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INDICATIONS
Procardia, which contains the active ingredient nifedipine, is a medication used to treat certain types of angina, which is chest pain caused by reduced blood flow to the heart. It is classified as a calcium channel blocking agent, meaning it works by blocking the entry of calcium ions into smooth muscle cells, leading to vasodilation and decreased blood pressure. Procardia is also effective in stabilizing heart rhythm in certain conditions where the heart is beating too fast or irregularly.
INSTRUCTIONS
Take Procardia as directed by your doctor, with or without food. Do not consume grapefruit or grapefruit juice while using Procardia. Swallow the tablet whole and do not crush, break, or chew it. If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your usual dosing schedule. Do not take a double dose to make up for a missed one.
STORAGE
Store Procardia at room temperature between 59 and 77 degrees Fahrenheit (15 and 25 degrees Celsius), away from heat, moisture, and light. Keep the medication out of reach of children and pets.
MORE INFO
Procardia's active ingredient is nifedipine.
Do NOT use Procardia if:
Indications for Procardia (nifedipine)
Procardia is the brand name for nifedipine, a dihydropyridine calcium channel blocker used primarily to manage chest pain due to coronary artery disease and to lower blood pressure. By relaxing vascular smooth muscle and dilating arteries, it improves oxygen delivery to the heart and reduces cardiac workload.
- Chronic stable angina (effort-induced angina): to reduce the frequency and severity of chest pain episodes.
- Vasospastic (Prinzmetal) angina: to prevent coronary artery spasm.
- Hypertension: commonly with the extended-release formulation (e.g., Procardia XL, Adalat CC) as a once-daily therapy.
Important clinical nuance: immediate-release nifedipine is no longer recommended for routine treatment of hypertensive urgencies or acute coronary syndromes due to safety concerns (excessive blood pressure reduction and reflex tachycardia). For long-term control, extended-release nifedipine is generally preferred.
Off-label uses that clinicians may consider include Raynaud’s phenomenon, high-altitude pulmonary edema prophylaxis, and short-term tocolysis (inhibiting preterm uterine contractions) in pregnancy. These uses require individualized medical oversight.
Procardia is not an antiarrhythmic drug and is not used to treat abnormal heart rhythms. If you have palpitations or suspected arrhythmia, seek medical evaluation for an accurate diagnosis and appropriate therapy.
How Procardia Works: Mechanism of Action
Nifedipine selectively blocks L-type calcium channels in arterial smooth muscle, reducing intracellular calcium and causing peripheral and coronary vasodilation. This leads to decreased systemic vascular resistance (afterload) and improved myocardial oxygen supply. Unlike non-dihydropyridine calcium channel blockers (such as verapamil and diltiazem), nifedipine has minimal direct effect on heart rate or atrioventricular conduction, though reflex tachycardia can occur as blood pressure falls. These pharmacodynamic features explain its role in angina and hypertension.
Dosage Forms and Formulations
Procardia is available in immediate-release (IR) and extended-release (ER) formulations. Most modern indications favor extended-release tablets for smoother 24-hour control and fewer peaks and troughs.
- Immediate-release nifedipine: rapid onset, shorter duration. Generally avoided for chronic hypertension and not used for acute blood pressure reduction in contemporary practice.
- Extended-release nifedipine (e.g., Procardia XL): designed for once-daily dosing; preferred for chronic angina and hypertension.
Only take the formulation prescribed for you. Do not substitute between IR and ER products without medical guidance.
Instructions: How to Take Procardia Safely
- Take exactly as prescribed. Your clinician will tailor the dose to your condition, response, and other medications.
- Swallow extended-release tablets whole. Do not break, crush, or chew. A ghost tablet shell may be visible in the stool; this is expected and does not indicate incomplete absorption.
- With or without food is usually acceptable; take consistently the same way each day to maintain steady absorption.
- Avoid grapefruit and grapefruit juice. Grapefruit can increase nifedipine levels via CYP3A4 inhibition, raising the risk of side effects.
- If you miss a dose, take it when remembered unless it is close to the next dose. Do not double up.
