Nifedipine

Generic name
nifedipine
Brand names
Procardia XL (US), Adalat CC (US), Adalat / Adalat XL / Adalat OROS (international), Coracten SR / Nifedipress MR (UK generics)
Drug class
Calcium Channel Blocker (Dihydropyridine)
Form
Extended-release tablet (for ongoing hypertension/angina); immediate-release capsule exists and is used off-label in specific obstetric/tocolysis contexts under clinician direction.
Route
Oral
Legal status
Prescription only. Confirmed Authorised in all 5 countries checked: US, UK, Australia, Canada, New Zealand.

Supply Rules Vary

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: APO-NIFEDIPINE XR (9) · Full directory

What nifedipine is and how it works

Nifedipine is a dihydropyridine calcium channel blocker. Extended-release nifedipine (Procardia XL, Adalat CC, and generics) is FDA-approved for hypertension and, for Procardia XL specifically, also for chronic stable angina and vasospastic (Prinzmetal's) angina. (1) (3) (5)

Nifedipine also has real, clinician-directed, evidence-based uses beyond its approved labeling: immediate-release nifedipine is used in hospital obstetric settings for acute severe high blood pressure in pregnancy and for stopping preterm labor (tocolysis), and is also used off-label for painful nipple vasospasm during breastfeeding. These are legitimate, guideline- or evidence-supported uses, but they are not the same as the FDA-approved indications and should only ever be started by a treating clinician.

Mechanism of action: how nifedipine works

Nifedipine is a dihydropyridine calcium channel blocker. The ER (Procardia XL) formulation delivers the drug at an approximately constant rate over 24 hours independent of GI pH/motility, achieving 86% relative bioavailability vs. the IR capsule at steady state, despite the drug's own short elimination half-life (~2 hours) — the extended effect comes from the controlled-release delivery system, not a longer-acting molecule. Protein binding 92-98%; hepatically metabolized via CYP3A4; elderly patients show ~33% reduced clearance. (1)

What nifedipine is used for

Hypertension

Extended-release nifedipine is FDA-approved to treat hypertension, alone or with other antihypertensive medicines. (1) (2)

Chronic stable (effort) angina

Procardia XL is FDA-approved for chronic stable angina in patients who remain symptomatic despite adequate beta-blocker/nitrate therapy or who cannot tolerate those medicines. (1)

Vasospastic (Prinzmetal's) angina

Procardia XL is FDA-approved for confirmed vasospastic angina. (1)

Acute severe hypertension in pregnancy — real, guideline-supported, OFF-LABEL use

ACOG's Practice Bulletin 222 (2020) names oral immediate-release nifedipine as one of three first-line options — alongside IV labetalol and IV hydralazine — for acute severe hypertension in pregnancy or postpartum. This is a real, respected obstetric guideline recommendation, not an FDA-approved indication for nifedipine, and is only ever given in a monitored clinical setting. (3)

Tocolysis (stopping preterm labor) — real, evidence-supported, OFF-LABEL use

A meta-analysis of 12 randomized trials (1029 women) found oral immediate-release nifedipine effective and better-tolerated than older tocolytics at delaying preterm delivery. This is an off-label use in the US, given under obstetric supervision with a specific dosing protocol, not a self-directed use. (4)

Nipple vasospasm / Raynaud's phenomenon of the nipple — real, OFF-LABEL use

Nifedipine is used off-label to relieve painful nipple vasospasm (a form of Raynaud's phenomenon) in breastfeeding mothers, helping some continue nursing who might otherwise stop. This is documented in the NIH's LactMed database, not as an FDA-approved indication. (5)

Before taking nifedipine

Do not take / not appropriate for

  • Do not use nifedipine if you have a known hypersensitivity to nifedipine. (hypersensitivity) (1)

