Adalat: Uses, dosage, side effects, warnings & patient reviews

What is Adalat (Nifedipine)?

Adalat CC is the brand name for an extended-release form of the prescription drug nifedipine. It is classified as a calcium channel blocker, specifically a dihydropyridine. This class of medication works by inhibiting the influx of calcium ions into the smooth muscle cells lining blood vessels and, to a lesser extent, cardiac muscle.

Its primary therapeutic effect is the relaxation and dilation of peripheral arteries. This action reduces systemic vascular resistance (afterload), which lowers blood pressure and decreases the heart’s workload and oxygen demand. At therapeutic doses, nifedipine has relatively little direct effect on cardiac conduction compared with non-dihydropyridine calcium channel blockers.

In the United States, Adalat CC is indicated for the management of essential hypertension. Other nifedipine formulations are also used for chronic stable angina and vasospastic angina. It belongs to the broader class of blood pressure medications. The extended-release formulation, marketed in the U.S. as Adalat CC, is intended for chronic once-daily use.

How to Take Adalat

Administration instructions for Adalat CC are specific to its extended-release formulation. The tablets should be taken exactly as prescribed.

Administration Guidelines for Extended-Release Tablets

Adalat CC (Extended-Release Tablets): Swallow the tablet whole with a glass of water. Do not crush, chew, or divide the tablet. Doing so can alter the release of the medication and may increase the risk of adverse effects. Adalat CC should be taken on an empty stomach and should not be administered with food.

Dosage and Timing

Dosage is individualized based on patient response and tolerability. The extended-release formulation is taken once daily. Patients should take it at approximately the same time each day. Common strengths include Adalat CC 30 mg, Adalat CC 60 mg, and Adalat CC 90 mg tablets.

Patients should not adjust their dose or discontinue therapy without consulting their physician. If discontinuation is necessary, dose reduction is generally done gradually under medical supervision.

Missed Dose

If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Do not take a double dose to make up for a missed one.

Side Effects of Adalat

The vasodilatory action of nifedipine is responsible for both its therapeutic benefits and many of its adverse effects. The incidence and severity of side effects are often dose-related.

Patients experiencing symptoms of severe hypotension, such as fainting, extreme dizziness, or shortness of breath, should seek medical attention.

What is Adalat Used For?

Approved uses depend on the specific nifedipine formulation. Adalat CC is labeled in the United States for hypertension, while other nifedipine formulations are also used for certain angina syndromes.

FDA-Approved Indications

• Hypertension (High Blood Pressure): Adalat CC is indicated for the management of essential hypertension.
• Chronic Stable Angina: Some nifedipine formulations are approved for the management of classic effort-associated angina.
• Vasospastic Angina (Prinzmetal’s Angina): Some nifedipine formulations are approved for angina caused by coronary artery spasm.

Off-Label Uses

Under physician supervision, nifedipine may also be prescribed for conditions not formally approved for every product label. These include:

• Raynaud’s Phenomenon: Used to reduce the frequency and severity of vasospastic attacks in fingers and toes. More details can be found on Raynaud’s disease.
• Preterm Labor (Tocolysis): In obstetric care, nifedipine may be used off-label under specialist supervision to help reduce premature uterine contractions.

Important Safety Concerns and Considerations

Excessive Hypotension and Syncope

While Adalat effectively lowers blood pressure, it may occasionally cause excessive hypotension, sometimes accompanied by syncope (fainting). This risk is highest during initial titration or when increasing the dose. Symptoms are more likely in patients who are volume-depleted or concurrently using other antihypertensive agents.

Worsening Angina or Myocardial Infarction

Rarely, patients, particularly those with severe obstructive coronary artery disease, have developed increased frequency, duration, or severity of angina or acute myocardial infarction upon starting nifedipine or at the time of dosage increase. For more on heart disease, this risk requires careful medical oversight.

Use in Patients with Heart Failure

Patients with heart failure, particularly those receiving a beta-blocker, should use nifedipine with caution. In susceptible patients, nifedipine may worsen heart failure symptoms or peripheral edema and may require closer monitoring.

