Calcium Channel Blockers

Brand name

  • Cardene®
  • Vascor®
  • Norvasc®
  • Adalat® , Procardia®
  • Plendil®
  • Cardizem® , Dilacor® , Tiazac®

Drug Class

  • Anti Hypertension medications

Preparations

Nicardipine

  1. BRAND NAME: Cardene
  2. PREPARATIONS:
    1. capsules (20, 30mg)
    2. sustained release ( 30, 45, 60mg)
  3. DOSING:
    1. Nicardipine can be administered with or without food.
    2. Nicardipine is metabolized mainly by the liver with some kidney excretion.
    3. Dosages may need to be lowered in patients with liver or kidney dysfunction.
  4. DRUG INTERACTIONS: Nicardipine can sometimes cause an increase in the frequency and duration of angina. The reason for this side effect is not clearly understood. Excessively low blood pressures can occur in rare instances, especially during initiation of treatment or following dose adjustment. Cimetidine (Tagamet) increases nicardipine levels and its effects. Safe use of nicardipine in children has not been established.
  5. NURSING MOTHERS: The medication can enter breast milk and should be avoided by nursing mothers.
  6. SIDE EFFECTS: Increased heart rate can occur because of the drop in blood pressure. Other side effects include swelling of the feet (edema), dizziness, headaches, flushing, palpitations, and nausea.

 

Bepridil

  1. BRAND NAME: Vascor
  2. PREPARATIONS: Tablets: 200mg.
  3. DOSING:
    1. Bepridil usually is taken once daily.
    2. It can be taken with meals or at bedtime if nausea is a problem.
  4. DRUG INTERACTIONS:
    1. Bepridil can reduce the strength with which the heart muscle contracts.
    2. Drugs which also have this effect could seriously reduce contractions and possibly precipitate congestive heart failure.
      1. Quinidine (Quinaglute; Duraquin; Quinidex)
      2. Procainamide (Procan-SR; Pronestyl)
      3. Disopyramide (Norpace)
      4. Flecainide (Tambocor)
      5. Verapamil (Calan; Isoptin; Covera; Verelan)
      6. Diltiazem (Cardizem; Tiazac; Dilacor)
      7. Beta-blockers
      8. Atenolol (Tenormin)
    3. Bepridil slows the ability of the heart’s muscle to recover electrically and get ready for the next contraction. Other drugs which have the same effect could interact with bepridil, possibly causing serious problems with abnormal heart rhythms and should be used cautiously if at all with bepridil.
      1. Quinidine (Quinaglute; Duraquin; Quinidex)
      2. Procainamide (Procan-SR; Pronestyl)
      3. Disopyramide (Norpace),
      4. Flecainide (Tambocor)
      5. Tricyclic Antidepressants
    4. Bepridil may increase levels of digoxin (Lanoxin) in the blood,
    5. Diuretics, e.g., furosemide (Lasix), bumetanide (Bumex), torsemide Demadex), hydrochlorothiazide (Hydrodiuril), chlorthalidone (Hygroton), metolazone (Zaroxolyn) may cause a reduction in blood potassium concentrations thereby increasing the risk of bepridil-induced abnormal heart rhythms.
  5. PREGNANCY: Bepridil crosses the placenta, and therefore should not be used during pregnancy unless the benefit to the mother outweighs the potential but unknown risk to the fetus.
  6. NURSING MOTHERS: Bepridil is secreted into breast milk and therefore should not be used by breast-feeding mothers unless benefit to the mother clearly outweighs the potential but unknown risk to the infant.
  7. SIDE EFFECTS:
    1. Bepridil can cause very serious cardiac arrhythmias. The risk is increased in patients with a specific electrocardiographic abnormality called QT prolongation and in patients with low blood concentrations of potassium or magnesium
    2. Bepridil also can cause increased or decreased heart rate and other abnormal rhythms.
  8. Other side effects that can occur in patients taking bepridil include:
    1. flu-like symptoms
    2. muscle aches
    3. fever
    4. Nausea
    5. Vomiting
    6. loss or appetite
    7. constipation
    8. gas
    9. stomach ache
    10. dry mouth
    11. diarrhea
    12. headache
    13. fatigue
    14. nervousness
    15. drowsiness
    16. dizziness
    17. depression
    18. inability to sleep
    19. blurred vision
    20. Impotence and reduction in sexual drive

 

