Switching from Amlodipine to Nifedipine

Rationale for Switching

• The European Respiratory Review recommends nifedipine for patients with relative bradycardia 1

Dosing Conversion Guidelines

• The American College of Cardiology suggests that nifedipine dosing options include extended-release formulation: 30-180 mg once daily 2
• The American College of Cardiology suggests that nifedipine dosing options include immediate-release formulation: 10-30 mg three times daily (maximum 90 mg/day) 2

Important Considerations

• The American Heart Association advises that immediate-release nifedipine should not be used without concomitant beta-blockade due to risk of adverse cardiovascular events 2, 3

Special Populations

• The European Heart Journal recommends high doses of nifedipine (120-240 mg daily) for patients with pulmonary arterial hypertension (PAH) who demonstrate vasoreactivity 1, 4
• The European Heart Journal suggests that nifedipine is one of the preferred CCBs for PAH patients with positive vasoreactivity testing 4
• The American Heart Association advises that amlodipine may be better tolerated than nifedipine in patients with mild left ventricular dysfunction 3
• The American Heart Association recommends avoiding both drugs in patients with severe heart failure 3

Implementation Strategy

• The American College of Cardiology suggests being vigilant for side effects, particularly peripheral edema, headache, and flushing 2
• The Journal of the American College of Cardiology recommends considering switching back to amlodipine or trying another CCB like felodipine if the patient experiences significant side effects with nifedipine 5

Potential Drug Interactions

• The American Heart Association advises that beta-blockers may be beneficial when combined with nifedipine to counteract reflex tachycardia 3