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Nifedipine

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Nifedipine (Adalat / Procardia)

**NOT BEING TAKEN — Confirmed 2026-05-06**

Clinic note dated 2026-05-06 states: "she is not taking nifedipine." Status changed from active → discontinued (non-adherence). The posaconazole-nifedipine CYP3A4 interaction is therefore no longer clinically active.

Action needed: Confirm with treating provider whether nifedipine should be resumed, substituted, or formally discontinued. The antihypertensive regimen now consists of losartan alone (if losartan is being taken).

Clinical Summary

Nifedipine is a dihydropyridine calcium channel blocker (CCB) used primarily for hypertension and angina.

Documented from handwritten prescription dated 2026-05-04 (30 mg twice daily, 1-0-1 dosing). Confirmed NOT being taken as of 2026-05-06 per clinic note.

Dosing / Adherence History

Date Dose Frequency Route Context
2026-05-04 30 mg Twice daily (1-0-1) Oral Documented from handwritten Rx — prescribed but see below
2026-05-06 — — — Clinic note: patient NOT taking nifedipine
**Major Documentation Gap**

This medication was NOT previously documented in any ingested raw source. No blood pressure readings have been documented. Indication is PRESUMED to be hypertension.

[!danger] Non-Adherence Confirmed 2026-05-06
Patient confirmed not taking nifedipine. It was on the 2026-05-04 prescription but has not been taken. The prescribing provider should be notified. If BP control is needed, the antihypertensive regimen must be reassessed — losartan alone may be insufficient.

[!note] Formulation Unclear
Handwritten Rx does not specify formulation. Nifedipine is available as:
- Immediate-release (IR): 10 mg, 20 mg capsules — dosed t.i.d., higher side effect risk (reflex tachycardia, headache, flushing)
- Extended-release (ER/XL): 30 mg, 60 mg, 90 mg tablets — dosed once or twice daily, preferred for hypertension

Given 30 mg b.i.d. dosing and absence of side effect documentation, this is likely extended-release nifedipine ER/XL.

Indication

Presumed: Hypertension (no BP readings documented yet in wiki). Nifedipine is also used for angina, but no angina documented in Ishamma's history.

Co-prescribed with Losartan (ARB) — suggests combination antihypertensive therapy for better BP control.

Pharmacology

  • Drug class: Dihydropyridine calcium channel blocker (CCB)
  • Mechanism: Blocks L-type calcium channels in vascular smooth muscle → vasodilation → reduced BP
  • Half-life: 2–5 hours (IR), 7 hours (ER)
  • Standard dose: 30–90 mg once or twice daily (ER formulation)

Monitoring

Parameter Frequency Rationale Ishamma Status
Blood pressure Weekly initially, then monthly Primary efficacy endpoint NOT YET DOCUMENTED — gap
Heart rate Periodic Reflex tachycardia (less common with ER formulation) Not documented
Peripheral edema Each visit Common side effect of CCBs Not documented

[!info] Blood Pressure Monitoring Gap
No BP readings have been documented in any ingested lab/clinic note. Home BP monitoring or clinic BP records should be obtained to confirm hypertension diagnosis and treatment efficacy.

Drug Interactions

  • CYP3A4 inhibitors (e.g., posaconazole): Can increase nifedipine levels → enhanced hypotensive effect, increased side effects (edema, headache, flushing)
  • Ishamma is on Posaconazole (strong CYP3A4 inhibitor) — this interaction is likely active
  • Monitor for excessive BP lowering, peripheral edema
  • Grapefruit juice: Increases nifedipine levels (avoid)
  • CYP3A4 inducers (e.g., rifampin): Decrease nifedipine levels
**Posaconazole-Nifedipine Interaction**

Ishamma is on Posaconazole (strong CYP3A4 inhibitor), which can increase nifedipine levels by 2–3 fold. This may:
- Enhance BP-lowering effect (potentially excessive)
- Increase side effects (peripheral edema, headache, flushing, dizziness)

Monitor BP closely. May need nifedipine dose reduction while on posaconazole.

Adverse Effects

  • Peripheral edema (most common, dose-dependent, ~10–30%)
  • Headache, flushing, dizziness (especially with IR formulation)
  • Reflex tachycardia (less common with ER)
  • Gingival hyperplasia (rare, long-term use)
  • Constipation (less common than with non-DHP CCBs like verapamil/diltiazem)

Advantages in Elderly Diabetic Patients

  • No metabolic effects: Does not affect glucose, lipids, or electrolytes
  • No renal dose adjustment required
  • Effective in elderly: CCBs are first-line agents in elderly hypertension
  • Additive effect with ARBs: ARB + CCB is a preferred combination for diabetes + hypertension

Related

  • Losartan — Co-administered ARB for hypertension / renoprotection
  • Posaconazole — CYP3A4 inhibitor; may increase nifedipine levels
  • Diabetes Mellitus — Nifedipine has no adverse metabolic effects in diabetes
  • Blood pressure — Should be monitored (not yet documented)

Medication page created during ingest of 2026-05-04 handwritten prescription. Status changed to discontinued (non-adherence) on 2026-05-06 per clinic note raw/clinic-notes/20260506_151247_note.md.

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