Which is inappropriate for use in older adults due to risk of hypotension when given as an immediate-release formulation?

• A. Amlodipine
• B. Nifedipine IR
• C. Diltiazem
• D. Felodipine

Answer: (B)

Immediate-release nifedipine carries a well-documented risk of causing a rapid and excessive drop in blood pressure in older adults. That sudden hypotension can lead to dizziness, falls, syncope, and potentially organ hypoperfusion, which is why Beers Criteria cautions strongly against using short-acting nifedipine for chronic hypertension or other indications in frail older patients. In contrast, longer-acting dihydropyridine calcium channel blockers like amlodipine or felodipine provide a more gradual BP reduction and are generally preferred when a dihydropyridine CCB is appropriate. Diltiazem, a nondihydropyridine CCB, has its own safety considerations (such as bradycardia or conduction abnormalities), but the specific high-risk scenario for abrupt hypotension in older adults is most clearly associated with the immediate-release form of nifedipine.