MEDICATION SAFETY ISSUES INVOLVING NIFEDIPINE IMMEDIATE-RELEASE

• There have been multiple medication safety incidents at Henry Ford Health over the last few years involving nifedipine immediate-release tablets, including a recent harm event.¹ In response, the Epic® build has been modified to allow a maximum of 30 mg per dose.
• Pharmacists should exercise caution when verifying orders for nifedipine immediate-release tablets.
  • When used for acute treatment of hypertension, there have been reports over several decades of profound hypotension, myocardial infarction, and death.^{2, 3} 
  • Severely hypertensive pregnant or post-partum patients are the only hypertensive patient populations where nifedipine immediate-release tablets have been shown to be safe and effective.⁴ 
• In patient populations where nifedipine extended-release tablets are not an option, consider other immediate-release calcium-channel blockers on the Henry Ford Health Formulary (isradipine, felodipine, and amlodipine).⁴

References:

1. Internal Radicalogic® report data. 
2. Procardia [Package Insert]. Pfizer Laboratories Div Pfizer Inc. 2018 Feb. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e04aa152-b08d-47f7-b976-f8bee4c386db
3. Mansoor AF, von Hagel Keefer LA. P & T 2002;27(7):362–5.
4. ACOG Committee on Obstetric Practice. Obstet Gynecol 2019;133(2):e174-80.

Therapeutic Alternative:

• Micromedex
• Clinical Pharmacology
• FDA DailyMed