Extended Release Nifedipine Intrapartum For Severe HTN

Oct 14, 2025

The discussion revolves around the use of extended-release nifedipine for managing severe hypertension during labor. Dr. Chapa contrasts ACOG's immediate-release guidelines with SASGOG's recommendations for intrapartum use. A new randomized trial highlights its effectiveness, showing a significant reduction in the need for urgent antihypertensive therapy. Practical dosing strategies and potential outcomes are explored, emphasizing safety and the importance of more research. Overall, the talk is an engaging deep dive into evolving practices in obstetric care.

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ANECDOTE

Local Practice Uses 30 mg XR Nifedipine

Dr. Chapa notes their institution has used 30 mg extended‑release nifedipine intrapartum after multiple IV doses.
He describes this practice as discretionary and not universal protocol.

INSIGHT

Extended-Release Nifedipine Has Limited Level‑One Evidence

Extended-release nifedipine intrapartum has level‑one evidence but limited trials support it.
It is not yet standard first-line therapy despite promising results.

ADVICE

Stabilize With Urgent IV Or Immediate PO First

Treat urgent severe hypertension first with IV hydralazine, IV labetalol, or immediate‑release PO nifedipine.
Consider oral maintenance only after acute control to keep pressures below the severe range.

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In the 09/1/2018 Society for Academic Specialists in General Obstetrics and Gynecology’s (SASGOG’s) Pearls of Exxcellence publication, “Management of Preeclampsia at Term”, it states: “If hypertension management requires acute IV treatment, it is often prudent to initiate oral labetalol or EXTENDED-release nifedipine to maintain blood pressures below the severe range. Intrapartum blood pressure management and consultation should not delay progress towards delivery. Fetal monitoring should be continuous.” In the original ACOG CO 692 from 2017, oral nifedipine was first referenced as an alternative to IV meds GIVEN INTRAPARTUM, stating, “Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available.” This may be given orally as 10mg, 20mg, and 20 mg separated in time by 20 minutes per dose. Notice it says “immediate release oral nifedipine”. But what about EXTENDED release nifedipine intrapartum as stated by the SASGOG? Is that an option after immediate attentive and therapy has been given with IV anti-hypertensives? Listen in for details.

1. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period: Committee Opinion, Number 692. Obstetrics & Gynecology 129(4):p e90-e95, April 2017. | DOI: 10.1097/AOG.0000000000002019

2. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.

3. Cleary EM, Racchi NW, Patton KG, Kudrimoti M, Costantine MM, Rood KM. Trial of Intrapartum Extended-Release Nifedipine to Prevent Severe Hypertension Among Pregnant Individuals With Preeclampsia With Severe Features. Hypertension. 2023 Feb;80(2):335-342. doi: 10.1161/HYPERTENSIONAHA.122.19751. Epub 2022 Oct 3. PMID: 36189646.

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