Nifedipine side effects and how to avoid them

Common nifedipine side effects | Headache | Weight gain | Swelling | Serious side effects | Heart failure | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Nifedipine is in a class of blood pressure-lowering medications called calcium channel blockers (CCBs). Nifedipine works by preventing the movement of calcium ions through channels into the cells of the heart and blood vessels. Since calcium causes the cardiac muscle in the heart and smooth muscle in the blood vessels to contract, nifedipine relaxes these muscles and lowers blood pressure. Nifedipine has been FDA-approved to reduce high blood pressure (hypertension), painful chest pain (angina), and spasms in the blood vessels as seen in conditions such as Raynaud’s syndrome. 

CCBs, including nifedipine and other members of the class such as amlodipine, are also used to help reduce overall cardiovascular mortality, although they are associated with a greater side effect profile than beta blockers such as propranolol. 

Nifedipine is not available over the counter. It is a prescription drug that is available in several preparations, dosages, and brand names. 

• Procardia, Procardia XL
• Adalat, Adalat CC
• Nifedical XL, Nifediac CC
• Afeditab CR
• Nifedipine, Nifedipine ER (generic)

Blood pressure-lowering medications can be associated with both common and serious adverse effects. In this article, we will discuss some important side effects, warnings, and drug interactions associated with nifedipine usage as well as how to avoid them. 

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Common side effects of nifedipine

Nifedipine use is associated with some very common side effects. If any of the following adverse effects become bothersome, be sure to notify your healthcare provider. 

• General symptoms of malaise including headache, dizziness, fatigue, weakness
• Gastrointestinal symptoms including nausea or constipation 
• Swelling in the arms, legs, hands, or feet
• Nervousness, nasal congestion, or heart palpitations 
• Shortness of breath
• Low blood pressure 
• Skin conditions such as eczema (associated with chronic use in seniors)
• Overgrowth of gum tissue
• Muscle cramps 
• Flushing

Headache

Calcium channel blockers, including nifedipine, are commonly associated with headaches, and even migraine headaches when taken in higher doses. Seemingly paradoxically, CCBs can both reduce headaches since they lower blood pressure, and increase headaches through the dilation of cerebral blood vessels. 

In a study published in the British Journal of Clinical Pharmacology, the authors noted that the effects of CCBs on headache were dose-dependent. At low doses (below typical treatment doses), CCBs were found to reduce headaches, and at high doses (above typical treatment doses), CCBs were shown to increase the incidence of headaches. At therapeutic doses, the effect on headache was variable, which is typical of many medications.

If you experience a severe or persistent headache while taking this medication, notify a healthcare professional right away. While most headache symptoms improve on their own or with a change in dose, some headaches could be associated with more serious conditions such as a cerebral aneurysm.

Weight gain

Weight gain is not a serious side effect associated with nifedipine. However, there are two mechanisms by which individuals may appear to gain or lose weight while taking this medication. Nifedipine has been associated with weight loss in obese animals, which is believed to be related to the positive effect nifedipine has on lipid metabolism and systolic blood pressure. 

Due to the relaxation effect nifedipine has on the smooth muscle in peripheral blood vessels, nifedipine is also associated with edema (discussed below). The additional fluid retention can cause weight gain, however, this usually resolves with stopping the medication or making dose adjustments. 

Swelling

Medications that relax vascular smooth muscle in the extremities are associated with edema. The reduced compliance of the blood vessels results in leakage and pooling of extracellular and lymphatic fluids. This is most commonly seen in the lower legs and feet. 

CCBs, including nifedipine, are known to cause peripheral edema. A systematic review published in the Journal of Hypertension found a 10.7% incidence of peripheral edema associated with CCB use with 2.1% of patients stopping the medication due to this effect.

Swelling in the extremities is usually not dangerous, however, it can be very uncomfortable, and is rarely associated with fluid retention in other areas of the body or under the skin. If you experience swelling in your body while taking this medication, make sure you bring this side effect to the attention of your healthcare provider. 

Serious side effects of nifedipine

There are some rare serious side effects associated with nifedipine use. Notify your healthcare provider right away if you experience any of the following adverse events. 

• Heart problems including heart attack (myocardial infarction), congestive heart failure (CHF), and irregular heartbeat (arrhythmia)
• Fluid in or around the lungs (pulmonary edema) 
• Gastrointestinal obstruction or ulcer (associated with the extended-release tablet)
• Blockage of bile flow (cholestasis) 
• Signs or symptoms of anaphylaxis or allergic reaction including allergic hepatitis, swelling around the eyes, mouth, or under the skin (angioedema) 
• Severe skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis 

Heart failure

An important distinction should be made regarding the use of CCBs in individuals at risk for heart failure and those with active heart failure. Long-standing hypertension can often lead to heart failure. There are good reasons to use CCBs in certain patients with long-standing hypertension who are at risk for developing heart failure. CCBs are known to provide better blood pressure control and to reduce death and the symptoms of heart disease in certain individuals and among certain ethnicities, including African Americans.

