nifedipine ER
Nifedipine (Procardia, Procardia XL) is a calcium channel blocker (CCB). It's used to treat certain heart conditions, such as chest pain (angina) and high blood pressure in adults. It mainly works by relaxing your blood vessels, making it easier for blood to flow. Nifedipine is available as an extended-release pill (ER) that's taken by mouth once daily, and a immediate-release pill (IR) that's taken three times a day. Keep in mind the nifedipine IR is rarely prescribed. Some side effects of nifedipine include swelling in the legs, dizziness, tiredness, and headache.
What is Nifedipine ER (Procardia XL)?
What is Nifedipine ER (Procardia XL) used for?
- Chest pain (angina)
- High blood pressure (hypertension) - extended-release tablets only
How Nifedipine ER (Procardia XL) works
Nifedipine ER (Procardia XL) is a calcium channel blocker (CCB). It mainly works by relaxing your blood vessels, which lowers blood pressure and gets more oxygen to your heart to help with chest pain.
Drug facts
Side effects of Nifedipine ER (Procardia XL)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Extended-release tablets:
- Swelling (edema) in the legs, feet, or hands (10-30%)
- Headache (16%)
- Fatigue (6%)
- Dizziness (4%)
Immediate-release capsules:
- Dizziness or lightheadedness (27%)
- Flushing (25%)
- Headache (23%)
- Weakness (12%)
- Nausea (11%)
- Swelling (10%)
Less Common Side Effects
- Muscle cramps or tremors (shakiness)
- Nervousness or mood changes
- Racing heart (palpitations)
- Shortness of breath, cough, or wheezing
- Constipation
Nifedipine ER (Procardia XL) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Low blood pressure or dizziness
- Heart attack: worsening or crushing chest pain, radiating jaw pain, racing heartbeat
- Heart failure: abnormal weight gain, difficulty breathing especially when you lie down
- Stomach or intestine (gut) injury: stomach pain or bloating, difficulty passing stool or gas
More on Nifedipine ER (Procardia XL) side effects
The following Nifedipine ER (Procardia XL) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Bloating or swelling of the face, arms, hands, lower legs, or feet
difficult or labored breathing
dizziness or lightheadedness
fast, irregular, pounding, or racing heartbeat or pulse
feeling of warmth
headache
muscle cramps
rapid weight gain
shakiness in the legs, arms, hands, or feet
shortness of breath
tightness in the chest
tingling of the hands or feet
trembling or shaking of the hands or feet
unusual weight gain or loss
weakness
Less common
Blue lips and fingernails
chest congestion
chills
coughing that sometimes produces a pink frothy sputum
decreased urine output
difficult, fast, or noisy breathing, sometimes with wheezing
dilated neck veins
extreme fatigue
increased sweating
irregular breathing
pain or discomfort in the arms, jaw, back, or neck
pale skin
severe unusual tiredness or weakness
sweating
troubled breathing
vomiting
Rare
Black, tarry stools
bleeding gums
blood in the eyes
blood in the urine or stools
bloody stools
bluish color
blurred vision
body aches or pain
changes in skin color
cold sweats
dark urine
difficulty with swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
dryness or soreness of throat
ear congestion or pain
extra heartbeats
feeling unusually cold
general tiredness and weakness
headache, severe and throbbing
hoarseness
increased urge to urinate during the night
irritation in the mouth
large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
neck pain
nervousness
no blood pressure or pulse
noisy breathing
pain in the groin or genitals
pain or burning while urinating
painful or difficult urination
pinpoint red spots on the skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
redness and swelling of the gums
redness in the whites of the eyes
shakiness and unsteady walk
sharp back pain just below ribs
shivering
skin rash
small clicking, bubbling, or rattling sounds in the lung when listening with a stethoscope
sores, ulcers, or white spots on the lips or in the mouth
stopping of heart
swelling around the eyes
swollen glands
tenderness
tender, swollen glands in the neck
troubled breathing with exertion
unconsciousness
unsteadiness, trembling, or other problems with muscle control or coordination
unusual bleeding or bruising
