E-drug: Nifedipine deletion from 13th Model Essential Drug List
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Given the published information, limited outcome studies, and safety
concerns about dihydropyridine calcium channel blockers and
comparing their performance with the unique advantages of less
expensive alternatives, I have been astounded that so much
nifedipine, amlodipine, and nimodipine is used World-Wide for
hyperension, often as monotherapy. But now with the publication of
the careful RCT ALLHAT study (JAMA. 2002;288:2981-2997), I do
not think that nifedipine should be removed from the Essential Drugs
List since the very similar amlodipine was clearly shown to be both
safe and effective compared to chlorthalidone and enalapril. My gut
reaction is that the earlier studies, taken as a body of knowledge, still
make dihydropyradine calcium channel blockers inferior to thiazides &
ACEIs, but I am no longer on firm ground in this prejudice, and it is
now too early to phase out the affordable and effective nifedipine 20
mg delayed release tablet, especially since the range of hypertension
treatment options to the poor is limited.
Norman D. Olson, MD
Global Health Ministries
Adj. Clin. Assoc. Prof. of Medicine
Stanford University
e-mail: nolsonmd@aol.com
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