The Basics
What is Nifedipine?
Used to treat high blood pressure and to control angina.
Brand names for Nifedipine
Procardia
How Nifedipine is classified
Antihypertensive Agents, Calcium Channel Blockers, Vasodilator Agents
Nifedipine During Pregnancy
Nifedipine pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Nifedipine while pregnant
Nifedipine has been shown to produce teratogenic findings in rats and rabbits, including digital anomalies similar to those reported for phenytoin. Digital anomalies have been reported to occur with other members of the dihydropyridine class and are possibly a result of compromised uterine blood flow. Nifedipine administration was associated with a variety of embryotoxic, placentotoxic, and fetotoxic effects, including stunted fetuses (rats, mice, rabbits), rib deformities (mice), cleft palate (mice), small placentas and underdeveloped chorionic villi (monkeys), embryonic and fetal deaths (rats, mice, rabbits), and prolonged pregnancy/decreased neonatal survival (rats; not evaluated in other species). On a mg/kg basis, all of the doses associated with the teratogenic embryotoxic or fetotoxic effects in animals were higher (5 to 50 times) than the maximum recommended human dose of 120 mg/day. On a mg/m² basis, some doses were higher and some were lower than the maximum recommended human dose but all were within an order of magnitude of it. The doses associated with placentotoxic effects in monkeys were equivalent to or lower than the maximum recommended human dose on a mg/m² basis. There are no adequate and well-controlled studies in pregnant women. PROCARDIA should be used during pregnancy only if the potential benefit justifies the potential risk.
Taking Nifedipine While Breastfeeding
What are recommendations for lactation if you're taking Nifedipine?
Because of the low levels of nifedipine in breastmilk, amounts ingested by the infant are small, even in women with a genetic variant of breast cancer resistance protein that increases the amount of drug transferred to milk. No adverse effects have been reported among infants exposed to nifedipine in breastmilk. Nifedipine is used to treat painful nipple vasospasm (e.g., Raynaud phenomenon) in nursing mothers.[1]
Maternal / infant drug levels
Because of the low levels of nifedipine in breastmilk, amounts ingested by the infant are small, even in women with a genetic variant of breast cancer resistance protein that increases the amount of drug transferred to milk. No adverse effects have been reported among infants exposed to nifedipine in breastmilk. Nifedipine is used to treat painful nipple vasospasm (e.g., Raynaud phenomenon) in nursing mothers.[1]
Possible effects of Nifedipine on milk supply
No direct effects are known. However, nifedipine has been used to decrease the pain of nipple vasospasm (or Raynaud phenomenon of the nipple), allowing mothers to continue nursing who might otherwise discontinue breastfeeding. The dosage of nifedipine reportedly used to treat the condition is 30 to 60 mg daily either as a single dose of a sustained-release product or 10 to 20 mg 3 times daily of an immediate-release product. Lower dosages can be tried if these doses are not tolerated.[1][7][8][9][10][13][14]
Nifedipine had no effect on milk composition (sodium, potassium, calcium, chloride, nitrogen, phosphorus and total lipids) in one woman.[3]
Possible alternatives to Nifedipine
Amlodipine, Nitrendipine.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Berens P, Eglash A, Malloy M et al. ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11:46-53. PMID: 26881962
2. Penny WJ, Lewis MJ. Nifedipine is excreted in human milk. Eur J Clin Pharmacol. 1989;36(4):427-8. PMID: 2737237
3. Ehrenkranz RA, Ackerman BA, Hulse JD. Nifedipine transfer into human milk. J Pediatr. 1989;114(3):478-80. PMID: 2921695
4. Manninen AK, Juhakoski A. Nifedipine concentrations in maternal and umbilical serum, amniotic fluid, breast milk and urine of mothers and offspring. Int J Clin Pharm Res. 1991;11:231-6. PMID: 1814844
5. Taddio A, Oskamp M, Ito S et al. Is nifedipine use during labour and breast-feeding safe for the neonate? Clin Invest Med. 1996;19(4 Suppl):S11. Abstract.
6. Malfara BN, Benzi JRL, de Oliveira Filgueira GC et al. ABCG2 c.421C>A polymorphism alters nifedipine transport to breast milk in hypertensive breastfeeding women. Reprod Toxicol. 2019;85:1-5. PMID: 30659932
7. Lawlor-Smith LS, Lawlor-Smith CL. Raynaud’s phenomenon of the nipple: A preventable cause of breastfeeding failure? Med J Aust. 1996;166:448. Letter. PMID: 9140358
8. Garrison CP. Nipple vasospasm, Raynaud’s syndrome, and nifedipine. J Hum Lact. 2002;18(4):382-5. PMID: 12449056
9. Anderson JE, Held N, Wright K. Raynaud’s phenomenon of the nipple: A treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360-4. PMID: 15060268
10. Page SM, McKenna DS. Vasospasm of the nipple presenting as painful lactation. Obstet Gynecol. 2006;108 (3 part 2):806-8. PMID: 17018510
11. O’Sullivan S, Keith MP. Raynaud phenomenon of the nipple: A rare finding in rheumatology clinic. J Clin Rheumatol. 2011;17:371-2. PMID: 21946463
12. Wu M, Chason R, Wong M. Raynaud’s phenomenon of the nipple. Obstet Gynecol. 2012;119 (2 Pt 2):447-9. PMID: 22270434
13. Barrett ME, Heller MM, Fullerton Stone H, Murase JE. Raynaud phenomenon of the nipple in breastfeeding mothers: An underdiagnosed cause of nipple pain. JAMA Dermatology. 2013;149:300-6. PMID: 23247299
14. Jansen S, Sampene K. Raynaud phenomenon of the nipple: An under-recognized condition. Obstet Gynecol. 2019;133:975-7. PMID: 30969221
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
