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| __NOTOC__
| | #REDIRECT [[Nifedipine#Adult Indications and Dosage]] |
| {{Nifedipine}}
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| {{CMG}}; {{AE}}: {{AK}}
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| '''''For patient information about Nifedipine, click [[Nifedipine (patient information)|here]].'''''
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| NIFEDIPINE CAPSULE DOSAGE AND ADMINISTRATION
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| '''The dosage of nifedipine needed to suppress angina and that can be tolerated by the patient must be established by titration. Excessive doses can result in hypotension.'''
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| Therapy should be initiated with the 10 mg capsule. The starting dose is one 10 mg capsule, swallowed whole, 3 times/day. The usual effective dose range is 10–20 mg three times daily. Some patients, especially those with evidence of coronary artery spasm, respond only to higher doses, more frequent administration, or both. In such patients, doses of 20–30 mg three or four times daily may be effective. Doses above 120 mg daily are rarely necessary. More than 180 mg per day is not recommended.
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| In most cases, nifedipine titration should proceed over a 7–14 day period so that the physician can assess the response to each dose level and monitor the blood pressure before proceeding to higher doses.
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| If symptoms so warrant, titration may proceed more rapidly provided that the patient is assessed frequently. Based on the patient's physical activity level, attack frequency, and sublingual [[nitroglycerin]] consumption, the dose of nifedipine may be increased from 10 mg t.i.d. to 20 mg t.i.d. and then to 30 mg t.i.d. over a three-day period.
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| In hospitalized patients under close observation, the dose may be increased in 10 mg increments over four- to six-hour periods as required to control pain and [[arrhythmias]] due to ischemia. A single dose should rarely exceed 30 mg.
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| Avoid co-administration of nifedipine with [[grapefruit juice]] (see [[Nifedipine clinical pharmacology |CLINICAL PHARMACOLOGY]] and [[Nifedipine precautions|PRECAUTIONS]]: Other Interactions).No "rebound effect" has been observed upon discontinuation of nifedipine. However, if discontinuation of nifedipine is necessary, sound clinical practice suggests that the dosage should be decreased gradually with close physician supervision.
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| Co-Administration with Other Antianginal Drugs
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| Sublingual nitroglycerin may be taken as required for the control of acute manifestations of angina, particularly during nifedipine titration. See[[Nifedipine precautions|PRECAUTIONS]], [[Nifedipine drug interactions|Drug Interactions]], for information on co-administration of nifedipine with beta blockers or long-acting nitrates.
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| ==NIFEDIPINE EXTENDED RELEASE TABLET DOSAGE AND ADMINISTRATION==
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| Dosage must be adjusted according to each patient's needs. Therapy for either [[hypertension]] or [[angina ]]should be initiated with 30 or 60 mg once daily. Nifedipine extended-release tablets should be swallowed whole and should not be bitten or divided. In general, titration should proceed over a 7–14 day period so that the physician can fully assess the response to each dose level and monitor blood pressure before proceeding to higher doses. Since steady-state plasma levels are achieved on the second day of dosing, if symptoms so warrant, titration may proceed more rapidly provided the patient is assessed frequently. Titration to doses above 120 mg are not recommended. | |
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| Angina patients controlled on nifedipine immediate-release capsules alone or in combination with other antianginal medications may be safely switched to nifedipine extended-release tablets at the nearest equivalent total daily dose (e.g., 30 mg t.i.d. of nifedipine immediate-release capsules may be changed to 90 mg once daily of nifedipine extended-release tablets). Subsequent titration to higher or lower doses may be necessary and should be initiated as clinically warranted. Experience with doses greater than 90 mg in patients with angina is limited. Therefore, doses greater than 90 mg should be used with caution and only when clinically warranted.
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| No "rebound effect" has been observed upon discontinuation of nifedipine extended-release tablets. However, if discontinuation of nifedipine is necessary, sound clinical practice suggests that the dosage should be decreased gradually with close physician supervision.
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| Care should be taken when dispensing nifedipine extended-release to assure that the extended release dosage form has been prescribed.
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| ===Co-Administration with Other Antianginal Drugs===
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| Sublingual [[nitroglycerin]] may be taken as required for the control of acute manifestations of angina, particularly during nifedipine titration. See [[Nifedipine precautions|PRECAUTIONS]], [[Nifedipine drug interactions|Drug Interactions]], for information on co-administration of nifedipine with beta blockers or long-acting nitrates.==References==
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| {{Reflist|2}}
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| http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=03be089c-07e5-4f94-bfcc-c6101b311785
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| [[Category:Cardiovascular Drugs]]
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| [[Category:Drugs]]
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