However, there are several historical studies that demonstrate associations between CCB use and heart failure. These articles largely describe effects from older CCBs. These medications tend to have a greater effect on the heart’s ability to pump blood, and therefore are a greater risk for people with heart failure. In current practice, the best guidance and evidence say to generally avoid CCB use in individuals who already have heart failure with reduced ejection fraction (HFrEF), but to use them in certain individuals with hypertension that has not yet progressed to heart failure, or in individuals with heart failure secondary to hypertension that has not been controlled with other medications.

How long do nifedipine side effects last?

Most common side effects and some serious side effects resolve on their own within several days to weeks of stopping or changing the dose of the medication. Other more serious side effects (anaphylaxis, cardiac symptoms, severe skin reactions) may have permanent effects or result in death. 

Nifedipine contraindications and warnings

Abuse and dependence

Nifedipine is not habit-forming or addictive. There are no withdrawal symptoms associated with nifedipine usage, however, this medication should not be abruptly stopped without talking to a healthcare professional. 

Overdose

It is possible to overdose on this medication and other CCBs. This medication should only be taken as prescribed and by the person it was prescribed for. The maximum dose of this medication for adults is 180 mg per day in the immediate-release form or 90 mg per day in the extended-release form. Taking too much of this medication could lead to life-threatening effects including hypotension (low blood pressure) that does not respond to medical treatment and severe heart failure. Overdose can result in rapid death. If you believe you have taken too much of this medication, seek medical attention right away or contact the Poison Control Centers at 1-800-222-1222.

Restrictions

This medication is absolutely contraindicated for use in those who are allergic to medications in this drug class or to components of the medication. This medication should be used with extreme caution in individuals who:

• Have low blood pressure
• Have a heart valve problem called aortic stenosis
• Have recently stopped taking beta blocker medications
• Have congestive heart failure (see above)
• Have gastrointestinal obstruction or motility problems

Nifedipine interactions

Nifedipine is not absolutely contraindicated for use with any medications. However, combining it with some other medications should be done with caution, including the following medications and supplements:

• Rifampin reduces nifedipine’s effects 
• Digoxin levels should be monitored closely when combined with nifedipine
• Itraconazole may lower blood pressure and worsen edema 
• Erythromycin may increase nifedipine levels 
• Cimetidine may increase nifedipine levels 
• Carbamazepine may decrease nifedipine levels and antihypertensive effects 
• Phenytoin may worsen the overgrowth of gum tissue 
• St. John’s wort may decrease nifedipine levels 
• Grapefruit juice may increase nifedipine levels 

There are many other medications that may interact with nifedipine. Tell your healthcare provider about all prescription and over-the-counter medications you are taking.

How to avoid nifedipine side effects

1. Take the prescribed dose of nifedipine

It is important to follow medical advice while taking this medication. Take only the dose prescribed by a healthcare professional. Do not take more medication and do not take less. Take all of the doses how and when they are prescribed. For any missed dose, take the next dose as soon as you remember. Use the medication preparation exactly as it was prepared. Swallow the tablet whole. Do not crush, break or chew the tablet or capsule. Do not modify it in any way.

2. Disclose your full medication list and health history

Tell your healthcare provider about all medications, health conditions, and allergies before taking nifedipine. 

3. Store nifedipine correctly

Store and dispose of the medication correctly and away from children. Nifedipine should be stored at room temperature (68 to 77 degrees Fahrenheit). Improper storage and disposal of this medication could potentially expose children who were not prescribed this medication, which could result in imminent death.

4. Do not suddenly stop taking nifedipine

Do not stop this medication without seeking medical advice. You should not stop any blood pressure medication, including nifedipine, unless you with your healthcare provider have decided that is the right decision. 

5. Avoid certain foods and supplements

Avoid grapefruit products, certain supplements such as St. John’s wort, and medications that interact with nifedipine. Nifedipine overdose is known to cause severe heart failure and should not be taken with any medications that could increase this risk.

6. Seek immediate medical attention for allergic symptoms or overdose

Patients should immediately seek medical care if they experience any type of allergic reaction to this medication or unexplained swelling in the body. Allergic responses should be reported and treated as early as possible. Any type of serious adverse effect or potential overdose should receive medical attention immediately as CCB overdose is often lethal. Intervene early. More lives are saved the sooner an overdose or accidental poisoning receives medical care.