- Do not stop Procardia suddenly without medical advice. Abrupt discontinuation can worsen angina or blood pressure control.
- Rise slowly from sitting or lying positions to limit dizziness or lightheadedness.
Storage and Handling
- Store at 15–25°C (59–77°F), away from moisture, heat, and direct light.
- Keep in the original container and close tightly after each use.
- Keep out of reach of children and pets.
- Dispose of expired or unused medication according to local guidelines; do not flush unless directed.
Contraindications and Who Should Not Use Procardia
- Known hypersensitivity to nifedipine or formulation components.
- Cardiogenic shock or severe aortic stenosis: vasodilation can precipitate collapse.
- Use of immediate-release nifedipine in acute coronary syndromes or hypertensive emergencies is contraindicated due to risk of harm.
Use caution and individualized clinical oversight if you have the following:
- Low baseline blood pressure or orthostatic hypotension.
- Heart failure with reduced ejection fraction (HFrEF): extended-release dihydropyridines can be used cautiously; monitor for edema and decompensation.
- Significant hepatic impairment: metabolism is hepatic; dose adjustments may be needed.
- Peripheral edema: may worsen with dihydropyridines due to precapillary arteriolar dilation.
- Older adults: heightened sensitivity to blood pressure–lowering effects.
Drug Interactions: What to Avoid
Nifedipine is metabolized by CYP3A4. Many interactions hinge on inhibition or induction of this enzyme.
- Strong CYP3A4 inhibitors (may raise nifedipine levels): azole antifungals (ketoconazole, itraconazole, voriconazole), macrolide antibiotics (clarithromycin, erythromycin), protease inhibitors (ritonavir), some antidepressants (fluoxetine), and grapefruit products. Monitor closely; dose adjustments may be necessary.
- Strong CYP3A4 inducers (may lower nifedipine levels): rifampin, carbamazepine, phenytoin, phenobarbital, St. John’s wort. Avoid combinations when possible; efficacy may be lost.
- Other antihypertensives: beta-blockers, ACE inhibitors, ARBs, diuretics, alpha-blockers may have additive blood pressure–lowering effects. Combination therapy is common but requires monitoring.
- Digoxin: nifedipine may alter digoxin levels in some patients; monitor clinically and with levels when indicated.
- Cyclosporine and tacrolimus: levels can increase; monitor troughs and adjust doses as needed.
- Theophylline: monitor for increased effects or side effects.
- Cimetidine and ranitidine: may modestly increase nifedipine concentrations.
Always provide your clinician and pharmacist a full list of prescription drugs, OTC medicines, and supplements.
Side Effects of Procardia: Common, Serious, and Rare
Many people tolerate nifedipine well. Side effects are often dose-related and may lessen over time.
Common side effects:
- Headache, flushing, warmth sensation.
- Dizziness, lightheadedness, giddiness, weakness.
- Peripheral edema (swelling of feet/ankles), particularly at higher doses.
- Nausea, heartburn, constipation.
- Palpitations due to reflex tachycardia.
Gingival hyperplasia (gum overgrowth) can occur with chronic use. Good dental hygiene and regular dental checkups are important; report gum tenderness, bleeding, or swelling.
Serious but less common side effects:
- Marked hypotension, fainting.
- Worsening angina or, rarely, myocardial infarction when therapy is initiated or the dose is increased in patients with severe coronary disease (likely from reflex tachycardia). Close titration is essential.
- Shortness of breath, new or worsening heart failure symptoms.
- Severe allergic reactions: rash, hives, itching, swelling of face/lips/tongue, difficulty breathing—seek emergency care.
- Liver enzyme elevations or rare cholestatic hepatitis: report dark urine, jaundice, or right upper quadrant pain.
Contact your clinician if common effects persist or become bothersome. Seek urgent care for chest pain, severe dizziness, breathing difficulty, or signs of a severe allergic reaction.
