Nifedipine

About Nifedipine

Nifedipine relaxes the muscle of blood vessel walls, lowering blood pressure and easing angina. Procardia XL and its generics, rated AB2, are labeled for vasospastic angina, chronic stable angina in people still having symptoms on, or unable to take, beta blockers and nitrates, and high blood pressure; they start at 30 or 60 mg once a day, raised over 7 to 14 days, and more than 120 mg a day is not recommended. Generics rated AB1, equivalent to the discontinued Adalat CC, are labeled only for high blood pressure: 30 mg once a day on an empty stomach, usually 30 to 60 mg, and no more than 90 mg. The capsules treat vasospastic and chronic stable angina, starting at 10 mg three times a day, usually 10 to 20 mg a dose, with no more than 180 mg a day.

There is no boxed warning. Blood pressure can drop too far, mostly while the dose is being raised or with a beta blocker; rarely, angina worsens or a heart attack occurs after starting or raising the dose, especially in severe coronary artery disease; heart failure has rarely developed, mostly in people also taking a beta blocker; and a beta blocker should be tapered rather than stopped abruptly. With the extended-release tablets, swelling of the ankles and feet, which rises with the dose, is the most common side effect, and headache is also common; with the capsules, dizziness, flushing, headache, weakness and nausea are the most frequent. Rare gut blockages, some needing surgery, have been reported with Procardia XL-type tablets, including in people with severe narrowing of the gut. The AB1 tablets must not be taken with rifampin or other strong enzyme inducers or in cardiogenic shock, and no form is taken by anyone allergic to nifedipine.

The capsule label says they should not be used to control high blood pressure or to lower it quickly: used that way, by mouth or under the tongue, they have caused profound low blood pressure, heart attacks and deaths, and they are avoided in the first week or two after a heart attack. MedlinePlus says older adults should not usually take the capsules. Extended-release tablets are swallowed whole, never chewed, divided or crushed, and with Procardia XL an empty tablet shell may appear in the stool. Animal studies showed harm to the fetus, and the Procardia XL and capsule labels advise use in pregnancy only if the benefit justifies the risk. It passes into breast milk: the AB1 labels advise against breastfeeding, while the Procardia XL label allows it only if the benefit justifies the risk.

Taking Nifedipine

How to take it

Extended-release tablets once a day, swallowed whole; take AB1 (Adalat CC type) tablets on an empty stomach, while the Procardia XL label gives no food rule. Capsules are usually taken three times a day, swallowed whole. Do not stop it without talking to the prescriber.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

All forms at room temperature in a tightly closed container, away from light, excess heat and moisture (not in a bathroom), and out of reach of children.

Interactions to know about

Avoid grapefruit and grapefruit juice. Fluconazole, itraconazole, clarithromycin, erythromycin, fluoxetine, nefazodone, some HIV medicines and cimetidine can raise its levels; phenytoin, rifampin and other CYP3A4 inducers lower them and are avoided. Digoxin levels are checked, beta blockers can add to low blood pressure or heart failure, and the clotting test (prothrombin time) has rarely risen with coumarin anticoagulants such as warfarin.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nifedipine differs from pharmacy to pharmacy

Generic extended-release nifedipine has many makers, but a pharmacist can substitute only within the type on the prescription, AB2 for Procardia XL and AB1 for Adalat CC. A prescription that names Procardia XL and blocks substitution is priced as a brand.

The capsules are a separate product with their own generic makers, and they cannot replace tablets or the reverse.

Ways to pay less for Nifedipine without insurance

• Ask for a generic of the same type as the product prescribed, and make sure the prescription does not block substitution.
• Ask whether nifedipine is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If you take it only for blood pressure, both tablet types are labeled for that use; ask the prescriber whether either would suit you, and compare quotes.
• Once your dose is stable, ask for a ninety-day supply.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nifedipine

1. 1.Is my tablet the Procardia XL type or the Adalat CC type, and should I take it on an empty stomach?
2. 2.What should I do about ankle swelling, headache or flushing?
3. 3.Do any of my antifungals, antibiotics, seizure medicines or digoxin interact with it?
4. 4.Which chest pain symptoms after a dose change mean I should get help?

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