upper right abdominal or stomach pain
vision changes
voice changes
vomiting of blood or material that looks like coffee grounds
waking to urinate at night
yellow eyes and skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Belching
feeling of indigestion
mood changes
pain in the chest below the breastbone
redness of the face, neck, arms, and occasionally, upper chest
Less common
Abnormal ejaculation
bloody nose
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
decreased interest in sexual intercourse
decreased sexual performance or desire
difficulty having a bowel movement (stool)
excess air or gas in stomach or intestines
feeling of constant movement of self or surroundings
full feeling
general feeling of discomfort or illness
inability to have or keep an erection
increased need to urinate
joint stiffness
leg cramps or pain
loss in sexual ability, desire, drive, or performance
nervousness
passing gas
passing urine more often
trouble sleeping
Rare
Acid or sour stomach
ankle, knee, or great toe joint pain
cracks in the skin
difficulty with moving
discouragement
excessive muscle tone
fear or nervousness
feeling sad or empty
hair loss or thinning of the hair
increased sensitivity of the skin to sunlight
irritability
itching, pain, redness, swelling, tenderness, or warmth on the skin
lack of appetite
lack or loss of strength
loss of heat from the body
loss of interest or pleasure
loss of strength or energy
loss in sexual ability, desire, drive, or performance
lower back or side pain
muscle pain or weakness
muscle stiffness
muscle tension or tightness
pain or burning in the throat
red, swollen skin
redness or other discoloration of the skin
severe sunburn
sleepiness or unusual drowsiness
stomach discomfort, upset, or pain
swelling of the breasts or breast soreness in both females and males
tiredness
trouble concentrating
unable to sleep
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Nifedipine ER (Procardia XL)
Pros
- Lowers risk of heart attack and stroke in people with high blood pressure
- Can take it alone or with other medications to help with blood pressure or chest pain
- Calcium channel blockers, such as nifedipine ER (Procardia XL), work especially well for Black people to lower blood pressure
- The extended-release tablets are taken once daily
- Available as a lower-cost, generic form
Cons
- Often causes swelling in the legs and feet
- Not a good choice if you have heart failure because of risk for swelling
- If you have severe heart disease, it can raise your risk of having a heart attack or worsening chest pain
- The immediate-release capsule needs to be taken 3 to 4 times a day
Pharmacist tips for Nifedipine ER (Procardia XL)
- Swallow nifedipine ER (Procardia XL) tablets and capsules whole. Don't chew, divide, or crush the extended-release tablets.
- It takes 1 to 2 weeks to see the full effects of nifedipine ER (Procardia XL). Let your provider know if you don't see an improvement in your chest pain symptoms or blood pressure after a week.
- Nifedipine ER (Procardia XL) can cause dizziness in the first few days, because it lowers your blood pressure, but your body will usually adjust. When first starting this medication or switching to a higher dose, make sure to sit or stand up slowly to avoid dizziness and risk of falling.
- Nifedipine ER (Procardia XL) can cause swelling (edema) in your feet, ankles, legs, or occasionally your hands and arms. This is usually harmless, but it doesn't usually go away with time and can be bothersome, so make sure to follow-up with your provider regularly. To help with swelling in the legs or feet, try sitting and propping your feet up for a while.
- Avoid eating grapefruit or drinking grapefruit juice, since it can raise the amount of nifedipine ER (Procardia XL) in your body and cause more side effects.
- The nifedipine ER (Procardia XL) tablet has an outer shell that doesn't get digested, so it's normal for you to see it in your stool.
- The immediate-release capsule form of nifedipine is rarely prescribed because it causes more side effects and is taken multiple times a day. The ER tablet form of nifedipine ER (Procardia XL) is still prescribed is still prescribed to treat chest pain (angina) or high blood pressure (hypertension) because it causes fewer side effects and is only taken once daily.