Tell your clinician about

  • Every prescription medicine, nonprescription medicine, vitamin, and supplement you currently use — especially phenytoin, cimetidine, or medicines your clinician identifies as strong CYP3A4 inhibitors (e.g. certain antifungals, some macrolide antibiotics, some HIV protease inhibitors).
  • Any history of heart failure or reduced heart pumping function, especially if you also take a beta-blocker.
  • Any liver disease.
  • If you are pregnant, planning pregnancy, in preterm labor, or breastfeeding — nifedipine has real roles in obstetric and breastfeeding care, but always under a clinician's direction, never self-directed.
  • Any history of gastrointestinal narrowing (strictures), since rare but serious GI obstruction has been reported with the extended-release tablet shell.
(1)

How to take nifedipine

  • Swallow extended-release tablets whole. Do not chew, divide, or crush them — the tablet shell controls the drug release and may pass visibly in the stool, which is expected and not a cause for concern.
  • The FDA label describes an initial dose of 30 or 60 mg once daily, titrated over 7-14 days (faster if clinically needed), up to a maximum of 120 mg/day for hypertension (lower ceilings apply for angina).
  • Do not stop nifedipine suddenly without consulting your doctor.
  • Immediate-release nifedipine used for obstetric or tocolysis purposes follows specific clinician-directed protocols in a monitored setting — this is never a self-administered or self-timed regimen, and sublingual (under-the-tongue) use of immediate-release nifedipine is specifically NOT recommended due to a real risk of excessive, dangerous blood pressure drops.
(1) (4)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

Missed dose

If you miss a dose, contact your prescriber or pharmacist for guidance rather than doubling your next dose.

Overdose

Seek emergency care immediately for a suspected overdose. The label describes supportive treatment — cardiovascular monitoring, elevating the limbs, careful use of calcium infusion, vasopressors, and fluids. Dialysis is unlikely to help because nifedipine is highly protein-bound. One documented case of a massive overdose (~4800 mg) recovered with supportive care alone. (1)

Side effects

Swelling and headache are the most common side effects in clinical trials, both more frequent than with placebo and generally related to nifedipine's vasodilating effect.

Swelling (edema)

What to notice: Occurs in 10-30% of people, dose-dependent, attributed to vasodilation rather than heart problems.

What to do: Mention it to your clinician, especially if significant. (1)

Headache

What to notice: Occurred in 15.8% of people on nifedipine vs. 9.8% on placebo.

What to do: Mention persistent or severe headache to your clinician. (1)

Fatigue, dizziness, constipation, nausea

What to notice: Each occurred in roughly 3-6% of people on nifedipine.

What to do: Mention persistent or bothersome symptoms to your clinician. (1)

Rare but serious gastrointestinal problems

What to notice: Symptoms of bowel obstruction (severe abdominal pain, vomiting, inability to pass stool/gas) or of the tablet adhering to the gut wall with ulceration.

What to do: Seek prompt medical assessment for these symptoms, especially if you have a history of bowel narrowing. (1)

Severe skin reactions (rare)

What to notice: Widespread rash, blistering, or peeling skin (possible exfoliative dermatitis, Stevens-Johnson syndrome, or toxic epidermal necrolysis).

What to do: Seek emergency care immediately. (1)

Serious warnings

Increased angina or heart attack on starting or increasing the dose — serious

Symptoms: New or worsening chest pain, rarely progressing to a documented heart attack, particularly around initiation or a dose increase.

Action: Contact your prescriber promptly for new or worsening chest pain; seek emergency care for severe or persistent chest pain. (1)

Heart failure, usually in people also taking a beta-blocker — serious

Symptoms: New or worsening shortness of breath, swelling, or fatigue after starting nifedipine.

Action: Report these symptoms to your clinician promptly. (1)

Excessive, poorly tolerated hypotension — serious

Symptoms: Marked blood pressure drop, especially during initial titration or with a concurrent beta-blocker.

Action: Your prescriber will monitor blood pressure at initiation and with dose changes; contact your clinician for severe dizziness or fainting. (1)

Sublingual immediate-release nifedipine — specifically not recommended — serious

Symptoms: Excessive hypotension leading to reflex tachycardia, or reduced blood flow to the brain or heart.

Action: Immediate-release nifedipine should be swallowed, not placed under the tongue, per current clinical guidance. (4)

Overdose — emergency

Symptoms: Marked hypotension and related cardiovascular effects.