Amlodipine

  1. BRAND NAME: Norvasc
  2. PREPARATIONS: Tablets ( 2.5mg, 5mg, 10mg.)
  3. DOSING:
  4. DRUG INTERACTIONS:
    1. MI: In patients with severe coronary artery disease, amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur, especially in patients already taking another blood pressure lowering medication.
    2. CHF: In rare instances, congestive heart failure has been associated with amlodipine, usually in patients already on a beta blocker.
  5. PREGNANCY: Generally, amlodipine is avoided in pregnancy, and by nursing mothers and children.
  6. NURSING MOTHERS: Generally, amlodipine is avoided in pregnancy, and by nursing mothers and children.
  7. SIDE EFFECTS:
    1. headache
    2. Edema (swelling) of the lower extremities
    3. Dizziness
    4. Flushing
    5. Fatigue
    6. Nausea
    7. Palpitations

Nifedipine

  1. BRAND NAMES: Adalat, Procardia
  2. PREPARATIONS:
    1. 10mg and 20mg capsules.
    2. extended release forms (Procardia XL, Adalat CC) in 30, 60, and 90mg capsules
  1. DOSING:
  2. DRUG INTERACTIONS:
    1. MI: In patients with severe obstructive coronary artery disease, nifedipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting nifedipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of nifedipine treatment can occur, especially in patients already taking another blood pressure lowering medication.
    2. CHF: In rare instances, congestive heart failure has been associated with nifedipine, usually in patients already on a beta blocker.
    3. Administration of nifedipine with digoxin can increase digoxin blood level
    4. cimetidine (Tagamet) interferes with the liver breakdown of nifedipine, and significantly increases nifedipine blood levels.
    5. PREGNANCY: Generally, nifedipine is avoided during pregnancy.
    6. NURSING MOTHERS: Generally, nifedipine is avoided in nursing mothers.
    7. SIDE EFFECTS:
      1. Side effects of nifedipine are generally mild, and reversible. Most side effects are expected consequences of the dilation of the arteries. The most common side effects of nifedipine include headache,
      2. Dizziness
      3. Flushing
      4. Edema (swelling) of the lower extremities
      5. Dizziness
      6. Nausea
      7. Constipation

Felodipine

  1. BRAND NAME: Plendil
  2. PREPARATIONS:
    1. Tablets: 2.5mg, 5mg, 10mg
  3. DOSING:
  4. DRUG INTERACTIONS:
    1. Blood levels of digoxin (Lanoxin) can be increased by felodipine.
    2. Cimetidine (Tagamet) can block the breakdown of felodipine, resulting in higher blood concentrations of felodipine and drops in blood pressure.
    3. Carbamazepine (Tegretol), phenobarbital, or phenytoin (Dilantin) can lower felodipine blood concentrations. Therefore, higher doses of felodipine may be necessary in patients receiving these medications.
  5. PREGNANCY: The effects of felodipine in pregnant women have not been adequately studied. Animal studies have shown adverse effects. Therefore, the physician must weigh the potential risks to the fetus against the potential benefits to the mother.
  6. NURSING MOTHERS: It is not known if felodipine is excreted in breast milk.
  7. SIDE EFFECTS:
    1. Peripheral edema
    2. Headache
    3. Dizziness

Diltiazem

  1. BRAND NAMES: Cardizem, Dilacor, Tiazac
  2. PREPARATIONS:
    1. tablets (30, 60, 90, and 120 mg.)
    2. sustained release SR capsules (60, 90, and 120 mg)
    3. extended release CD capsules (120, 180, 240, and 300 mg)
  3. DOSING:
  4. DRUG INTERACTIONS:
    1. Diltiazem slows heart electrical conduction, and can cause a dangerously slow heart rate in patients with existing electrical conduction disease of the heart.
    2. Concurrent use of diltiazem with a beta blocker (another class of medications that slow heart rate) can occasionally cause profound heart slowing.
    3. Diltiazem can aggravate heart failure and cause excessive lowering of blood pressure.
    4. Administration of diltiazem with digoxin can increase digoxin blood levels.
    5. anti-seizure medication carbamazepine (Tegretol) can increase blood levels of the seizure medication, and occasionally lead to toxicity.
    6. Cimetidine (Tagamet) interferes with the liver breakdown of diltiazem, and significantly increases diltiazem blood levels.
  5. PREGNANCY: Generally, diltiazem is avoided in pregnancy.
  6. NURSING MOTHERS: Generally, diltiazem is avoided in nursing mothers.
  7. SIDE EFFECTS:
    1. Side effects are generally mild and transient.
    2. Diltiazem can cause difficulty breathing or wheezing as a result of worsening heart failure. It can cause
    3. Dizziness
    4. Weakness or fainting because of slow heart rate or low blood pressure
    5. swelling of the lower extremities, rash, headache, and constipation
    6. abnormal liver tests

Indications

  • Prescribed for the treatment of HTN
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