Depin (Nifedipine)
Also sold as: Depin, Calchek, Nicardia, Adalat, Angizem (CCB but diltiazem)
Pregnancy
Cat C
Lactation
Safe
Schedule
H
Forms
Capsule 5mg, 10mg (IR — rarely used now) +1
Indications
- Hypertension (SR/GITS formulation — first or second line)
- Stable angina (vasospastic angina — first choice; exertional angina second choice)
- Raynaud's phenomenon
- Preterm labour (tocolytic — off-label)
Adult Dosing
Hypertension (SR)
20–30 mg PO BD (SR) or 30–60 mg once daily (GITS)
Always use slow-release formulations for hypertension. IR capsule for hypertension is dangerous — avoid.
Angina (SR)
10–20 mg PO TDS (SR) or 30 mg GITS once daily
Titrate based on response and tolerability
Preterm labour (off-label)
20 mg sublingual/PO initially, then 10–20 mg every 4–6 hours; or 60 mg GITS once daily
Obstetric specialist use only
Pediatric Dosing
Paediatric use — specialist only
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No dose adjustment required — hepatically metabolised |
Hepatic Adjustment
Reduce dose in cirrhosis — reduced first-pass metabolism increases bioavailability (start lower)
Pregnancy & Lactation
Pregnancy: Category C
Used as tocolytic in 2nd/3rd trimester preterm labour (specialist decision). Avoid in 1st trimester where possible. Antihypertensive use in pregnancy: methyldopa or labetalol preferred first-line; nifedipine acceptable for severe hypertension in pregnancy.
Lactation: Safe
Compatible with breastfeeding — WHO Compatible list. Small amounts in breast milk; no adverse effects reported in infants.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| CYP3A4 inhibitors (erythromycin, clarithromycin, ketoconazole, grapefruit juice) | Increase nifedipine levels — hypotension, reflex tachycardia | Major |
| CYP3A4 inducers (rifampicin, phenytoin, carbamazepine) | Dramatically reduce nifedipine levels — loss of BP control | Major |
| Beta-blockers | Additive negative inotropic effect — use with caution in LV dysfunction | Moderate |
| Magnesium sulphate (in obstetrics) | Enhanced neuromuscular blockade and hypotension when combined with nifedipine — monitor carefully | Moderate |
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Side Effects
Common
- Peripheral oedema (ankle swelling — most common; dose-related)
- Flushing (face, neck)
- Headache (vasodilation)
- Reflex tachycardia (IR formulation — avoid)
- Dizziness
- Gingival hyperplasia (long-term)
Serious / Discontinue If
- Severe hypotension (IR capsule — reason IR is avoided for hypertension)
- Reflex tachycardia precipitating angina (IR; SR/GITS avoids this)
- AV block / heart failure worsening (less than verapamil/diltiazem but possible)
Contraindications
- Cardiogenic shock
- Advanced aortic stenosis
- Unstable angina (IR formulation)
- Porphyria
- IR capsule for acute hypertension (dangerous — avoid)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Depin 10mg SR | Torrent | 30 tab ₹58 |
| Calchek 20mg SR | Cipla | 30 tab ₹72 |
| Nicardia 10mg SR | J B Chemicals | 30 tab ₹55 |
| Adalat OROS 30mg | Bayer | 30 tab ₹148 |
Monitoring Required
- Blood pressure and heart rate
- Ankle oedema assessment
- Gingival health (long-term)
- Hepatic function (if cirrhosis)
Patient Counseling Points
- Always swallow SR/GITS tablet whole — do not crush, chew, or break (ruins slow-release mechanism)
- Take at the same time each day — with or without food
- Ankle swelling is common — keep legs elevated when sitting, reduce salt intake
- Avoid grapefruit and grapefruit juice — significantly increases drug levels
- Flushing and headache in first weeks are common — usually settles
- Do not stop suddenly — even though no major withdrawal risk, consult your doctor first
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Clinically reviewed by: Dr. Meenakshi Iyer, DM (Cardiology), Consultant Cardiologist
Last reviewed: 2026-04-01
References
- ESC Hypertension Guidelines 2023
- ESC Stable Coronary Artery Disease Guidelines
- BNF — Nifedipine
- WHO Compatible in Breastfeeding List