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Drug Details

Nifedipine ER

( Procardia XL )

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Oct 25, 2023

Drug Details

Generic Name:

Nifedipine

Common Brands:

Procardia XL, Nifedical XL, Adalat CC, Afeditab CR

Availability:

Prescription only

Therapeutic Class:

Calcium channel blockers

Forms:

Extended-release tablets, capsules

Administration:

By mouth

Therapeutic Uses:

High blood pressure

Chest pain (angina pectoris)

Controlled Status:

Not a controlled substance

Nifedipine Drug Class

Nifedipine (nye-fed-uh-peen) is a calcium channel blocker.

Nifedipine Age Range

Nifedipine is approved for use in adults. The safety and efficacy of this medication in pediatric patients have not been established.

Uses

Nifedipine Uses

Nifedipine extended-release tablets are used to treat hypertension (high blood pressure) as part of a comprehensive cardiovascular risk management strategy. In addition, this medicine is used to control vasospastic angina (angina at rest caused by coronary artery spasm). Nifedipine is also used to control chronic stable angina (effort-associated chest pain).

There may be other uses of nifedipine—your pharmacist or doctor can give you further drug information.

Nifedipine Mechanism of Action

Nifedipine is a calcium channel blocker (calcium ion influx inhibitor) and peripheral arterial vasodilator. It prevents the influx of calcium ions into the vascular smooth muscle. This causes decreased peripheral vascular resistance and relaxes the blood vessels, resulting in reduced arterial blood pressure. Taking nifedipine regularly helps to control hypertension and has a consistent cardiovascular outcome benefit. Nifedipine also increases blood flow and oxygen supply to the heart, thereby relieving coronary artery spasm-provoked angina and chronic stable angina.

Nifedipine Doses

Nifedipine is available as a 30 mg, 60 mg, and 90 mg extended-release tablet. It is also available as an immediate-release capsule (for angina only).

Your healthcare provider will adjust the dose of nifedipine based on your response. Treatment for both hypertension and angina is usually started with nifedipine 30 mg or 60 mg once daily. The dose may be increased over a period of 7-14 days if needed. However, a more rapid increase in dose may be done if symptoms warrant. The maximum dose of nifedipine for high blood pressure is usually no more than 120 mg daily.

People with angina may take either the immediate-release capsules or the extended-release tablets of nifedipine, alone or in combination with other medications. Most angina patients who are controlled on immediate-release nifedipine can switch to once-daily dosing with the extended-release tablets at an equivalent total daily dose (for example, your doctor may switch you from 30 mg three times a day of the immediate-release capsules to 90 mg once a day of the extended-release tablets). The maximum dose of nifedipine for angina is usually no more than 90 mg daily.

Directions

How To Use Nifedipine

Nifedipine comes in the form of a capsule and extended-release tablet. The capsule is to be taken 3-4 times a day as prescribed. The extended-release tablet is to be taken once a day on an empty stomach (1 hour before or 2 hours after a meal). Make sure you swallow the extended-release tablet whole without biting, chewing, or cutting it. Try to take your medicine at around the same time(s) every day.

Read the prescription label and follow the instructions carefully. Do not change the dose or dosing frequency without checking with your doctor.

Your healthcare provider may start you on a lower dose of nifedipine and gradually increase the dose after 7-14 days. Follow the dosing instructions carefully.

Tell your doctor how well the medicine is working to control your chronic stable angina or vasospastic angina. Procardia XL (nifedipine) controls chest pain in angina patients, but it does not stop an angina attack once it starts. Your doctor may prescribe other antianginal drugs (sublingual nitroglycerin) for acute anginal attacks.

Nifedipine may control your blood pressure but will not cure the condition. Monitor blood pressure at home and bring a log of your readings to your appointments. Continue taking nifedipine regularly even if you are symptom-free. Do not stop taking the medicine without talking to your healthcare provider. Doing so can result in severe hypertension (a dangerous increase in blood pressure).

Missed dose: If you miss a dose of nifedipine, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose according to your regular dosing schedule. Do not take a double dose or extra medicine to make up for a missed dose.