Action: Seek emergency care immediately. (1)

Interactions

Medicine or testEffectAction
PhenytoinReduces nifedipine exposure by about 70%.This combination is generally discouraged; your prescriber may choose an alternative. (1)
Named CYP3A4 inhibitors (fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, fluoxetine, protease inhibitors)May increase nifedipine exposure.Your clinician may adjust your dose if these are combined. (1)
CimetidineIncreases nifedipine peak levels by about 80% and total exposure by about 74%.Cautious titration is advised if these are combined. (1)
DigoxinCan increase digoxin levels by an average of about 45% in some studies.Your clinician may monitor digoxin levels when starting, adjusting, or stopping nifedipine. (1)
Grapefruit and grapefruit juiceRoughly doubles nifedipine's peak level and total exposure.Avoid grapefruit and grapefruit juice during treatment. (1)
Beta-blockersGenerally well tolerated together, but combined use has been linked to heart failure, severe hypotension, or worsened angina in some patients; severe hypotension has also been reported with high-dose fentanyl anesthesia when combined with a beta-blocker and nifedipine.Combination is common in practice but needs monitoring, particularly around anesthesia or in heart failure. (1)
Long-acting nitratesCan generally be combined safely, though no formal controlled efficacy studies were cited.Commonly combined in angina management under clinician direction. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Hepatic impairment

People with liver cirrhosis have a longer half-life and higher bioavailability of nifedipine; your clinician may adjust your dose and monitor more closely. (1)

Renal impairment

Nifedipine's pharmacokinetics are not significantly affected by kidney impairment, including dialysis; dialysis itself is unlikely to remove meaningful amounts of the drug because it is highly protein-bound. (1)

Older adults

Clearance is reduced by about 33% in elderly patients in the data reviewed; your clinician may start at a lower dose. (1)

Pregnancy — genuinely mixed evidence, and a real, separate guideline-supported acute-care role

Two different things are true at once, and neither should be dropped: (1) MotherToBaby's review of the evidence on nifedipine and birth defects is genuinely mixed — some studies found a small increase in first-trimester birth-defect risk, others found none, and the miscarriage-risk signal across calcium channel blockers as a class is similarly inconclusive and confounded by other factors. (2) Separately, ACOG's own clinical guidance names oral immediate-release nifedipine as a first-line option for treating dangerously high blood pressure in pregnancy, and it has real evidence supporting its use to delay preterm labor. These uses are guideline- and evidence-based but are not the same as an FDA-approved pregnancy indication, and any decision here belongs to your obstetric care team, weighing the real risk of untreated severe hypertension or preterm labor against the uncertain teratogenicity signal. (1) (6) (3) (4)

Breastfeeding — the most favorably documented of the calcium channel blockers reviewed so far

The NIH's LactMed database reports low milk levels, small estimated infant exposure, and no adverse effects reported in breastfed infants even at higher maternal doses (30 mg/day or more) continued for up to 6 months. Nifedipine does not appear to affect milk composition. It is also used, off-label, specifically to treat painful nipple vasospasm during breastfeeding, helping some mothers continue nursing. Still, discuss any medicine use during breastfeeding with your prescriber and your baby's healthcare provider. (5)

Monitoring

Before starting

  • Review liver function and current medicines, especially phenytoin, cimetidine, and known CYP3A4 inhibitors.
  • Discuss pregnancy, pregnancy plans, preterm labor risk, and breastfeeding directly with your prescriber or obstetric team.
  • Confirm whether you have a history of GI strictures, given the rare but serious obstruction risk with the extended-release tablet.

During treatment

  • Blood pressure monitoring at initiation and with any dose change.
  • Watch for new or worsening chest pain, especially at initiation or a dose increase.
  • Watch for signs of heart failure, especially if also taking a beta-blocker.
  • Watch for symptoms of bowel obstruction if you have a history of GI strictures.
(1)

Storage

Store at controlled room temperature, protected from light and moisture, per the product's specific packaging instructions.