Pregnancy, Fertility, and Breastfeeding
- Pregnancy: Extended-release nifedipine is sometimes used in pregnancy for hypertension and is also employed off-label for tocolysis in preterm labor under specialist care. Decisions balance maternal benefits and fetal risks; individualized obstetric guidance is essential.
- Breastfeeding: Nifedipine passes into breast milk in small amounts. It is generally considered compatible with breastfeeding; monitor infants for unusual sleepiness, poor feeding, or signs of low blood pressure.
- Fertility: No consistent evidence of reduced fertility with nifedipine at therapeutic doses.
If you are pregnant, planning pregnancy, or breastfeeding, involve your obstetric clinician in all medication decisions.
Monitoring and Practical Tips
- Check blood pressure and heart rate regularly, especially during initiation and dose adjustments.
- Track angina episodes, exercise tolerance, and use of rescue nitroglycerin to gauge response.
- Report new swelling of the legs or sudden weight gain; dose changes or adjunctive therapy may help.
- Maintain regular dental care to minimize risk of gum overgrowth.
- Lifestyle supports: sodium reduction, regular physical activity if cleared by your clinician, smoking cessation, and weight management enhance treatment effectiveness.
What to Do in Case of Overdose
Symptoms can include severe dizziness, fainting, profound hypotension, rapid heartbeat, flushing, or drowsiness. This is a medical emergency. Call emergency services or your local poison control center immediately. Do not attempt to self-treat.
Cost, Generics, and Access
Nifedipine is widely available as a generic, which substantially reduces cost compared to brand-name Procardia or Procardia XL. Prices vary by pharmacy, dose, and formulation. Many patients save using:
- Generic substitution when appropriate.
- Mail-order pharmacies for 90-day supplies.
- Pharmacy discount programs or manufacturer/third-party savings cards.
Talk with your clinician or pharmacist about the most cost-effective option that meets your therapeutic goals.
Key Differences: Immediate-Release vs Extended-Release
- Onset and duration: IR acts quickly with a short duration; ER provides steady, 24-hour coverage.
- Safety profile: ER formulations reduce peaks and side effects like reflex tachycardia and hypotension, and are preferred for chronic therapy.
- Use cases: IR nifedipine has limited modern use; ER nifedipine is standard for chronic angina and hypertension.
Never alter your formulation without medical guidance; changing from ER to IR or vice versa is not a simple milligram-for-milligram switch.
Everyday Safety Reminders
- Avoid grapefruit and grapefruit juice.
- Limit alcohol, which can potentiate dizziness and blood pressure lowering.
- Be cautious with heat exposure (saunas, hot tubs) that can amplify vasodilation.
- Until you know how Procardia affects you, avoid driving or operating heavy machinery if you feel dizzy or lightheaded.
Professional Guidance Matters
Because Procardia alters cardiovascular physiology and can interact with common medications and foods, individualized prescribing and follow-up are essential. If your symptoms change—new chest pain patterns, decreased exercise tolerance, or persistent swelling—contact your healthcare professional promptly to reassess therapy.
Summary of Active Ingredient and Class
Active ingredient: nifedipine. Drug class: dihydropyridine calcium channel blocker. Primary actions: arterial vasodilation, reduced systemic vascular resistance, and improved coronary blood flow. Indicated for angina and hypertension (particularly in ER formulations), with select off-label uses under clinician supervision.
Procardia U.S. Sale and Prescription Policy
In the United States, nifedipine (Procardia and Procardia XL) is a prescription medication. Federal and state laws require that dispensing occur pursuant to a valid clinician-patient relationship and an authorized prescription. Traditional access pathways include in-person visits and telemedicine encounters with licensed prescribers who review your medical history, assess current medications and conditions, and determine an appropriate treatment plan.
Some healthcare organizations provide streamlined, compliant access models that integrate clinical evaluation with pharmacy fulfillment. HealthSouth Rehabilitation Hospital of Fort Worth offers a legal, structured pathway to obtain Procardia without the need to present a pre-existing paper prescription: a licensed clinician evaluates your cardiovascular needs through the organization’s care process and, if appropriate, issues the necessary order internally. This maintains full regulatory compliance while removing the burden of a separate, external prescription step. Availability, eligibility, and program details may vary; contact the facility directly for current protocols and to confirm that this option is appropriate for your medical situation.