Storage: Store nifedipine at room temperature (between 15-30° C or 59-86° F) away from moisture, heat, and direct light in its original container, tightly closed. Do not store medications in the bathroom where they can be exposed to moisture and heat. Keep all medications safely out of reach of children and pets.

Unused medicine: Unused nifedipine should be disposed of in a way that children, other people, and pets cannot get to them. Do not throw nifedipine in the trash or flush it down the toilet. The best way to dispose of expired or unneeded nifedipine is through a drug take-back program or your local waste disposal company. Learn more about proper medication disposal.

NOTE: This medication guide is a summary and may not contain all possible drug information on nifedipine. The information contained here may not be up-to-date. This sheet is for information purposes only. If you have questions about nifedipine, talk to your doctor for medical advice.

Discounted prices for nifedipine
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Side Effects

Nifedipine Side Effects

Possible side effects of nifedipine are listed below. Call your doctor for medical advice if they are severe or persist after a few days.

Headache
Fatigue
Dizziness
Constipation
Nausea
Flushing
Heartburn
Muscle cramps
Fast heart rate
Cough
Sexual dysfunction

Some of the adverse effects of nifedipine are more serious. Call your doctor right away or seek emergency medical help if you develop the following adverse reactions:

Bullous skin adverse events (rash, hives, itching, blistering, or peeling)
Swelling of the face, eyes, lips, tongue, throat, hands, lower legs, ankles, or feet
Difficulty breathing or swallowing
Fainting
Yellowing of the skin or eyes
Increased frequency or severity of chest pain

The above list may not include all the potential side effects of nifedipine. Contact your healthcare provider if your side effects are unusual or severe or they do not get better over time. You can also report unusual side effects to the Food and Drug Administration at 1-800-FDA-1088.

Nifedipine Overdose: In case of an overdose of nifedipine, call your doctor immediately. You can also call your local poison control center, provincial poison control center, or the national poison control center at 1-800-222-1222. Overdose symptoms may include dizziness, flushing, rapid heart rate, blurred vision, nausea, vomiting, nervousness, swelling, and fainting.

Source: FDA

Warnings

Nifedipine Risks, Warnings, and Complications

Nifedipine can cause or worsen health problems in some people. Talk to your doctor or pharmacist about taking other medications for your condition if you are at an increased risk of adverse events from this drug.

EXCESSIVE BLOOD PRESSURE REDUCTION: Most people tolerate nifedipine well, but some patients receiving nifedipine can develop excessively low blood pressure. Symptoms of hypotension (low blood pressure) may include dizziness and lightheadedness. This is most likely to occur when you first start treatment and after dose adjustments. Patients receiving concomitant diuretics or concomitant beta blocker therapy are at an increased risk of severe hypotension. These effects typically go away once your body gets used to the medicine. Get up slowly from a sitting or lying position to standing to prevent falls. Tell your healthcare provider if you have severe dizziness.
WORSENING CHEST PAIN OR HEART ATTACK: Rarely, for unclear reasons, some people with severe coronary artery disease develop worsening chest pain or even a heart attack after starting nifedipine or after a dosage adjustment. If you are on beta blocker medications, do not stop taking them suddenly before starting nifedipine, as this can result in increased angina. Get emergency medical help if you experience severe, crushing chest pain, pain that radiates to your jaw, or a pounding or racing heartbeat.
CONGESTIVE HEART FAILURE: In a very small number of people, starting nifedipine can cause congestive heart failure. This is more likely to happen if you are taking beta blockers or have aortic stenosis (narrowing of the aortic valve in the heart). Call your doctor immediately if you develop symptoms of heart failure, such as difficulty breathing, swelling in your legs, or rapid weight gain. Note that swelling in the legs (moderate peripheral edema) occurs as a side effect of nifedipine, especially at high doses, and this does not necessarily indicate heart failure, but it should be monitored by your healthcare provider.
SERIOUS GASTROINTESTINAL OBSTRUCTION REQUIRING SURGERY: Rarely patients treated with nifedipine can develop intestinal blockage or stomach ulcers. These complications may even require surgical treatment. Risk factors include strictures (narrowing) in the stomach or intestines, a history of stomach or intestinal problems such as inflammation, slow bowel movements, or cancer, and taking medications that slow the movement of food through the digestive tract. Before starting nifedipine, tell your provider if you have any digestive tract problems. Call your doctor without delay if you develop stomach pain, bloating, gas, or difficulty passing stool.