Study the drug class: Dihydropyridine calcium channel blockers

Professional information

Clinician-facing context only. Use the current product-specific prescribing information and complete medication review. Obstetric and Raynaud's/nipple-vasospasm uses are guideline/evidence-based off-label uses, not FDA-labeled indications — cite the guideline/literature sources, not the product label, for those uses.

United States

Indication: Hypertension (Procardia XL, Adalat CC); chronic stable and vasospastic angina (Procardia XL only)

Dose summary: Initial 30-60 mg PO once daily (ER), titrate over 7-14 days; max 120 mg/day for hypertension. Off-label IR use: ACOG-guideline acute severe hypertension in pregnancy (alongside IV labetalol/hydralazine); tocolysis protocol 20 mg PO immediately, 20 mg PO at 30 min if contractions persist, then 20 mg PO q3-8h for 48-72h. Sublingual IR use is specifically not recommended.

Renal context: No significant PK effect from renal impairment; dialysis unlikely to help due to high protein binding. (1) (3) (4)

United Kingdom

Indication: Authorised — 93 MHRA substance files confirmed, specific products found (Adalat, generic capsules).

Dose summary: Not itemized in this pass beyond confirming licensure; refer to the specific UK product's own SmPC for exact UK dosing.

Renal context: Not itemized in this pass. (8)

Australia

Indication: Authorised — APO-NIFEDIPINE XR ARTG-registered and PBS-subsidised as of 2026-07-01.

Dose summary: Not itemized in this pass beyond confirming licensure.

Renal context: Not itemized in this pass. (9)

Canada

Indication: Authorised — 65 real DPD-listed products, 19 under the Adalat brand.

Dose summary: Not itemized in this pass beyond confirming licensure.

Renal context: Not itemized in this pass. (7)

New Zealand

Indication: Authorised — Nyefax Retard (Pharmac-funded), Adalat OROS current Medsafe data sheets confirmed.

Dose summary: Not itemized in this pass beyond confirming licensure.

Renal context: Not itemized in this pass. (10)

Mechanism of action

Hepatic guidance

Cirrhosis produces a longer half-life and higher bioavailability; dose adjustment and closer monitoring are reasonable.

Overdose note

Supportive care (cardiovascular monitoring, limb elevation, careful calcium infusion, vasopressors, fluids); dialysis unlikely to help due to high protein binding. (1)

Frequently asked questions

Is nifedipine used for high blood pressure in pregnancy?

Immediate-release nifedipine is named by ACOG as one of three first-line treatments for dangerously high blood pressure in pregnancy (alongside IV labetalol and IV hydralazine). This is a real, respected obstetric guideline use, but it is not the same as an FDA-approved pregnancy indication for nifedipine, and it is always given by a treating clinician in a monitored setting — never self-directed. (3)

Can nifedipine stop preterm labor?

Yes, oral immediate-release nifedipine has real evidence (a meta-analysis of 12 trials, over 1,000 women) supporting its use to delay preterm delivery, and it was better tolerated than older tocolytic medicines. This is an off-label use in the US, given under obstetric supervision with a specific protocol — not something to start on your own. (4)

Why does the legacy description mention Raynaud's phenomenon?

Nifedipine is genuinely used off-label for Raynaud's phenomenon, including a specific form affecting the nipple during breastfeeding, which can help some mothers continue nursing comfortably. This is a real, documented use, but it's off-label — not an FDA-approved indication like hypertension or angina — so it's presented separately here. (5)

Is nifedipine safe while breastfeeding?

Yes, based on the strongest breastfeeding evidence of any calcium channel blocker reviewed in this family so far — low milk levels, small estimated infant exposure, and no adverse effects reported even with higher, longer-term maternal dosing. Still, discuss it with your prescriber and your baby's healthcare provider. (5)

Is nifedipine available outside the United States?

Yes — confirmed currently authorised and marketed in the UK, Australia, Canada, and New Zealand, in addition to the US, based on direct checks against each country's own regulatory database or a current national data sheet. (8) (9) (7) (10)

What is the mechanism of action of nifedipine?

