Can High-Dose Nifedipine Lower Your Heart Rate or Lead to Sudden Cardiac Arrest?

Nifedipine (Procardia) is a common blood pressure medication. It’s a calcium channel blocker (CCB). Some medications in the CCB medication class — like verapamil and diltiazem — can lower the heart rate. 

Nifedipine is less likely than other CCBs to slow the heart rate. But there are still a few uncommon situations where nifedipine might cause the heart rate to fall below normal. And high doses of nifedipine have been linked to a risk for sudden cardiac arrest. In this article, we’ll go over these and other possible side effects of nifedipine.

What is nifedipine used for?

Nifedipine is a calcium channel blocker used for high blood pressure (hypertension). These medications lower blood pressure by relaxing the muscles of the heart and blood vessels. Nifedipine was once a first-choice treatment for high blood pressure. Its popularity declined when the FDA approved newer medications with fewer side effects. 

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Save over 40% on Qsymia with GoodRx

Discover the once daily Qsymia for weight management. Qsymia is for adults and children 12-17 in combination with a healthy diet and regular exercise.

Save now

Nifedipine is sometimes used to treat angina, a type of chest pain that comes from the heart. That’s because it relaxes the blood vessels that feed the heart. And it can be used for Raynaud’s syndrome. This condition causes the blood vessels in the fingers and toes to constrict when exposed to cold. Nifedipine will help prevent that from happening by keeping open these small blood vessels.

Can nifedipine increase your risk for cardiac arrest?

A cardiac arrest happens when the heart stops beating, or when it’s not beating well enough to push blood through the body. This is a life-threatening event with a low survival rate. 

A 2019 analysis compared people taking nifedipine to people taking other blood pressure medications. The study found that more than 60 mg of nifedipine daily may increase risk for sudden cardiac arrest. But taking lower doses of nifedipine (under 60 mg a day) was not associated with the same increased risk. The study also looked at people taking amlodipine (Norvasc), another common CCB. Amlodipine did not increase the risk for cardiac arrest.

Promotion disclosure

Nifedipine

Avg retail price

$98.13(Save 87.02%)

GoodRx discount

$12.74

Compare all prices

But it’s important to know that this was just a single study. And more research is needed before we can be certain about the risk of high-dose nifedipine. 

Can nifedipine lower your heart rate?

Some CCBs — like verapamil and diltiazem — often lower heart rate.  As it turns out, short-acting nifedipine can briefly raise the heart rate. But short-acting nifedipine is rarely prescribed. Long-acting nifedipine usually has no significant effect on heart rate. 

There are a few situations where nifedipine can lower the heart rate. But these are very unusual. One situation is a drug overdose. Even in this case, a drop in heart rate isn’t common. 

The other possible issue concerns people with autonomic neuropathy. There’s a single report of a very low heart rate in an 80-year-old adult who was taking nifedipine. His doctors stopped the medication and the heart rate improved. Since this is the only report in the literature, researchers can’t be certain if this would happen to other people with the same condition.

What are other side effects of nifedipine?

Although nifedipine was once a very popular medication, it’s used less commonly now. That’s partly because it causes edema, or leg swelling, in up to 30% of people who take it. Now there are more options to treat blood pressure that don’t cause this problem. 

Other side effects of nifedipine include: 

• Dizziness (if it lowers your blood pressure too much)

• Constipation

• Headaches

• Nausea 

If you have these problems, check with your provider to see if there’s a better option for you.

What alternatives are there to nifedipine?

Nifedipine is usually prescribed for high blood pressure. If it’s working well for you, you may not need to change to another medication. But it’s good to know that there are other medications in the CCB class that have fewer side effects. 

And there are several other classes of blood pressure medications that may work just as well or better. Your healthcare provider will work with you to find the best option for your needs.

If you take nifedipine for angina, you may have other medication options. Nitrate drugs, like isosorbide, work well for some people. And so does ranolazine (Ranexa). If you have angina, you will likely need a cardiologist (heart specialist) to check out your heart.

If you take nifedipine for Raynaud’s, there are fewer alternative options. Sometimes the nitrate drugs will help. But the good news is that Raynaud’s can often be managed by avoiding the cold, not smoking, and avoiding other triggers such as stimulants.

Why trust our experts?

Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, the American Society of Nuclear Cardiology, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Our editorial standards

Meet our experts