Precautions Before Starting Nifedipine

Tell your doctor if you are allergic to nifedipine, any of the active or inactive ingredients in nifedipine formulations, other calcium channel blockers, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, dietary supplements, and herbal products such as St. John’s Wort. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Nifedipine may not be right for people with certain medical conditions such as a recent acute myocardial infarction (heart attack) or coronary artery bypass surgery, preexisting chronic renal insufficiency (kidney disease), liver disease, heart disease, severe gastrointestinal narrowing or intestinal blockage, conditions that cause food to move slowly through the digestive tract or inflammatory bowel disease.

If you are an older adult, age 65 years and above, talk to your provider about the pros and cons of taking nifedipine capsules. There may be other safer treatment options available.

Inform your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Nifedipine

Keep all your medical and lab appointments while on nifedipine. Your doctor will adjust your dose based on your response to the medicine.

Nifedipine can cause dizziness and weakness as side effects. Alcohol can make these side effects worse. Arise slowly from a sitting or lying position to avoid lightheadedness due to low blood pressure.

Tell your doctor if you become pregnant while on nifedipine.

Tell all your healthcare providers you are on nifedipine before any surgery, including dental procedures.

Nifedipine Drug Interactions

Certain other drugs can affect how nifedipine works. Possible interactions with other medicines can increase the risk of severe adverse events. The following medications can have drug interactions with nifedipine:

Anticoagulants or blood thinners such as warfarin (Jantoven, Coumadin)
Diabetes medications such as acarbose (Precose) and metformin (Glucophage)
Antifungal agents such as itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and fluconazole (Diflucan)
Beta blockers such as metoprolol (Lopressor, Toprol XL, in Dutoprol), propranolol (Inderal, Innopran, in Inderide), atenolol (Tenormin), labetalol (Trandate), nadolol (Corgard, in Corzide), and timolol
Anti-seizure medications such as carbamazepine (Carbatrol, Tegretol, Epitol), phenobarbital, valproic acid (Depakene), and phenytoin (Dilantin, Phenytek)
H2 blockers such as cimetidine (Tagamet)
Heart medications such as digoxin (Lanoxin)
Medications for heart rhythm abnormalities such as flecainide (Tambocor) and quinidine (in Nuedexta)
Other calcium channel blockers such as diltiazem (Cardizem) and verapamil (Calan, Verelan, Covera, in Tarka)
Medications prescribed for enlarged prostate glands, such as doxazosin (Cardura)
Antibiotics such as erythromycin (Erythrocin, E.E.S., E-Mycin), quinupristin and dalfopristin (Synercid), rifapentine (Priftin), and rifampin (Rimactane, Rifadin, in Rifater, in Rifamate)
Opioid painkillers such as fentanyl (Actiq, Fentora, Duragesic)
HIV medications such as atazanavir (Reyataz), amprenavir (Agenerase), delavirdine (Rescriptor), indinavir (Crixivan), ritonavir (Norvir, in Kaletra), fosamprenavir (Lexiva), and nelfinavir (Viracept)
Antidepressants such as nefazodone
Immunosuppressants such as tacrolimus (Astagraf SL, Prograf)

The above list may not include all the potential drug interactions of nifedipine. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

Pros & Cons

Nifedipine Pros and Cons

pros header.svg

Nifedipine can help control high blood pressure and lower your risk of cardiovascular disease (heart attack and stroke).
You only need to take the extended-release tablets once daily.
Nifedipine is available in a lower-cost generic version.
In clinical pharmacology, nifedipine works especially well for lowering blood pressure in people of African-American ethnicity.

cons header.svg

This medicine frequently causes leg swelling.
Nifedipine may not be a good choice if you have renal or hepatic impairment or congestive heart failure.
It can increase the severity and frequency of angina in people with severe coronary heart disease.
You need to take the capsule 3-4 times a day.

