2.6.2 Calcium-channel blockers

There are important differences between dihydropyridines and other classes of calcium channel blockers.

Avoid the combination of verapamil with a beta-blocker (including eye drops). The combination of diltiazem with beta-blockers should be used with caution.

Avoid verapamil and diltiazem in heart failure.

Amlodipine
  • Tablets 5mg, 10mg (£0.73 = 5mg)

Indications

Dose

  • Initially 5mg once daily; maximum 10mg once daily

Notes

  1. Patients experiencing ankle oedema whilst taking amlodipine may benefit from a change to lercanidipine.
Diltiazem hydrochloride
  • Tildiem® tablets 60mg (£41.59 = 60mg three times daily)
  • Adizem-XL® 120mg, 180mg, 200mg, 240mg, 300mg (£9.14 = 300mg once daily)
  • Slozem® capsules 120mg, 180mg, 240mg, 300mg (£7.80 = 180mg daily)
  • Tildiem LA® capsules 200mg, 300mg (£6.29 = 200mg)

Indication

Notes

  1. There are pharmacokinetic differences between diltiazem brands and we do not advocate switching patients stabilised on one brand.
  2. If diltiazem prescriptions have been written generically in the past, the prescriber should attempt to ascertain which brand the patient has been taking and amend the prescription accordingly. If the brand taken has constantly changed, the prescriber should choose a formulary brand and prepare to review the patient and titrate the dose as appropriate.
  3. The combination of diltiazem with beta-blockers should be used with caution.
Lercanidipine
  • Tablets 10mg, 20mg (£4.68 = 10mg daily)

Indication

Dose

  • Initially 10mg once daily; increased, if necessary, after at least 2 weeks to 20mg daily
Verapamil
  • Tablets 40mg, 80mg, 120mg, 160mg (£4.80 = 120mg three times daily)
  • Half Securon SR® modified release tablets 120mg (£7.71)
  • Securon SR® modified release tablets 240mg (£5.55)
  • Univer® modified release capsules 120mg, 180mg, 240mg (£11.38 = 180mg daily)

Indications

  • Arrhythmias
  • Angina
  • Prophylaxis after myocardial infarction where beta-blockers not appropriate

Notes

  1. Avoid the combination of verapamil with a beta-blocker (including eye drops).
  2. Avoid verapamil and diltiazem in heart failure.
Adalat LA®
  • Nifedipine prolonged release tablets 20mg, 30mg, 60mg (£6.85 = 30mg daily)

Indications

Dose

  • 30mg once daily, increased if necessary to maximum 90mg once daily
Adalat Retard®
  • Nifedipine modified release tablets 10mg, 20mg (£7.34 = 10mg twice daily)

Indications

Notes

  1. Nifedipine may be used in conjunction with methyldopa. Side effects include headaches, facial flushing and oedema. If it is used in conjunction with magnesium sulfate it may cause profound hypotension. Nifedipine should not be given sublingually.
Nifedipine (short-acting)
  • Capsules 5mg, 10mg (£19.14 = 5mg three times daily)

Indications

  • Raynaud's phenomenon

Notes

  1. The short-acting nifedipine capsules are not to be prescribed for hypertension or angina.
  2. General measures, e.g. withdrawal of beta-blockers, stopping smoking, use of hand warmers, should be encouraged before introduction of drug therapy for Raynaud's phenomenon.
Nimodipine
  • Tablets 30mg
  • Intravenous infusion 200 micrograms/ml

Indications

  • Prevention and treatment of ischaemic neurological deficits following aneurysmal subarachnoid haemorrhage

 

Home > Formulary > Chapters > 2. Cardiovascular > 2.6 Nitrates, calcium-channel blockers, and other antianginal drugs > 2.6.2 Calcium-channel blockers

 

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