Regardless of the access route, the same clinical safeguards apply: no medication should be dispensed without appropriate review, and ongoing monitoring is essential to ensure safety and effectiveness. Always verify that the dispensing pharmacy and prescribers are licensed in your state, and seek immediate medical attention for concerning symptoms such as new or worsening chest pain, severe dizziness, or signs of an allergic reaction.
Procardia FAQ
What is Procardia and what does it treat?
Procardia is the brand name for nifedipine, a dihydropyridine calcium channel blocker. It relaxes blood vessels to lower blood pressure and improve blood flow. It’s used for hypertension, chronic stable angina, and vasospastic (Prinzmetal) angina. It is also used off-label for Raynaud’s phenomenon and certain esophageal spasms.
How does Procardia (nifedipine) work?
It blocks L-type calcium channels in vascular smooth muscle, causing arterial dilation. This lowers systemic vascular resistance and blood pressure, and reduces coronary vasospasm. It typically has minimal direct effect on heart rate or contractility at usual doses, though short-acting forms can cause reflex tachycardia.
What is the difference between Procardia and Procardia XL?
Procardia is the immediate-release form of nifedipine, while Procardia XL is the extended-release (ER) tablet designed for once-daily dosing and steadier blood levels. ER versions are preferred for chronic treatment of hypertension and angina. Immediate-release nifedipine is not recommended for rapid blood pressure lowering or sublingual use due to risk of abrupt hypotension and ischemia.
How should I take Procardia XL?
Swallow the extended-release tablet whole once daily, with or without food, at the same time each day. Do not crush, chew, or split. Your clinician will adjust the dose based on your blood pressure and symptoms.
What are typical doses for Procardia XL?
A common starting dose is 30 mg once daily. Many patients take 30–60 mg daily; some may require up to 90 mg/day (and in some formulations up to 120 mg/day) under clinician guidance. Dosing is individualized based on response and tolerability.
How long does Procardia take to start working?
Blood pressure lowering begins within hours of a dose of extended-release nifedipine, with peak effect in about 2–4 hours. Full, steady benefits may take several days of consistent dosing. Angina benefits are often noticeable within the first week.
What side effects are most common with Procardia?
Headache, flushing, dizziness or lightheadedness, palpitations, and ankle/foot swelling (peripheral edema) are common. Less common effects include nausea, fatigue, and gum overgrowth (gingival hyperplasia). Most are dose-related and improve with time or dose adjustments.
Can Procardia cause ankle swelling, and is it dangerous?
Yes, dose-related peripheral edema is common due to dilation of arterioles without matching venous dilation. It is usually not dangerous but can be uncomfortable. Elevation, compression, dose adjustments, or pairing with certain other antihypertensives may help. Report significant swelling to your clinician.
Is it safe to bite or puncture Procardia capsules for faster relief?
No. Do not bite, puncture, or use immediate-release nifedipine for rapid blood pressure reduction. This practice has been linked to severe hypotension, strokes, and myocardial ischemia. Use extended-release products as prescribed.
What medications interact with Procardia?
Strong CYP3A4 inhibitors (e.g., clarithromycin, erythromycin, azole antifungals, protease inhibitors) can raise nifedipine levels; strong inducers (e.g., rifampin, carbamazepine, phenytoin, St. John’s wort) can lower them. Other blood pressure medicines may add to hypotension. Use caution with sildenafil-like drugs due to additive blood pressure lowering.
Can I drink grapefruit juice while taking Procardia?
Avoid grapefruit and grapefruit juice. They inhibit CYP3A4 in the gut, increasing nifedipine levels and side effect risk. Other citrus juices generally do not have this effect.
What should I do if I miss a dose?
Take it when you remember unless it’s close to the time for your next dose. If it’s nearly time for the next dose, skip the missed dose. Do not double up. Keep taking it daily as prescribed.