Common questions about Nifedipine ER (Procardia XL)
Calcium channel blockers (CCBs) are one of the first-choice medications for lowering blood pressure. But among the CCBs, nifedipine ER (Procardia XL) isn't as commonly prescribed as some of the others because it tend to cause more bothersome side effects, such as swelling and headaches. CCBs, like nifedipine ER (Procardia XL), are also first-choice medications for chest pain. Talk with your provider if you have more questions about your heart medications.
When you start nifedipine ER (Procardia XL), it can take 1 to 2 weeks to see the full effect of the dose. During this time, your provider might ask you to record your blood pressure daily to see how its improving. Your provider might need to slowly adjust your nifedipine ER (Procardia XL) dose, depending on your symptoms of chest pain or blood pressure numbers.
Check in with your provider when's the best time for your to take nifedipine ER (Procardia XL). In general, you can take nifedipine ER (Procardia XL) at any time of the day. What's most important is that you take nifedipine ER (Procardia XL) around the same time every day. Work with your provider to choose a time that's best for you and that you can remember.
You can take nifedipine ER (Procardia XL) with or without food since food won't really affect how well the medication works. A discontinued brand name of nifedipine, Adalat CC, was affected by food and thus needed to be taken on an empty stomach. If you're unsure about the best way or time to take this medication, speak with your pharmacist.
Nifedipine ER (Procardia XL) isn't known to cause slow heart rate as a side effect. Some CCBs, like verapamil and diltiazem (Cardizem), can lower heart rate because they affect the strength and speed of your heartbeat. Nifedipine ER (Procardia XL), on the other hand, doesn't typically have a major effect on heart rate.
Nifedipine ER (Procardia XL) isn't known to harm the kidneys. In general, taking this medication to lower blood pressure can improve kidney health. But there have been rare reports of some people (who already have kidney problems) experiencing worsening kidney function tests after starting nifedipine ER (Procardia XL), but the labs usually return to normal once they've stopped the medication. If you have kidney problems, talk with your provider.
Talk with your provider if you're pregnant or thinking of becoming pregnant. Based on limited research, nifedipine ER (Procardia XL) is one of the recommended medications for treating high blood pressure in pregnancy. It's best to talk with your provider about the benefits and risks of all your medication options, so you can make the most informed choice about your health.
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Risks and warnings for Nifedipine ER (Procardia XL)
Nifedipine ER (Procardia XL) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood pressure
- Risk factors: First starting nifedipine ER (Procardia XL) or changing to a higher dose | Taking beta-blocker medications
Nifedipine ER (Procardia XL) can lower your blood pressure, even if you're taking it for chest pain. For most people, the lowered blood pressure isn't much of a problem. If it drops too much, it can cause dizziness and other side effects. Typically, the effects will go away over time as your body gets used to the lowered blood pressure, but talk to your provider if the dizziness is unbearable. If you're sensitive to low blood pressure, change positions slowly, and don't sit or stand up too fast.
Risk of worsening chest pain or heart attack
- Risk factors: Severe heart vessel (coronary artery) disease | Suddenly stopping beta-blocker medications right before starting nifedipine ER (Procardia XL)
In some rare cases, in people with severely diseased blood vessels in the heart, nifedipine ER (Procardia XL) can cause chest pain that's even worse or even a heart attack. This tends to happen when starting nifedipine ER (Procardia XL) treatment or changing to a higher dose. Get medical help right away if you experience worsening or crushing chest pain, radiating jaw pain, or a racing heartbeat, as these can be signs of a heart attack.
