Ribociclib and Nifedipine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ribociclib
Nifedipine
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
Increased NIFEdipine exposure and an increased risk of hypotension, bradycardia, or acute renal injury
Interaction Deep Dive
Coadministration of NIFEdipine and strong CYP3A4 inhibitors has been reported to increase the risk of NIFEdipine related side effects, including hypotension, bradycardia5, and acute renal injury 6. Coadministration of clarithromycin with a calcium channel blocker (including NIFEdipine) was associated with significantly increased short-term risk of hospital admission within 7 days for hypotension or shock in a cohort study of geriatric patients 4. If concomitant use is required, NIFEdipine dose adjustment and careful monitoring of heart rate and blood pressure may be necessary 31. In a case report, a 50% reduction of the NIFEdipine dose was necessary 5.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of NIFEdipine
Literature reports
4 reports — tap to read
a) Severe hypotension, dizziness, orthostasis, and complete heart block developed in a 51-year-old man with a history of coronary artery disease, HIV, and hypertension after 3 days of concomitant treatment with NIFEdipine and antiretroviral therapy consisting of zidovudine, lamiVUDine, and nelfinavir. After evaluation, antiretroviral therapy was held, but the patient continued his other medications (NIFEdipine, losartan, aspirin, and atenolol). Upon restarting his antiretroviral therapy, the patient noticed similar symptoms of weakness and fatigue within 2 days, with resolution several days after discontinuing antiretroviral therapy. The patient eventually tolerated an alternate antiretroviral regimen that did not contain a protease inhibitor (stavudine/didanosine/efavirenz), but then developed symptoms of hypotension, weakness, fatigue, and bradycardia when switched to zidovudine, abacavir, ritonavir and indinavir. Subsequent dosage reduction of NIFEdipine (by 50%) and atenolol led to symptom resolution 5.
b) In a large retrospective cohort study of elderly adults, initiation of clarithromycin (a strong CYP3A inhibitor) in patients receiving NIFEdipine was associated with a significant 5-fold increase in the risk of hospitalization for acute kidney injury compared with initiation of azithromycin 6.
c) In a case report, hypotension and acute kidney injury were observed within 2 days of oral voriconazole therapy in a 69-year-old woman who was concurrently receiving NIFEdipine, arotinolol, and terazosin for hypertension. Medical history included antineutrophil cytoplasm antibody associated vasculitis and was hospitalized for fibrocellular crescent nephritis and coexistence of membranous nephropathy. Voriconazole was initiated on day 10 of admission. On day 12, fatigue was noted and blood pressure (BP) was 120/70 mmHg. By day 15, the patient gained 6 kg, serum potassium was 6.08 mcmol/L, urine output was decreased, serum creatinine (SCr) was 340 mcmol/L, the calculated nitrogen:SCr ratio was 22, and BP was 90/40 mmHg; all hypertensive drugs and voriconazole were discontinued due to acute kidney injury, hypotension, hyperkalemia, and sinus arrest with junctional escape rhythm. Upon rechallenge of NIFEdipine and voriconazole, the patient experienced hypotension and anuria again. Voriconazole was discontinued and gradually the urine output increased. A drug interaction between voriconazole and NIFEdipine was suspected which may have caused NIFEdipine toxicity, therefore an antihypertensive not metabolized through CYP3A4 was utilized instead of NIFEdipine once her BP rose again to 170/90 mmHg. Voriconazole was resumed with concomitant terazosin without incident. She remained stable for the next 3 days prior to discharge, and 2 months after discharge, her SCr was 220 mcmol/L with normal urine output and serum potassium 7.
d) Coadministration of macrolide antibiotics erythromycin or clarithromycin with a calcium channel blocker was associated with significantly increased short-term risk of hospital admission within 7 days for hypotension or shock ([OR, 5.8; 95% CI, 2.25 to 14.98] or [OR, 3.7; 95% CI, 2.26 to 6.06]) in a case-crossover cohort study of geriatric patients (N=7100); there was no significant risk associated with azithromycin. In a stratified analysis of dihydropyridine calcium channel blockers (amLODIPine, felodipine, NIFEdipine), the results remained significant for coadministration of erythromycin or clarithromycin. Calcium channel blocker treatment included dilTIAZem (40%), amLODIPine (29.6%), NIFEdipine (19.4%), verapamil (8%), or felodipine (3%). The findings suggest that erythromycin and clarithromycin potentiate calcium channel blockers (CYP3A4 substrates) by inhibiting CYP3A4; azithromycin does not inhibit CYP3A4 4.
Common questions
Can I take Ribociclib and Nifedipine together?
Increased NIFEdipine exposure and an increased risk of hypotension, bradycardia, or acute renal injury Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ribociclib and Nifedipine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Ribociclib or Nifedipine 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 (7)
- Product Information: PROCARDIA(R) oral capsules, nifedipine oral capsules. Pfizer Labs (per FDA), New York, NY, 2014. DailyMed
- Product Information: NIFEDIPINE oral tablet, extended-release, nifedipine oral tablet, extended-release. Aurobindo Pharma Limited (per DailyMed), East Windsor, NJ, 2024. DailyMed
- Product Information: PROCARDIA XL(R) oral extended-release tablets, nifedipine oral extended-release tablets. Pfizer Labs (per Dailymed), New York, NY, 2023. DailyMed
- Wright AJ, Gomes T, Mamdani MM, et al: The risk of hypotension following co-prescription of macrolide antibiotics and calcium-channel blockers. CMAJ 2011; 183(3):303-307. PubMed
- Rossi DR, Rathbun RC, & Slater LN: Symptomatic orthostasis with extended-release nifedipine and protease inhibitors. Pharmacotherapy 2002; 22(10):1312-1316. PubMed
- Gandhi S, Fleet JL, Bailey DG, et al: Calcium-channel blocker–clarithromycin drug interactions and acute kidney injury. JAMA 2013; 310(23):2544-2553. PubMed
- Zhao X, Zhang C, Zhu L, et al: Severe secondary hyperkalemia and arrhythmia from drug interactions between calcium-channel blocker and voriconazole: a case presentation. BMC Nephrol 2021; 22(1):172. PubMed
Keep reading about Ribociclib
Keep reading about Nifedipine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist