Nifedipine is not feasible for biliary pain in patients with gallbladder stones

Objective: Biliary pain is generally treated with NSAIDs and spasmolytics, but some patients do not tolerate them. Nifedipine has been suggested to have some analgesic effect and it has been used succesfully in many painful smooth muscle disorders. Our aim was to evaluate the effect of nifedipine for biliary colics and gallbladder volume. Patients and methods: Twenty-seven patients suffering from uncomplicated symptomatic gallbladder stones were prospectively randomized to receive either oral nifedipine (10 mg 3 times daily) or placebo in a double-blind manner. Liver chemistry and ultrasonography were examined before and after the 8-week study period. The patients completed each day a diary of their pain, headache, palpitation, burning feeling in skin, dizziness, and their use of painkillers. Results: Biliary pain seemed to be less intensive and shorter in duration, but without statistical significance, whereas headache tended to be more common (p = 0.077) in nifedipine group than that in placebo group. This difference would have reached statistical significance with over 155 patients randomized. Overall additional drug use was similar in both groups, and was increased in nifedipine group for headache (p = 0.05). The fasting gallbladder volume tended to decrease (p = 0.085) during the nifedipine treatment but not with placebo. Serum liver chemistry remained within normal range. Conclusions: This small study shows that nifedipine may decrease slightly biliary pain intensity and duration, and contrary to previous findings in healthy volunteers, it seems to decrease resting gallbladder volume in patients with symptomatic uncomplicated gallbladder stones, but did not reduce the need of traditional pain medication partly because of increased need for headache. Thus it is not a feasible choice for routine use against biliary pain in symptomatic gallbladder stones, which is why the study was not continued to reach statistical significance in respect to biliary pain.