Adalat CC, Procardia, Procardia XL
Classifications: antianginal, antihypertensive, calcium channel blocker; Therapeutic: antiarrhythmic (class iv); antianginal
Pregnancy Category: C
10 mg, 20 mg capsules; 30 mg, 60 mg, 90 mg sustained release tablets
Calcium channel blocking agent that selectively blocks calcium ion influx across cell membranes of cardiac muscle and vascular
smooth muscle without changing serum calcium concentrations. Reduces myocardial oxygen utilization and supply and relaxes
and prevents coronary artery spasm; has little or no effect on SA and AV nodal conduction with therapeutic dosing. Decreases
peripheral vascular resistance and increases cardiac output.
Class IV antiarrhythmic. Decreased peripheral vascular resistance, leading to a rise in peripheral blood flow, the basis
for use of this drug in treatment of Raynaud's phenomenon.
Vasospastic "variant" or Prinzmetal's angina and chronic stable angina without vasospasm. Mild to moderate hypertension
alone or in combination with a diuretic.
Esophageal disorders; vascular headaches; Raynaud's phenomenon; asthma; cardiomyopathy; primary pulmonary hypertension.
Known hypersensitivity to nifedipine; unstable angina; acute MI; cardiogenic shock; aortic stenosis; GI obstruction. Safety
during pregnancy (category C) or in children is not established.
Concomitant use with hypotensives; GERD; CHF; lactation.
Route & Dosage
Adult: PO 1020 mg t.i.d. up to 180 mg/d
Adult: PO 1020 mg t.i.d. up to 180 mg/d or 3090 mg sustained release once/d
- Do not give within the first 12 wk following an MI.
- Use only the sustained release form to treat chronic hypertension. Ensure that sustained release form is not chewed or crushed.
It must be swallowed whole.
- Discontinue drug gradually, with close medical supervision to prevent severe hypertension and other adverse effects.
- Store at 15°25° C (59°77° F); protect from light and moisture.
Adverse Effects (≥1%)Body as a Whole:
Sore throat, weakness, fever, sweating, chills, febrile reaction. CNS: Dizziness, light-headedness,
nervousness, mood changes, weakness, jitteriness, sleep disturbances, blurred vision, retinal ischemia, difficulty in balance,
Hypotension, facial flushing, heat sensation,
palpitations, peripheral edema, MI
(rare), prolonged systemic hypotension with overdose. GI:
Nausea, heartburn, diarrhea, constipation
, cramps, flatulence, gingival hyperplasia
, hepatotoxicity. Musculoskeletal:
Inflammation, joint stiffness, muscle cramps. Respiratory:
Nasal congestion, dyspnea
, cough, wheezing. Skin:
Dermatitis, pruritus, urticaria. Urogenital:
Sexual difficulties, possible male infertility.
Diagnostic Test Interference
Nifedipine may cause mild to moderate increases of alkaline phosphatase, CPK, LDH, AST, ALT.
InteractionsDrug: beta blockers
may increase likelihood of CHF; may increase risk of phenytoin toxicity
. Herbal: Melatonin
may increase blood pressure and heart rate. Ginkgo, ginseng
may increase plasma
concentrations. St. John's wort
may decrease plasma
concentrations. Food: Grapefruit juice
(>1 qt/d) may increase plasma
concentrations and adverse effects.
Readily absorbed from GI tract; 4575% reaches systemic circulation (first pass metabolism
1030 min. Peak:
30 min. Distribution:
Distributed into breast milk. Metabolism:
In liver. Elimination:
7580% in urine, 15% in feces. Half-Life:
Assessment & Drug Effects
- Monitor BP carefully during titration period. Patient may become severely hypotensive, especially if also taking other drugs
known to lower BP. Withhold drug and notify physician if systolic BP <90.
- Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties.
- Monitor for gingival hyperplasia and report promptly. This is a rare but serious adverse effect (similar to phenytoin-induced
Patient & Family Education
- Keep a record of nitroglycerin use and promptly report any changes in previous pattern. Occasionally, people develop increased
frequency, duration, and severity of angina when they start treatment with this drug or when dosage is increased.
- Be aware that withdrawal symptoms may occur with abrupt discontinuation of the drug (chest pain, increase in anginal episodes,
- Inspect gums visually every day. Changes in gingivae may be gradual, and bleeding may be exhibited only with probing.
- Seek prompt treatment for symptoms of gingival hyperplasia (easy bleeding of gingivae and gradual enlarging of gingival mass,
especially on buccal side of lower anterior teeth). Drug will be discontinued if gingival hyperplasia occurs.
- Research shows that smoking decreases the efficacy of nifedipine and has direct and adverse effects on the heart in the
patient on nifedipine treatment.