Procardia: Advanced Calcium Channel Blocker for Hypertension & Angina Control
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Procardia (nifedipine) is a prescription calcium channel blocker medication designed to manage hypertension and chronic stable angina. By selectively inhibiting calcium influx into vascular smooth muscle and cardiac cells, it promotes peripheral arterial vasodilation, reducing systemic vascular resistance and myocardial oxygen demand. This mechanism offers a targeted approach to cardiovascular management, supported by decades of clinical use and research. Available in extended-release formulations, Procardia provides sustained 24-hour blood pressure control and angina prophylaxis with once-daily dosing.
Features
- Active ingredient: nifedipine
- Available in extended-release tablet formulations (30mg, 60mg, 90mg)
- Once-daily dosing regimen
- Bioavailability approximately 45-56%
- Peak plasma concentration reached in 2.5-5 hours
- Plasma half-life of approximately 7 hours
- Metabolized primarily via CYP3A4 pathway
- Excreted predominantly in urine (60-80%) as inactive metabolites
Benefits
- Effectively lowers systolic and diastolic blood pressure through arterial vasodilation
- Reduces frequency and severity of angina episodes by decreasing myocardial oxygen demand
- Provides 24-hour therapeutic coverage with single daily dosing
- Demonstrates consistent antihypertensive efficacy across diverse patient populations
- May be used as monotherapy or in combination with other antihypertensive agents
- Extended-release formulation minimizes peak-trough fluctuations in plasma concentrations
Common use
Procardia is primarily indicated for the management of essential hypertension and chronic stable angina pectoris. In hypertension management, it is used as first-line therapy or as an adjunct to other antihypertensive regimens. For angina patients, Procardia reduces the frequency of anginal episodes and decreases nitroglycerin consumption. Off-label uses include Raynaud’s phenomenon and preterm labor management (though other nifedipine formulations may be preferred for obstetric indications). Treatment should be individualized based on therapeutic response and tolerability.
Dosage and direction
Hypertension: Initial dose typically 30-60 mg orally once daily. Dosage may be increased gradually over 7-14 day intervals. Maximum recommended dose: 90-120 mg daily. Angina: Initial dose 30-60 mg once daily. Titrate based on clinical response. Maximum dose: 120 mg daily.
Administration guidelines: Tablets must be swallowed whole and not crushed, chewed, or divided. Administer with a glass of water. May be taken with or without food, but consistency in administration relative to meals is recommended. Dose titration should be performed under clinical supervision. Elderly patients or those with hepatic impairment may require lower initial doses and slower titration.
Precautions
- Periodic monitoring of blood pressure and heart rate recommended, especially during initiation and titration
- Use with caution in patients with heart failure or significantly impaired cardiac function
- May cause peripheral edema, which is generally dose-dependent
- Abrupt withdrawal may rarely cause rebound hypertension or angina exacerbation
- Use cautiously in patients with gastrointestinal narrowing or obstruction due to tablet formulation
- Hepatic impairment may increase nifedipine exposure; consider dose reduction
- Monitor patients with severe coronary artery disease for increased angina frequency during initiation
Contraindications
- Known hypersensitivity to nifedipine or other calcium channel blockers
- Patients with cardiogenic shock
- Concurrent use with strong CYP3A4 inhibitors in patients with hypertension or angina
- Advanced aortic stenosis
- Unstable angina or acute myocardial infarction (especially immediate-release formulations)
- Severe hypotension (systolic pressure <90 mmHg)
Possible side effect
Common (≥1%): Peripheral edema (7-29%), headache (10-23%), dizziness (4-12%), flushing (4-10%), fatigue (5-7%), nausea (3-6%), palpitations (2-5%)
Less common (0.1-1%): Constipation, muscle cramps, hypotension, syncope, tachycardia, dyspnea, rash, impotence
Rare (<0.1%): Gingival hyperplasia, leukopenia, thrombocytopenia, hepatic enzyme elevations, allergic reactions, Stevens-Johnson syndrome
Serious: Myocardial infarction, heart failure exacerbation, severe hypotension, syncope, marked elevation of liver enzymes
Drug interaction
Strong CYP3A4 inhibitors: Ketoconazole, itraconazole, clarithromycin - may significantly increase nifedipine exposure Beta-blockers: May potentiate hypotension and heart failure risk; monitor closely Digoxin: Nifedipine may increase digoxin levels by 15-45% Cimetidine: Increases nifedipine bioavailability Phenytoin: May reduce nifedipine efficacy Grapefruit juice: May increase bioavailability and prolong effect Magnesium sulfate: Potentiates hypotensive effect Tacrolimus: Nifedipine may increase tacrolimus levels Rifampin: Decreases nifedipine exposure significantly
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. If multiple doses are missed, contact healthcare provider for guidance. Maintain regular dosing schedule to ensure consistent therapeutic effect.
Overdose
Symptoms: Severe hypotension, bradycardia or tachycardia, cardiac arrhythmias, shock, metabolic acidosis, hyperglycemia. Management: Administer activated charcoal if recent ingestion. Cardiovascular monitoring essential. Treat hypotension with intravenous fluids and vasopressors (avoid epinephrine in beta-blocked patients). Calcium gluconate infusion (10% solution) may be beneficial. Bradycardia may require atropine or cardiac pacing. Hemodialysis not effective due to high protein binding.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep in original container with lid tightly closed. Do not remove desiccant from bottle. Keep out of reach of children. Do not use if tablets are discolored or show signs of deterioration. Properly dispose of expired medication.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Procardia is available by prescription only. Always consult with a qualified healthcare professional before starting, stopping, or changing any medication regimen. Individual response to medication may vary. Not all side effects or interactions are listed here. Report any adverse effects to your healthcare provider promptly.
Reviews
Clinical studies: Multiple randomized controlled trials demonstrate Procardia’s efficacy in reducing blood pressure by 10-15 mmHg systolic and 8-10 mmHg diastolic. Angina studies show 40-60% reduction in weekly angina attacks and nitroglycerin use.
Patient feedback: Many patients report effective blood pressure control and reduced angina symptoms. Common positive comments include convenience of once-daily dosing. Frequently mentioned concerns include peripheral edema and headache during initial treatment phase.
Expert consensus: Considered effective first-line therapy for hypertension and stable angina. American College of Cardiology/American Heart Association guidelines include calcium channel blockers as recommended antihypertensive agents. Particularly beneficial in elderly patients and those with isolated systolic hypertension.