SHOULD
A MORATORIUM BE PLACED ON SUBLINGUAL NIFEDIPINE CAPSULES GIVEN FOR HYPERTENSIVE
EMERGENCIES AND PSEUDOEMERGENCIES?
Grossman
E, et al. JAMA 1996 Oct 23-30;276(16):1328-31
Over
the past 2 decades, nifedipine in the form of capsules has become widely
popular in the treatment of hypertensive emergencies. Unlike other agents, such
as sodium nitroprusside, nicardipine hydrochloride, diazoxide, and
nitroglycerin--which require intravenous administration and monitoring of blood
pressure--nifedipine can be given orally, and close monitoring is said not to
be necessary. Although administration of nifedipine capsules has been reported
to be expedient and safe, it has not been approved by the Food and Drug
Administration for labeling for treatment of hypertensive emergencies or of any
other form of hypertension because of lack of outcome data. A review of the
literature revealed reports of serious adverse effects such as cerebrovascular
ischemia, stroke, numerous instances of severe hypotension, acute myocardial
infarction, conduction disturbances, fetal distress, and death. Sublingual
absorption of nifedipine has been found to be poor; most of the drug is
absorbed by the intestinal mucosa. Given the seriousness of the reported
adverse events and the lack of any clinical documentation attesting to a
benefit, the use of nifedipine capsules for hypertensive emergencies and
pseudoemergencies should be abandoned.