Mibefradil and Nisoldipine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nisoldipine
Mibefradil
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Severe bradycardia and hypotension
Interaction Deep Dive
One case report describes severe hypotension and bradycardia in a patient who took nisoldipine the day after discontinuing mibefradil therapy. Mibefradil has a half-life of 17 to 25 hours. Therefore, a washout period of seven days should elapse after the discontinuation of mibefradil before therapy with a different calcium channel blocker should be considered. In addition, since mibefradil blocks both T (transient) and L (long) calcium channels, other available calcium channel blockers which only block L-type calcium channels are unlikely to be more effective at controlling hypertension1.
Why it happens (mechanism)
Additive calcium channel blockade
Literature reports
1 report — tap to read
a) A 60-year-old male with hypertension had been taking mibefradil 100 mg daily in addition to metoprolol, hydrochlorothiazide, quinapril, and terazosin. Because of poor control of his hypertension, mibefradil was discontinued and nisoldipine 20 mg daily was initiated the next day. Within 90 minutes of taking the first dose of nisoldipine, he developed severe chest pain, nausea, vomiting, and dizziness. Upon arrival at the emergency department, his systolic blood pressure was 80 mm Hg and his heart rate was 40 beats per minute. An echocardiogram confirmed the diagnosis of an acute myocardial infarction. He received infusions of dopamine, norepinephrine, and glucagon, along with an intra-aortic balloon pump. He eventually recovered and was discharged from the hospital 1.
Common questions
Can I take Mibefradil and Nisoldipine together?
Severe bradycardia and hypotension Always confirm with your pharmacist or prescriber before making any change.
How serious is the Mibefradil and Nisoldipine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Mibefradil or Nisoldipine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Mullins ME, Horowitz BZ, Linden DHJ, et al: Life-threatening interaction of mibefradil and beta-blockers with dihydropyridine calcium channel blockers. JAMA 1998; 280:157-158.
Keep reading about Nisoldipine
Keep reading about Mibefradil
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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