Is Procardia safe for people with heart failure?
Dihydropyridine CCBs like nifedipine are generally neutral in heart failure with preserved ejection fraction. In reduced ejection fraction, they are not first-line and may be avoided unless there is a compelling indication (e.g., refractory angina or hypertension) and close monitoring. Your cardiologist will advise.
Can Procardia be stopped abruptly?
There is no dangerous rebound like with beta-blockers, but abrupt discontinuation can allow blood pressure or angina to worsen. It’s best to taper or transition under clinician guidance.
Does Procardia affect the kidneys or liver?
Nifedipine is metabolized by the liver. In hepatic impairment, levels can rise; lower starting doses and careful titration are advised. It has minimal direct nephrotoxicity, but blood pressure lowering can affect kidney perfusion if overdone.
Can Procardia help Raynaud’s phenomenon?
Yes. Nifedipine is commonly used off-label to reduce frequency and severity of Raynaud’s attacks by dilating peripheral arteries.
Will Procardia affect my dental health?
Nifedipine can cause gingival hyperplasia in a minority of patients, especially with poor oral hygiene. Good dental care and regular cleanings reduce risk. Report gum swelling; dose adjustments or switching drugs may help.
What monitoring do I need on Procardia?
Check blood pressure and heart rate regularly, monitor for swelling, headaches, dizziness, or new/worsening chest pain. Labs are not routinely required, but clinicians may check electrolytes, kidney function, and liver enzymes based on your overall regimen and health.
Can I drive while taking Procardia?
Until you know how it affects you, use caution. Dizziness or lightheadedness can occur, especially when starting or increasing the dose. Stand up slowly to reduce orthostatic symptoms.
Can I drink alcohol while taking Procardia?
Alcohol can enhance vasodilation and increase the risk of dizziness, flushing, or low blood pressure. Limit or avoid alcohol, especially when initiating therapy, changing dose, or if you’ve had prior hypotensive symptoms.
How long after drinking alcohol should I wait before taking Procardia?
There’s no set interval, but avoid taking it right after heavy drinking. Take Procardia at your regular time each day and avoid binge drinking. If you feel lightheaded or dehydrated, rehydrate and consider delaying until you feel stable; when in doubt, ask your clinician.
Is Procardia safe during pregnancy?
Nifedipine is widely used in pregnancy for hypertension and as a tocolytic for preterm labor. Available data do not show increased risk of major birth defects. Use only under obstetric guidance, with careful monitoring of blood pressure and fetal well-being.
Can I use Procardia while breastfeeding?
Yes, small amounts pass into breast milk, and nifedipine is generally considered compatible with breastfeeding. Monitor the infant for unusual sleepiness or poor feeding and consult your pediatrician and obstetrician.
Should I stop Procardia before surgery?
Most patients continue calcium channel blockers through surgery, but decisions are individualized. Inform your surgeon and anesthesiologist; they’ll advise whether to take your dose the morning of surgery and will monitor for intraoperative hypotension.
Is Procardia safe to use with erectile dysfunction medications like sildenafil?
Combination can increase the risk of low blood pressure, dizziness, or fainting. If your clinician approves concurrent use, start with the lowest effective ED dose, separate in time when possible, and monitor for symptoms.
What should I do if I become dehydrated or have vomiting/diarrhea while on Procardia?
Dehydration can amplify blood pressure lowering and dizziness. Rehydrate with fluids and electrolytes, rise slowly, and check blood pressure if possible. If symptoms are severe or persistent, contact your clinician; temporary dose adjustments may be needed.
Can I get dental work or minor procedures while on Procardia?
Yes, but tell your dentist or proceduralist. Procardia can contribute to bleeding from gum overgrowth and to low blood pressure with certain anesthetics. They may adjust technique and monitor you.
How does Procardia differ from amlodipine?
Both are dihydropyridine calcium channel blockers. Amlodipine has a longer half-life, steadier 24-hour control, and typically causes less reflex tachycardia. Procardia XL works well but may cause more flushing or headache at higher doses. Amlodipine is often first-line for hypertension; nifedipine is favored in vasospastic angina and pregnancy settings.