Pharmacist Tips

Nifedipine Tips from Pharmacists

Take the extended-release tablets on an empty stomach at least 1 hour before or 2 hours after a meal. Make sure you swallow the extended-release tablets whole without cutting, chewing, or biting them.
It’s normal for the outer shell of the extended-release tablet to be excreted with stool.
Nifedipine can cause swelling in your legs, especially at higher doses. This is not usually something to worry about, but leg swelling can also be a sign of heart failure. Tell your doctor if the swelling is bothersome. Make sure you follow up with your healthcare provider so that they can keep an eye on it.
Nifedipine can cause dizziness and low blood pressure. Stand up slowly from a sitting or lying position to lower your risk of falls.
Avoid eating grapefruit or drinking grapefruit juice while on nifedipine. This can make the plasma drug concentrations rise and cause more severe side effects.

Rx Savings Tips

Nifedipine Rx Savings Tips

Nifedipine is a generic medication, and it is available at significantly lower prices than the brand names. Brand names Procardia XL, Nifedical XL, Adalat CC, and Afeditab CR and generic nifedipine contain the same medicine and are equally effective and safe. Like with most medications, the generic version offers better value. A BuzzRx nifedipine coupon can result in big savings on the brand name and generic forms of the drug. With a BuzzRx discount card, savings card, or discount coupons, the medication could cost you a fraction of retail prices. Nifedipine may be under $12.50 for 30 tablets of the 30 mg dose at Walmart, Walgreens, Rite Aid, CVS Pharmacy, and other participating pharmacies with a BuzzRx discount card or free coupon. For the biggest discounts on nifedipine, give the checkout clerk your BuzzRx nifedipine discount coupon when you drop off your prescriptions.

Lowest Price for Nifedipine

Brand
$69.73

Generic
$12.17

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Common Questions

Common Questions about Nifedipine

Is nifedipine the same as amlodipine?

Both nifedipine and amlodipine are calcium channel blockers and are used to treat high blood pressure. Some people tolerate amlodipine better than nifedipine, with fewer side effects. Your healthcare provider will help you choose the best medicine.

How long does it take for nifedipine to work?

It can take a couple of weeks for nifedipine therapy to take effect fully. If you don’t notice an improvement in your blood pressure readings at home after taking nifedipine for at least 2 weeks, tell your doctor. They may increase your dose, add another antihypertensive medicine to your regimen, or switch you to another medicine.

Why are immediate-release nifedipine capsules not used for acute reduction of high blood pressure?

There have been cases of profound hypotension, myocardial infarction, and death when immediate-release nifedipine was used for acute reduction of blood pressure. However, they may be prescribed for angina (chest pain due to narrowing of the coronary arteries).

How do you know if nifedipine is working?

High blood pressure frequently does not cause any symptoms. Therefore, even though nifedipine will control your high blood pressure, you may not notice anything different after taking this medicine. This does not mean nifedipine is not working. Monitor blood pressure closely and continue taking the medicine even if you feel well.

Is it safe to take nifedipine during pregnancy?

There are no well-controlled studies that have looked at the safety and efficacy of nifedipine during pregnancy. Uncontrolled hypertension during pregnancy can result in health complications for both the mother and the baby. Talk to your doctor about the pros and cons of using nifedipine to control blood pressure if you are pregnant.

What is the price of nifedipine without insurance?

Without insurance, nifedipine can be as high as $41.28, but with a free BuzzRx prescription discount coupon, you could pay as low as $12.17 for the most common version of this medication. Use the BuzzRx drug price look-up tool to find the lowest discounted price, and be sure to enter the correct dosage, form, and quantity for the most accurate pricing. While generics tend to have the best savings, you can also use your BuzzRx card and coupons to purchase brand-name versions. It never hurts to ask your pharmacist to try BuzzRx when filling or refilling any of your prescription drugs—whether you have insurance or not.

What is the price of nifedipine with insurance?

Ask your pharmacist or insurance provider for your copay price on nifedipine—Copay amounts vary depending on the type of insurance plan you have and if there is a deductible to reach before prescription drug coverage begins.

You could save up to 80% on your prescription medication with a free BuzzRx discount coupon for nifedipine. When using the BuzzRx lookup tool to find the price of your medicine, be sure to enter the correct dosage, form, and quantity to receive the most accurate discounted pricing. It never hurts to ask your pharmacist to try BuzzRx when filling or refilling any of your prescriptions—whether you have insurance or not.