Can Nifedipine cause dizziness in a 44-year-old male?

Question

Hello doctor,

I am asking on behalf of a 44-year-old male who is having a sudden onset of vertigo that began two days ago. Initially, his blood pressure was very high, but it is now under control. Despite the improvement in blood pressure, he continues to experience mild dizziness and a sense of imbalance. There have been no episodes of fainting or seizures reported.

The current medicines he is taking are listed below:

Nifedipine 20 milligrams (mg) – for controlling blood pressure (taken once daily).
Betahistine 8 mg – for managing dizziness (taken two times a day).
Prochlorperazine 5 mg (mouth-dissolving tablet) – taken when needed for nausea or feeling lightheaded.

Recent electrocardiogram (ECG) report:

Heart rate: 76 beats per minute.
PR interval: 165 milliseconds (ms).
QRS duration: 76 ms.
QT interval / corrected QT interval (QTc): 400 / 428 ms (QTc is borderline high).
P axis / QRS axis / T axis: 30° / 47° / 17°.
RV5: 1.965 millivolts (mV).
SV1: 0.576 mV.
No major irregular heart rhythm or dangerous findings on ECG.

The patient has previously used Amlodipine with Atenolol to manage blood pressure without experiencing any side effects. Nifedipine was also tried in the past, but it may have led to discomfort or dizziness. Based on the current symptoms, the patient suspects that Nifedipine might be contributing to the ongoing dizziness.

The patient is carefully checking blood pressure and symptoms at home with a digital blood pressure monitor. There is no reported chest pain, vision trouble, or loss of consciousness.

Could Nifedipine be the reason for the ongoing dizziness? Should it be stopped or changed back to Amlodipine with Atenolol?
Should the dose of Betahistine be increased for a short period to better control the vertigo?
Is the corrected QT interval of 428 ms important or serious in this case?
Should additional tests, such as a magnetic resonance imaging (MRI) of the brain, a Holter monitor, or a two-dimensional echocardiogram (2D echo), be done?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Nifedipine is a calcium channel blocker. One of its common side effects is dizziness or feeling lightheaded, especially when starting the medicine or if the blood pressure drops too quickly.

You can switch to Amlodipine with Atenolol because you used it before without any problems. You are currently taking Betahistine 8 milligrams (mg) two times a day. For sudden or ongoing vertigo (spinning sensation), the dose can be increased up to 16 mg two times a day. It is safe to use at this dose for about one week.

A corrected QT interval (QTc) of 428 milliseconds (ms) is at the borderline. It is not a serious concern in most cases, but it should be watched if symptoms get worse or new ones appear. If the dizziness lasts for more than ten days or comes back again, you can get a magnetic resonance imaging (MRI) of the brain and a two-dimensional echocardiogram (2D echo) to check your heart.

Prevention and lifestyle tips:

Your blood sugar and blood pressure levels are not currently at dangerous levels, but lifestyle changes such as maintaining a healthy weight, reducing salt intake, and engaging in regular exercise are crucial for long-term health.
Drink enough water and get plenty of rest to help alleviate vertigo symptoms. Avoid sudden head movements.
Watch for serious warning signs like fainting, a strong headache, double vision, weakness, or slurred speech. These symptoms require urgent tests like brain imaging.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.