Nifedipine is commonly used to treat high blood pressure and chest pain (angina). It can also be used to relieve symptoms in Raynaud’s phenomenon, a condition caused by the narrowing of the small blood vessels in the fingers and toes, and often associated with scleroderma.
How nifedipine works
Nifedipine and other calcium channel blockers inhibit, or block, the influx of calcium into heart muscle cells and smooth muscle cells surrounding blood vessels. Because these cells depend on calcium for contraction, a decrease in calcium influx dilates the blood vessels and lowers blood pressure, improving the symptoms of Raynaud’s phenomenon.
Nifedipine in clinical trials
An early Phase 1 clinical trial (NCT03027674) in 10 patients with secondary Raynaud’s phenomenon compared the effectiveness of two vasodilators used as topical creams: nifedipine and sildenafil. Nifedipine cream at 10 percent was applied to one hand, and sildenafil cream at 5 percent to the other hand. Published results found a benefit for sildenafil, both in terms of increased blood flow and vessel diameter, but not for nifedipine.
A meta-analysis of five randomized, double-blinded, and placebo-controlled trials that included a total of 44 systemic scleroderma patients with Raynaud’s phenomenon looked at the effect of nifedipine treatment compared to placebo. This analysis found the frequency of ischemic attacks significantly decreased over a two-week period by an average of 10.21 attacks nifedipine-treated patients compared to placebo. The mean severity of the attacks was also reported to be significantly lower.
Nifedipine should not be used in people with severe coronary artery disease or within two weeks after a heart attack.
Consumption of grapefruit or grapefruit juice is incompatible with the use of nifedipine, because it can worsen side effects.
The most common side effects include dizziness, peripheral and lower extremity edema and flushing. Less common are muscle cramps, tremors, low blood pressure, heart attacks, cough, wheezing, and shortness of breath.
Side effects may ease with longer use, as the body adjusts to the medication.
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