90): $121.16
Capsules (Procardia)
10 mg (90): $97.35
Tablet, 24-hour (Adalat CC)
30 mg (30): $54.19
90 mg (30): $98.63
Tablet, 24-hour (Afeditab CR)
30 mg (30): $46.52
60 mg (30): $63.86
Tablet, 24-hour (Nifediac CC)
30 mg (100): $108.99
60 mg (30): $49.99
90 mg (30): $60.99
Tablet, 24-hour (Nifedical XL)
30 mg (30): $32.99
60 mg (30): $55.99
Tablet, 24-hour (NIFEdipine CR Osmotic)
30 mg (30): $33.99
60 mg (30): $59.99
90 mg (30): $67.99
Tablet, 24-hour (Procardia XL)
30 mg (30): $68.24
60 mg (30): $110.24
90 mg (30): $121.26
References
Braunwald E, Antman EM, Beasley JW, et al, “ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina),” J Am Coll Cardiol, 2000, 36(3):970-1062.
Chobanian AV, Bakris GL, Black HR, et al, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,” JAMA, 2003, 289(19):2560-71.
Furberg Cd, Psaty BM, and Meyer JV, “Nifedipine: Dose-Related Increase in Mortality in Patients With Coronary Heart Disease,” Circulation, 1995, 92(5):1326-31.
Galie N, Torbicki A, Barst R, et al, “Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology,” Eur Heart J, 2004, 25(24):2243-78.
Gibbons RJ, Abrams J, Chatterjee K, et al, “ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients With Chronic Stable Angina),” 2002. Available at http://www.acc.org/qualityandscience/clinical/guidelines/stable/stable_clean.pdf .
Grossman E, Messerli FH, Grodzicki T, et al, “Should a Moratorium Be Placed on Sublingual Nifedipine Capsules Given for Hypertensive Emergencies and Pseudoemergencies?” JAMA, 1996, 276(16):1328-31.
Ishikawa K, Nakai S, Takenaka T, et al, “Short-Acting Nifedipine and Diltiazem Do Not Reduce the Incidence of Cardiac Events in Patients With Healed Myocardial Infarction. Secondary Prevention Group,” Circulation, 1997, 95(10):2368-73.
“Management of Preterm Labor,” ACOG Practice Bulletin No. 43. American College of Obstetricians and Gynecologists, Obstet Gynecol, 2003, 101(5 Pt 1):1039-47.
Messerli FH, Kowey P, and Grodzicki T, “Sublingual Nifedipine for Hypertensive Emergencies,” Lancet, 1991, 338(8771):881.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, “The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents,” Pediatrics, 2004, 114(2 Suppl):555-76.
Poole-Wilson PA, Lubsen J, Kirwan BA, et al, “Effect of Long-Acting Nifedipine on Mortality and Cardiovascular Morbidity in Patients with Stable Angina Requiring Treatment (Action Trial): Randomized Controlled Trial,” Lancet, 2004, 364(9437):849-57.
Psaty BM, Heckbert SR, Koepsell TD, et al, “The Risk of Myocardial Infarction Associated With Antihypertensive Therapies,” JAMA, 1995, 274(8):620-5.
Scognamiglio R, Rahimtoola SH, Fasoli G, et al, “Nifedipine in Asymptomatic Patients With Severe Aortic Regurgitation and Normal Left Ventricular Function,” N Engl J Med, 1994, 331(11):689-94.
Silberschmidt AL, Kuhn-Velten WN, Juon AM, et al, “Nifedipine Concentration in Maternal and Umbilical Cord Blood After Nifedipine Gastrointestinal Therapeutic System for Tocolysis,” BJOG, 2008, 115(4):480-85.
Sitbon O, Humbert M, Jais X, et al, “Long-Term Response to Calcium Channel Blockers in Idiopathic Pulmonary Arterial Hypertension,” Circulation, 2005, 111(23):3105-11.
Steele RM, Schuna AA, and Schreiber RT, “Calcium Antagonist-Induced Gingival Hyperplasia,” Ann Intern Med, 1994, 120(8):663-4.
Wigley FM, “Clinical Practice. Raynaud's Phenomenon,” N Engl J Med, 2002, 347(13):1001-8.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2009
Content last modified August 2009
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