Adalat (nifedipine) is a trusted calcium channel blocker prescribed for the management of hypertension and angina. Developed with decades of clinical research, it effectively relaxes and widens blood vessels, improving blood flow and reducing cardiac workload. This medication is a cornerstone in cardiovascular therapy, offering reliable control for patients requiring long-term management of high blood pressure or chronic stable angina. Its well-understood pharmacokinetic profile allows for tailored dosing, making it a versatile option in a comprehensive treatment plan under specialist supervision.

Features

• Active ingredient: Nifedipine (30 mg or 60 mg extended-release tablets)
• Drug class: Dihydropyridine calcium channel blocker
• Formulation: Gastrointestinal therapeutic system (GITS) for controlled 24-hour release
• Administration: Oral, once daily
• Prescription status: Rx-only medication
• Manufacturer: Bayer AG (under license)
• FDA approval: Originally approved 1981; multiple formulations available

Benefits

• Provides consistent 24-hour blood pressure control with single daily dosing
• Reduces frequency and severity of angina episodes by improving coronary blood flow
• Lowers risk of stroke, myocardial infarction, and other cardiovascular events
• Minimizes peripheral edema compared to earlier calcium channel blockers
• Demonstrates predictable pharmacokinetics with low inter-patient variability
• Compatible with comprehensive antihypertensive regimens when combination therapy is needed

Common use

Adalat is primarily indicated for the management of essential hypertension and chronic stable angina pectoris. In hypertension management, it is used as monotherapy or in combination with other antihypertensive agents when additional blood pressure control is required. For angina patients, Adalat reduces myocardial oxygen demand and increases oxygen supply through coronary vasodilation. Off-label uses include Raynaud’s phenomenon and preterm labor management (though other nifedipine formulations may be preferred for obstetric use). The extended-release formulation maintains therapeutic plasma concentrations throughout the dosing interval, preventing early morning blood pressure surges associated with increased cardiovascular risk.

Dosage and direction

The recommended starting dose for hypertension or angina is 30 mg or 60 mg once daily, taken whole with a glass of water without crushing, chewing, or dividing the tablet. Dosage should be individualized based on therapeutic response and tolerability, with adjustments made at 7- to 14-day intervals. Maximum recommended dose is 90 mg daily. Administration should occur at approximately the same time each day, with or without food, though consistent timing relative to meals is recommended. Elderly patients or those with hepatic impairment may require lower starting doses (30 mg daily) with careful titration. Tablets must be swallowed whole to maintain the extended-release properties.

Precautions

Regular blood pressure monitoring is essential, particularly during initiation and titration periods. Patients should avoid grapefruit juice as it may significantly increase nifedipine bioavailability. Use with caution in patients with heart failure or severe aortic stenosis due to potential negative inotropic effects. Peripheral edema may occur and is typically dose-dependent. Abrupt discontinuation should be avoided as it may precipitate rebound hypertension or angina. Dental procedures may require special consideration due to potential gingival hyperplasia association. Patients should be cautioned about potential dizziness or lightheadedness, especially when rising quickly from sitting or lying positions.

Contraindications

Adalat is contraindicated in patients with known hypersensitivity to nifedipine or any tablet components. It must not be used in patients with cardiogenic shock, clinically significant aortic stenosis, or unstable angina. Concomitant use with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, or ritonavir is contraindicated due to dramatically increased nifedipine exposure. The medication is contraindicated in patients with gastrointestinal obstruction or narrowing that might compromise tablet passage. Use during pregnancy requires careful risk-benefit assessment and is generally not recommended unless clearly needed.

Possible side effects

Common side effects (≥1%) include peripheral edema (7-29%), headache (6-15%), dizziness (3-10%), flushing (4-9%), and fatigue (4-6%). Less frequent adverse reactions include palpitations (1-3%), nausea (2-5%), constipation (1-3%), and muscle cramps (1-2%). Serious but rare side effects requiring immediate medical attention include significant hypotension (<1%), syncope (0.5%), myocardial infarction (0.4%), and severe skin reactions. Laboratory abnormalities may include transient elevations in liver enzymes (ALT, AST) in approximately 1% of patients. Most side effects are dose-dependent and often diminish with continued therapy.

Drug interaction

Adalat undergoes extensive CYP3A4 metabolism, creating numerous potential interactions. Strong CYP3A4 inhibitors (clarithromycin, HIV protease inhibitors) increase nifedipine exposure up to 4-fold. CYP3A4 inducers (rifampin, carbamazepine) may decrease efficacy. Concurrent use with beta-blockers may increase heart failure risk in susceptible patients. Additive hypotensive effects occur with other antihypertensives, nitrates, and phosphodiesterase-5 inhibitors. Digitalis levels may increase by approximately 45% with coadministration. Quinidine levels may decrease by approximately 25%. Magnesium sulfate coadministration may result in profound hypotension and neuromuscular blockade.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is nearly time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed dose. Consistency in dosing is important for maintaining stable blood pressure control, so patients should establish routines to support adherence. Use of pill organizers or reminder systems is recommended for patients with history of missed doses.

Overdose

Nifedipine overdose manifests as severe hypotension, bradycardia or tachycardia, metabolic acidosis, and hyperglycemia. Cerebral hypoxia and shock may develop in severe cases. Gastric lavage may be beneficial if performed soon after ingestion. Activated charcoal (50-100 g) should be administered. Cardiovascular support with intravenous fluids and vasopressors (norepinephrine, dopamine) is primary treatment. Calcium gluconate (10% solution, 10-20 mL IV) may reverse calcium channel blockade. Atropine may be used for bradycardia. Glucagon (50-150 mcg/kg IV) has been used with variable success. Hemodialysis is not effective due to high protein binding.

Storage

Store at room temperature (15-30°C or 59-86°F) in original container, protected from light and moisture. Keep tightly closed and away from excessive heat or humidity. Do not store in bathroom medicine cabinet due to moisture variations. Keep out of reach of children and pets. Properly discard expired medication or unused portions through medication take-back programs. Do not flush medications down toilet or pour into drain unless specifically instructed.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual patient needs may vary significantly. Always consult with a qualified healthcare professional before starting, stopping, or changing any medication regimen. Only a licensed physician can determine appropriate treatment based on complete medical history, current health status, and individual risk factors. Never disregard professional medical advice or delay seeking treatment based on information contained in this document.

Reviews

Clinical studies demonstrate Adalat’s efficacy in reducing systolic blood pressure by 12-15 mmHg and diastolic pressure by 8-10 mmHg in hypertensive patients. Angina patients experience 40-60% reduction in attack frequency and nitrate consumption. Long-term extension studies show maintained efficacy over 12-24 months of treatment. Patient satisfaction surveys indicate high continuation rates due to once-daily dosing and generally favorable side effect profile compared to earlier antihypertensive options. Real-world evidence supports cardiovascular risk reduction when used as part of comprehensive management.