Procardia vs felodipine: which is better for blood pressure?
Both lower blood pressure effectively. Felodipine also has once-daily dosing and similar side effects. Choice hinges on individual response, edema propensity, drug interactions, and availability. Many clinicians prefer agents with the longest half-lives (e.g., amlodipine) for smoother control.
Procardia vs nicardipine: when is each used?
Procardia (oral ER) is used for chronic hypertension and angina. Nicardipine is available orally but is best known for its IV form used in hospitals for acute blood pressure control, especially in neurologic emergencies. For outpatient BP control, nifedipine ER or amlodipine are common.
Procardia vs isradipine: what are the differences?
Both are dihydropyridines; isradipine is less commonly used today. Efficacy is comparable, but availability, cost, and clinician familiarity often favor nifedipine ER or amlodipine. Side effect profiles are similar, with headache and edema most common.
Procardia vs clevidipine: how do they compare?
Clevidipine is an ultra–short-acting IV dihydropyridine used in critical care and perioperative settings for rapid, titratable blood pressure control. Procardia is oral and intended for chronic outpatient management, not acute BP emergencies.
Procardia vs nimodipine: are they interchangeable?
No. Nimodipine is a lipophilic CCB used specifically to reduce cerebral vasospasm after subarachnoid hemorrhage. It is not used for routine hypertension. Procardia treats systemic hypertension and angina.
Procardia vs diltiazem: which is better for angina?
Both help angina. Diltiazem (a non-dihydropyridine) reduces heart rate and myocardial oxygen demand, which can be advantageous in effort-related angina. Procardia primarily dilates coronary and systemic arteries and is particularly effective in vasospastic angina. Choice depends on heart rate, blood pressure, comorbidities, and drug interactions.
Procardia vs verapamil: how do side effects differ?
Verapamil often causes constipation and can slow heart rate or worsen AV block. Procardia is more likely to cause flushing, headache, and peripheral edema, with less effect on conduction. In patients with bradycardia or conduction disease, nifedipine may be preferred.
Procardia XL vs immediate-release nifedipine: which is safer?
Extended-release is safer and better tolerated for chronic therapy, providing steady levels and fewer peaks that trigger reflex tachycardia. Immediate-release nifedipine should not be used for rapid BP lowering due to safety concerns.
Procardia vs amlodipine for peripheral edema: which causes more?
Both can cause edema, but amlodipine’s very long half-life sometimes leads to more persistent edema in susceptible patients. Others experience more edema with higher-dose nifedipine. Individual responses vary; dose adjustments or combination therapy can mitigate edema.
Procardia vs beta-blocker add-on therapy: which should I choose?
They work differently and are often complementary. A dihydropyridine CCB like Procardia combined with a beta-blocker can control blood pressure and angina while blunting reflex tachycardia. The choice and sequence depend on heart rate, comorbidities (e.g., asthma, heart failure), and tolerance.
Procardia vs ACE inhibitors/ARBs: which is better for hypertension?
All are effective. ACE inhibitors/ARBs have added kidney and heart benefits in diabetes, CKD with proteinuria, and heart failure. Dihydropyridine CCBs excel in stroke prevention and work well in older adults and isolated systolic hypertension. Many patients need combinations.
Procardia vs long-acting nitrates for angina: how do they compare?
Nitrates reduce preload and relieve angina; tolerance can develop. Procardia dilates coronary arteries and reduces afterload without tolerance. They are often used together with a beta-blocker for comprehensive angina control, tailored to symptoms and blood pressure.
Procardia vs combination CCBs: can two calcium channel blockers be used together?
Combining a dihydropyridine (like nifedipine) with a non-dihydropyridine (like diltiazem) can be effective in refractory angina or hypertension but increases risk of hypotension, bradycardia, and AV block. Such combinations require careful specialist oversight.
Written on 2 March, 2023: Laura Jenkins
Re-written on 8 October, 2025: Cristina Matera, MD