This monograph does not cover the use of nifedipine ointment for chronic anal fissure.
Issues for surgery
For treatment of hypertension – loss of blood pressure (BP) control if omitted.
For treatment of angina – exacerbation of angina if omitted.
For Raynaud's syndrome - loss of symptom control if omitted.
Risk of hypotension when continued.
Advice in the perioperative period
Elective and emergency surgery
Continue – including combination products (see below).
Monitor BP
Combination product:
- Tenif® – contains nifedipine + atenolol - also see Atenolol drug monograph.
For patients taking modified-release preparations of nifedipine, confirm the specific manufacturer’s brand (see Further information).
Consideration should be given to prescribing the components of combination products as separate medicines perioperatively.
Post-operative advice
Restart post-operatively when next dose is due.
Monitor BP.
Interactions with common anaesthetic agents
Inhalational Anaesthetics
See also Hypotension below.
Nifedipine may reduce the minimum alveolar concentration (MAC) of inhalational anaesthetics by up to 20%.
Hypotension
Nifedipine can increase the risk of hypotension when used concomitantly with remifentanil or inhalational / intravenous anaesthetics.
Neuromuscular blocking drugs (NMBDs)
Nifedipine may prolong neuromuscular blockade when used concomitantly with NMBDs. The clinical significance is unknown, but bear the potential interaction in mind in case of unexpected response to treatment.
Dantrolene
There is a potential interaction between intravenous dantrolene and calcium-channel blockers leading to acute hyperkalaemia and cardiovascular collapse. This interaction has occurred in animal studies with some calcium-channel blockers (CCBs). It is recommended that co-administration of nifedipine with dantrolene should be avoided.
Interactions with other common medicines used in the perioperative period
Hypotension
Nifedipine can increase the risk of hypotension when used concomitantly with droperidol or prochlorperazine.
Macrolide antibiotics
Macrolide antibiotics (e.g. clarithromycin, erythromycin), which are inhibitors of CYP3A4, may increase the effects of nifedipine leading to hypotension. Monitor the patient and consider reducing the dose of the nifedipine if necessary.
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring. Consult current product literature.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12th April 2019]
British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 12th April 2019]
Dantrolene Sodium. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 9th October 2019]
Diazepam. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 12th April 2019]
Nifedipine. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 12th April 2019]
Scarth E, Smith S. Drugs in Anaesthesia and Intensive Care, 5th Edition. Oxford University Press; 2016
Summary of Product Characteristics – Adalat LA® (nifedipine) 60 mg prolonged-release tablets. Bayer plc. Accessed via www.medicines.org.uk 09/10/2019 [date of revision of the text August 2019]
The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. European Heart Journal. 2014; 35:2383-2431