Risk of heart failure
- Risk factors: Taking beta-blocker medications | Aortic stenosis (narrowing of the aortic valve)
In some rare cases, nifedipine ER (Procardia XL) can cause heart failure. This is more likely to happen if you are also taking a beta-blocker medication or if one of your heart valves (the aorta valve) is abnormally narrow, a condition called aortic stenosis. Contact your provider if you experience symptoms of heart failure, such as abnormal weight gain, difficulty breathing especially when you lie down, or swelling in your legs and feet (though this could also be a normal side effect of the medication).
Swelling in legs and feet
- Risk factors: Taking higher doses of nifedipine ER (Procardia XL)
Swelling in the legs and feet is a common side effect of nifedipine ER (Procardia XL) and tends to happen with higher doses. This side effect is usually harmless, but let your provider know if it becomes too bothersome. Swelling in the legs and feet can also be a sign of heart failure, so make sure to follow up regularly with your provider to monitor your heart health.
Stomach or intestinal injury (extended-release form only)
- Risk factors: Narrowing in the stomach or intestines (strictures) | Any history of stomach or intestinal problems, including cancer, surgery, inflammation, or abnormally slow bowel movement | Taking medications that slow movement of food through the body
In some rare cases, nifedipine ER (Procardia XL) can cause blockage or an ulcer in the stomach or intestines (gut), which can be severe or even require surgery. This tends to happen to people who have a narrow part of the stomach and intestines (strictures), usually due to past injury and scarring, but it can happen to people with no history of problems. If you have any history of digestive tract problems, talk to your provider before starting this medication. Contact your provider if you experience stomach pain or bloating that doesn't go away, or if you have difficulty passing stool or gas.
More on Nifedipine ER (Procardia XL) warnings
Nifedipine ER (Procardia XL) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30mg | 30 tablets | $13.18 | $0.44 |
| 60mg | 30 tablets | $13.76 | $0.46 |
| 90mg | 90 tablets | $32.47 | $0.36 |
Typical dosage for Nifedipine ER (Procardia XL)
- Extended-release tablets (Procardia XL): The typical starting dose is 30 mg or 60 mg by mouth once daily. Based on your blood pressure or chest pain symptoms, your provider will adjust your dose after a couple of weeks. The maximum recommended dose is 120 mg daily, though people with angina rarely need higher than 90 mg daily.
- Immediate-release capsules (Procardia): The typical starting dose is 10 mg by mouth three times daily. Based on your blood pressure or chest pain symptoms, your provider will adjust your dose after a couple of weeks. The typical maintenance dose ranges from 10 mg to 20 mg three times daily. The usual maximum recommended dose is 120 mg daily total.
More on Nifedipine ER (Procardia XL) dosage
Interactions between Nifedipine ER (Procardia XL) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Amobarbital
- Aprobarbital
- Armodafinil
- Atazanavir
- Boceprevir
- Bosentan
- Butabarbital
- Butalbital
- Carbamazepine
- Ceritinib
- Clarithromycin
- Clobazam
- Clopidogrel
- Cobicistat
- Conivaptan
- Dantrolene
- Dexamethasone
- Digoxin
- Efavirenz
- Enzalutamide
- Epirubicin
- Etravirine
- Fentanyl
- Fosnetupitant
- Fosphenytoin
- Idelalisib
- Itraconazole
- Ketoconazole
- Lacosamide
- Lopinavir
- Mephobarbital
- Methohexital
- Mibefradil
- Modafinil
- Nafcillin
- Nefazodone
- Nelfinavir
- Netupitant
- Nevirapine
- Oxcarbazepine
- Pentobarbital
- Phenobarbital
- Phenytoin
- Pioglitazone
- Posaconazole
- Prednisone
- Primidone
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Saquinavir
- Secobarbital
- St John's Wort
- Telaprevir
- Telithromycin
- Thiopental
- Topiramate
- Voriconazole
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cimetidine
- Dalfopristin
- Doxazosin
- Ginkgo
- Ginseng
- Indinavir
- Magnesium
- Micafungin
- Quinidine
- Quinupristin
- Tacrolimus
- Vincristine
- Vincristine Sulfate Liposome
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