Peripheral Edema

Mild to moderate peripheral edema, typically ankle edema, is one of the most common side effects. This is a localized vascular effect due to precapillary dilation and is not generally caused by systemic fluid retention. It may require dose adjustment if persistent or bothersome.

Critical Warnings for Adalat Use

Excessive Hypotension

Although the blood pressure-lowering effect of nifedipine is usually modest and well tolerated, some patients can develop excessive and poorly tolerated hypotension, especially during initial titration or after a dose increase. This risk may be higher in patients taking concomitant beta-blockers or other blood pressure-lowering agents.

Increased Angina and/or Myocardial Infarction

Rarely, patients, particularly those with severe obstructive coronary artery disease, have developed increased frequency, duration, or severity of angina or acute myocardial infarction when starting nifedipine or at the time of a dosage increase.

Grapefruit Juice Interaction

Grapefruit and grapefruit juice should be avoided while taking nifedipine. Grapefruit can increase nifedipine exposure by inhibiting intestinal CYP3A4, which may increase the risk of hypotension and other adverse effects. For more on medication rules, see this article on medicine schedules.

Beta-Blocker Withdrawal

Adalat is not a beta-blocker and does not prevent the consequences of abrupt beta-blocker withdrawal. Patients being withdrawn from beta-blockers should generally be tapered gradually rather than stopping suddenly before starting nifedipine.

Use in Patients with Severe Aortic Stenosis

The drug should be used with extreme caution in patients with fixed left ventricular outflow obstruction (e.g., severe aortic stenosis). In this setting, lowering afterload may not improve cardiac output and may worsen ischemia or heart failure symptoms.

Adalat Dosage Information

Dosage must be individualized based on the patient’s clinical needs and response. The following table outlines general dosing guidance for Adalat CC extended-release tablets; patients must follow their physician’s specific prescription.

Important Administration Notes

• Dosage titration should generally proceed over 7-14 day intervals so that response and tolerability can be assessed.
• Patients with hepatic impairment may require lower doses and careful monitoring due to reduced drug clearance.
• Therapy should not be changed abruptly without medical advice. If discontinuation is necessary, the dose is generally reduced gradually under supervision.
• Administration with food is not recommended for Adalat CC; the tablet should be taken on an empty stomach and swallowed whole.

Drug Interactions with Adalat

Nifedipine is subject to significant pharmacokinetic and pharmacodynamic interactions. All concomitant medications, including over-the-counter drugs and supplements, should be reviewed with a healthcare provider.

Additional Information

Storage and Handling

Store Adalat tablets at room temperature between 20°C to 25°C (68°F to 77°F), in a tightly closed container, and away from light, excess moisture, and heat. Keep all medications out of the reach of children and pets. Do not use medication beyond its expiration date.

Generic Availability

Generic nifedipine extended-release tablets are widely available. Generic medications contain the same active ingredient at the same strength and are required to meet applicable standards for quality and bioequivalence.

Reporting Side Effects

Patients and caregivers are encouraged to report adverse effects to their healthcare provider and, where applicable, to the relevant national regulatory authority (for example, the U.S. Food and Drug Administration’s MedWatch program). Reporting contributes to ongoing drug safety monitoring.

References and Medical Sources

The information on this page is compiled from prescribing information and other reputable medical sources.

1. U.S. Food and Drug Administration (FDA). Adalat CC (nifedipine) extended-release tablets prescribing information. Revised 2011. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020198s023lbl.pdf
2. DailyMed. PROCARDIA XL (nifedipine) extended-release tablets. Revised November 2023. Available at: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8ebcb33c-f43b-4b36-9f94-9774b2a59e06
3. MedlinePlus. Nifedipine drug information. Updated October 15, 2017. Available at: https://medlineplus.gov/druginfo/meds/a684028.html
4. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127-e248. DOI: 10.1016/j.jacc.2017.11.006

Disclaimer: The information on this site is provided for informational purposes only and is not medical advice. It does not replace professional medical consultation, diagnosis, or treatment. Do not self-medicate based on the information presented on this site. Always consult with a doctor or other qualified healthcare professional before making any decisions about your health.