AA Pharma Nifedipine should be used with care in the following conditions: 1. Beta Blocker Withdrawal: Patients recently withdrawn from beta blockers may develop a withdrawal syndrome with increased angina, probably related to increased sensitivity to catecholamines. Initiation of nifedipine treatment will not prevent this occurrence and might be expected to exacerbate it by provoking reflex catecholamine release. There have been occasional reports of increased angina in a setting of beta blocker withdrawal and nifedipine initiation. It is important to taper beta blockers if possible, rather than stopping them abruptly before beginning nifedipine.
2. Heart Failure: There have been reports of severe hypotension and a lowering of cardiac output after administration of nifedipine to patients with severe heart failure. Thus, nifedipine should be used cautiously in patients with heart failure. Rarely, patients usually receiving a beta blocker, have developed heart failure after beginning nifedipine.
Nifedipine should be used cautiously in patients with severe aortic stenosis. In such cases, nifedipine will not produce its usual afterload reducing effects, and there is a possibility that an unopposed negative inotropic action of nifedipine may produce heart failure if the end-diastolic pressure is raised.
3. Essential Hypertension and Chronic angina pectoris: In patients with essential (non-organ related) hypertension or chronic angina pectoris treated with regular or immediate release (short-acting) dosage forms of nifedipine, there is evidence to suggest a dose-related increase in complications of the cardiovascular system (eg. Myocardial Infarction) and increased mortality. Such preparations should therefore be used in these two conditions only if other drugs are not indicated.
The maximum dose is limited to 60mg.