In patients with clinically significant hepatic impairment, the half-life increases to an average of 7 hours. The drug's half-life is likely to be prolonged in the elderly, but the degree has not been fully characterized. Nifedipine is minimally removed by hemodialysis or hemoperfusion. Nifedipine should be used cautiously in patients with severe bradycardia. The development or worsening of pulmonary edema is a marker for discontinuation of nifedipine.
Nifedipine decreases peripheral resistance and can worsen hypotension.
Nifedipine should be used with caution in patients with mild to moderate hypotension. Blood pressure should be monitored carefully in all patients receiving nifedipine. Nifedipine is relatively contraindicated in patients with advanced aortic stenosis because the drug can worsen the abnormal pressure gradient associated with this condition. The elderly, patients with renal impairment, or patients with hepatic disease, such as cirrhosis or hepatic failure, can experience a delayed clearance of nifedipine and can be at greater risk for accumulation and toxicity. This is believed to be due to decreased renal and nonrenal clearance of digoxin brought on by nifedipine.