A calcium-channel blocker (dihydropyridine)
Nifedipine
A calcium-channel blocker for high blood pressure; the modified-release form is important, and it also has uses in pregnancy and Raynaud's.
What is Nifedipine?
Nifedipine is a calcium-channel blocker that mainly relaxes and widens blood vessels to lower blood pressure. It is also used to prevent angina and to ease the circulation problems of Raynaud's, which cause cold, painful fingers and toes.
Education and reference only. This is a plain-language guide to Nifedipine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Nifedipine is a dihydropyridine calcium-channel blocker. This group acts mainly on blood vessels, relaxing and widening them to lower blood pressure, and nifedipine is used for high blood pressure as well as for certain types of angina. It also has particular roles in raised blood pressure during pregnancy and in Raynaud's phenomenon (where fingers and toes go cold, white and painful). For routine blood-pressure treatment it is used in a modified-release form, which matters greatly — certain short-acting forms are not used for this purpose because they can drop blood pressure too sharply.
How it works
Muscle cells in the walls of blood vessels need calcium to flow into them in order to contract. Nifedipine blocks the channels that let calcium in, so these muscles relax and the blood vessels widen. Wider vessels mean less resistance for the heart to pump against, which lowers blood pressure and improves blood flow. Because it works mainly on blood vessels rather than the heart's electrical system, it does not slow the heart rate the way some other calcium-channel blockers do.
Company & origin
Originated / developed by: Bayer.
Nifedipine, a dihydropyridine calcium-channel blocker, was developed by Bayer in Germany, having been synthesised in 1969. It was introduced in the 1970s under the brand Adalat.
What it treats
Conditions Nifedipine is used for
Practical use
How to take Nifedipine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it as prescribed; many forms are modified-release and should be swallowed whole, not crushed or chewed.
- Take it at the same time each day, with or without food as advised for your form.
- Be aware it can cause flushing, headache and ankle swelling, especially when starting.
- Get up slowly if you feel dizzy or light-headed.
- Tell your pharmacist before using grapefruit juice or new medicines, as some can interact.
Weighing it up
Advantages & disadvantages of Nifedipine
Advantages
- Effectively lowers blood pressure and prevents angina.
- Helps with Raynaud's by improving blood flow to the fingers and toes.
- Does not slow the heart, so it can suit people who cannot take rate-slowing medicines.
- Available in once-daily modified-release forms.
Disadvantages
- Commonly causes ankle swelling, flushing and headache.
- Can cause dizziness and a faster heartbeat in some people.
- Modified-release forms must be swallowed whole and not crushed.
- Grapefruit juice and some medicines can increase its effects.
- Short-acting forms are generally avoided for routine blood-pressure control.
Practical use
Good to know
For ongoing blood-pressure treatment, nifedipine is taken as a modified-release tablet that releases the drug slowly and steadily across the day; this is important, because older short-acting forms can lower blood pressure too quickly and are not used for routine treatment. Modified-release tablets should usually be swallowed whole, not crushed or chewed. Ankle swelling, flushing and headache are common, especially early on, and often settle. It is one of the calcium-channel blockers considered suitable for high blood pressure in pregnancy, and is also used for Raynaud's. Grapefruit juice can raise its levels and is best avoided.
Who should not take it / use with caution
- People with certain unstable heart conditions, very low blood pressure, or significant narrowing of the heart's outflow (aortic stenosis).
- Short-acting forms are not used for routine blood-pressure control, as they can drop blood pressure too sharply.
- Used with caution in significant liver impairment and in some forms of heart failure.
Monitoring
- Blood pressure
- For ankle swelling and tolerability
- In pregnancy, monitoring as part of antenatal care
Side effects
- Ankle and leg swelling, flushing, and headache — common, especially when starting, and often settling with time.
- A faster heartbeat or palpitations, and sometimes dizziness.
- Constipation is less of an issue than with some other calcium-channel blockers; rarely, low blood pressure or gum swelling.
Key interactions
- Grapefruit juice raises its levels and is best avoided.
- Certain medicines (some antibiotics, antifungals and others) can raise or lower its levels, and some other heart medicines can add to its effects.
- Care alongside other blood-pressure-lowering medicines, which can add to its effect.
Available as: Modified-release tablets and capsules for ongoing blood-pressure treatment (swallowed whole); short-acting forms exist but are not used for routine blood-pressure control.
Answers
Nifedipine: frequently asked questions
Why does nifedipine make my ankles swell?
Calcium-channel blockers like nifedipine widen small blood vessels, which can let a little fluid collect in the lower legs and cause ankle swelling. It is common, usually harmless, and often settles. If it is troublesome, tell your prescriber, who may adjust treatment.
Why must I take the modified-release form for blood pressure?
The modified-release tablet releases nifedipine slowly and steadily, giving smooth blood-pressure control. Older short-acting forms act quickly and can drop blood pressure too sharply, which is why they are not used for routine blood-pressure treatment. Modified-release tablets should usually be swallowed whole, not crushed.
Can I take nifedipine in pregnancy?
Nifedipine is one of the medicines considered suitable for treating high blood pressure during pregnancy, and is used under specialist guidance. If you are pregnant or planning pregnancy and take it (or any blood-pressure medicine), discuss it with your healthcare team so the right choice is made for you.
Does nifedipine slow the heart rate like other calcium-channel blockers?
No — nifedipine works mainly on blood vessels rather than the heart's electrical system, so it does not slow the heart rate. In fact it can sometimes cause a slightly faster heartbeat. The "rate-limiting" calcium-channel blockers diltiazem and verapamil are the ones that slow the heart.
What is the difference between nifedipine and Adalat or Procardia?
They are the same medicine — nifedipine is the generic (active-ingredient) name, Adalat is a UK brand name and Procardia is a US brand name. Because the release form matters, your prescriber may specify a particular brand of modified-release tablet. The active ingredient is identical.
The wider class
About Calcium-channel blockers
Nifedipine belongs to the calcium-channel blockers class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF: Nifedipine.
- NICE NG133: Hypertension in pregnancy.
- NICE CKS: Nifedipine.
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