Nifedipine is a dihydropyridine calcium channel blocker. The ER (Procardia XL) formulation delivers the drug at an approximately constant rate over 24 hours independent of GI pH/motility, achieving 86% relative bioavailability vs. the IR capsule at steady state, despite the drug's own short elimination half-life (~2 hours) — the extended effect comes from the controlled-release delivery system, not a longer-acting molecule. Protein binding 92-98%; hepatically metabolized via CYP3A4; elderly patients show ~33% reduced clearance. (1)

What is the generic name of Nifedipine?

The generic name is nifedipine. It is sold under brand names including Procardia XL (US), Adalat CC (US), Adalat / Adalat XL / Adalat OROS (international), Coracten SR / Nifedipress MR (UK generics). (1) (2)

What class of drug is nifedipine?

Nifedipine is classed as: Calcium Channel Blocker (Dihydropyridine). (1) (2)

References

  1. PROCARDIA XL (nifedipine) Extended Release Tablets — prescribing informationDailyMed / FDA (Pfizer) · United States · accessed 2026-07-27 · source 1
  2. ADALAT CC (nifedipine) Extended Release Tablets — prescribing informationDailyMed / FDA · United States · accessed 2026-07-27 · source 2
  3. Gestational Hypertension and Preeclampsia (Practice Bulletin 222, 2020)American College of Obstetricians and Gynecologists (ACOG), Practice Bulletin 222 · United States (obstetric clinical guideline, not FDA labeling) · accessed 2026-07-27 · source 3
  4. Nifedipine as a tocolytic agent for preterm laborPeer-reviewed meta-analysis (12 RCTs, 1029 women), cited via Medscape/AJOG secondary summary · not country-specific — clinical evidence base · accessed 2026-07-27 · source 4
  5. Nifedipine (LactMed entry, NBK501047, last revised 2025-11-15)LactMed, NICHD / NCBI Bookshelf · United States · accessed 2026-07-27 · source 5
  6. Nifedipine (Procardia) — MotherToBaby fact sheet (NBK582876)MotherToBaby / NCBI Bookshelf · United States · accessed 2026-07-27 · source 6
  7. DPD active-ingredient and brand-name API queries for nifedipine / AdalatHealth Canada Drug Product Database, public API · Canada · accessed 2026-07-27 · source 7
  8. NIFEDIPINE substance page (93 files) plus specific product listingsMHRA Products (search-engine index of products.mhra.gov.uk) · United Kingdom · accessed 2026-07-27 · source 8
  9. Nifedipine XR (Apo) — ARTG-registeredHealthdirect Australia / TGA · Australia · accessed 2026-07-27 · source 9
  10. Multiple registered nifedipine data sheets (Nyefax Retard, Adalat 10, Adalat OROS)Medsafe (New Zealand) · New Zealand · accessed 2026-07-27 · source 10
  11. Calcium Channel BlockersStatPearls, NCBI Bookshelf · class_level_not_country_specific · accessed 2026-07-27 · source 11

Brand names by country

Single-ingredient nifedipine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Procardia XL60 mg, 30 mg · pfizer laboratories div pfizer inc

United Kingdom

  • Adalat / Adalat LA (8)MHRA licensed · not specified in fetched source · not specified in fetched source
  • Coracten SR / Nifedipress MR (generic modified-release) (8)MHRA licensed per family research pack NHS source · not specified in fetched source · not specified in fetched source

Canada

  • NIFEDIPINE ER
  • ADALAT XL - SRT
  • PMS-NIFEDIPINE ER
  • APO-NIFED PA - SRT
  • APO-NIFED PA -

Australia

  • APO-NIFEDIPINE XR (9)ARTG registered PBS subsidised · 30 mg, 60 mg · Apotex

New Zealand

  • Nyefax Retard (10)Pharmac funded current data sheet · 20 mg · not specified in fetched source
  • Adalat OROS (10)current data sheet · 30 mg, 60 mg · not specified in fetched source
View brands in additional countries.

This page provides general medicine information, not a diagnosis, prescription, dosing plan, or substitute for the prescriber, pharmacist, obstetric team, emergency services, and current product-specific prescribing information. Off-label obstetric, tocolysis, and Raynaud's/nipple-vasospasm uses are real and evidence-based but must always be clinician-directed.

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