Sustained-release nifedipine: new indication. Angina: safer drugs are available

The efficacy of sustained-release osmotic tablets of nifedipine in the symptomatic treatment of stable angina is poorly documented. The safety of nifedipine remains uncertain, as high-dose treatment with immediate-release preparations increased mortality in trials involving coronary patients. In angina, nifedipine can be used only in combination with a betablocker, and only to treat patients with no recent history of myocardial infarction, or unstable angina. In stable angina with inadequate symptom control by betablockers, it is no more effective than other dihydropyridines also indicated in the treatment of angina, i.e. amlodipine and felodipine. Furthermore, medium-term data on amlodipine are relatively reassuring. Nifedipine appears a little more effective than sustained-release nitrate derivatives, but less safe.