Nifedipine

Pregnancy & gynaecology-specific. Every dose row is source-referenced; verify against institutional protocols.

NifedipineEMERGENCY KITCalcium channel blocker

Guideline conflict

India NHM CEmONC, chapter 4 — prose
Acute oral nifedipine: 10 mg, reassess at 20 minutes, repeat 10–20 mg; stated initial-course maximum 30 mg.

Same NHM chapter — adjacent flowchart
The flowchart shows 10 mg, then 20 mg, then another 20 mg at 20-minute reassessments, implying 50 mg.

Population/setting difference: These refer to the same severe-pregnancy-hypertension setting; this is an internal document discrepancy, not a demonstrated population difference.

Practical India consideration: Confirm the sequence formally approved in the treating unit. Extended-release maintenance tablets are a separate regimen.

App default: Use the prose-based 30 mg initial limit with prompt senior reassessment and selection of another agent if severe BP persists.
Reason: This avoids silently combining incompatible limits or prolonging oral loading in uncontrolled severe hypertension.

Guideline conflict

MSF nifedipine tocolysis monograph
Advises against combining nifedipine with magnesium sulfate because of hypotension/neuromuscular-blockade concerns.

India NHM CEmONC 2024, chapter 4
States the feared interaction has not been demonstrated in retrospective reviews, while requiring careful BP and pulse monitoring.

Population/setting difference: MSF addresses nifedipine tocolysis; NHM discusses emergency hypertension/eclampsia care. Dose, indication and monitoring setting differ.

Practical India consideration: Magnesium for indicated seizure prevention or fetal neuroprotection has its own priority; do not withhold it merely to continue tocolysis.

App default: Avoid routine concurrent tocolytic nifedipine and magnesium in this reference. If both are clinically required, a senior obstetric/anaesthetic decision must define monitoring and doses.
Reason: This preserves the source-specific caution and does not turn a monitored emergency-use discussion into blanket permission for coadministration.

Regimens checked: 2026-10-17. Each indication has its own preparation, limits and safety checks.

Nifedipine: indication-specific regimens
Indication	Dose	Route	Frequency	Duration / preparation	Maximum	Monitoring / cautions
Acute severe hypertension when oral dosing is appropriate Government of India, MoHFW / NHMchecked	10 mg swallowed; reassess at 20 min and give another 10–20 mg if still severe	Oral, swallowed	Reassess after each 20-minute interval; switch/escalate when the initial-course limit is reached	Acute sequence, followed by senior review and a separately prescribed maintenance regimen · Use immediate-release oral tablets/capsules; swallow whole. NEVER sublingual administration; do not use an extended-release tablet as a rapid-loading substitute NHM CEmONC contains an internal discrepancy: its prose caps the initial course at 30 mg, while the adjacent flowchart shows 10 mg then 20 mg then 20 mg. The app uses the 30 mg prose limit with prompt escalation; confirm the locally approved sequence.	30 mg cumulative for the NHM prose-based initial course; seek senior selection of another agent rather than continuing oral loading	Monitor Check BP and pulse before and after each acute dose; fetal monitoring when appropriate Persistent severe BP despite the initial sequence requires senior/anaesthetic review, a different agent and HDU-level monitoring; avoid uncontrolled stacking Contraindications / cautions Hypotension, significant aortic stenosis or acute cardiac compromise Magnesium co-administration requires close respiratory/neuromuscular and BP monitoring; follow the named unit protocol
Maintenance hypertension in pregnancy/postpartum Government of India, MoHFW / NHMchecked	Start sustained-release nifedipine 10 mg twice daily; titrate according to BP and the exact release formulation	Oral extended release	Twice daily for the cited sustained-release regimen	While hypertension persists; reassess after birth and reduce when BP allows · Use the specified sustained-release tablet, swallowed intact. Other extended-release products may use different strengths/schedules; do not interchange them or use them for acute oral loading.	80 mg/day for the NHM CEmONC sustained-release regimen	Monitor BP, headache, flushing, oedema and pulse Contraindications / cautions Maternal hypotension or significant cardiac outflow obstruction
Selected threatened preterm labour to gain time for steroids/transfer, without infection, major bleeding or a reason for immediate birth MSFchecked	10 mg orally; if contractions persist repeat every 15 min up to four loading doses; then 20 mg every 6 h	Oral, never sublingual	Loading as specified, then every 6 h	Maximum 48 hours · 10 mg immediate-release tablet/capsule; check BP before dosing and confirm the formulation	40 mg loading; maintenance 80 mg/day; stop after 48 h	Monitor BP/pulse, contraction frequency and fetal heart rate; stop for hypotension or ischaemic chest pain Contraindications / cautions Systolic BP <90 mmHg, severe cardiac disease MSF advises against concurrent magnesium; if magnesium is needed, use the agreed obstetric/anaesthetic protocol and do not combine regimens casually

Pregnancy safety

First-line; most studied CCB

Lactation

Nifedipine is used in NICE postpartum/breastfeeding hypertension care; check the formulation and maternal/infant circumstances.

Adverse effects

Headache/flushing/tachycardia; additive weakness with MgSO4

Government of India, MoHFW / NHMcheckedIN REVIEW