Calcium Channel Blockers

Clevidipine (Cleviprex)

Initiate the intravenous infusion of Cleviprex at 1-2 mg/hour.

Diltiazem (Cardizem)

Starting with 30 mg four times daily, before meals and at bedtime, dosage should be increased gradually (given in divided doses three or four times daily) at 1- to 2-day intervals until optimum response is obtained.

Nicardipine (Cardene)

Cardene I.V. 20 mg in 200 mL (0.1 mg/mL): Initiate therapy at 50 mL/hr (5 mg/hr). If desired blood pressure reduction is not achieved at this dose, the infusion rate may be increased by 25 mL/hr (2.5 mg/hr) every 5 minutes (for rapid titration) to 15 minutes (for gradual titration) up to a maximum of 150 mL/hr (15 mg/hr), until desired blood pressure reduction is achieved.

Nifedipine {Procardia)

Therapy should be initiated with the 10 mg capsule. The starting dose is one 10 mg capsule, swallowed whole, 3 times/day. The usual effective dose range is 10–20 mg three times daily.

Verapamil

Dose should be individualized by titration. The usual initial monotherapy dose in clinical trials was 80 mg three times a day (240 mg/ day).

Calcium Channel Blockers May Reduce Peripheral Arterial Disease Risk in Hypertensive Patients

PAD events occurred in 547 (2%) individuals out of 27,737 who were receiving CCBs. In the control group, 1264 (3%) participants out of 43,894 experienced PAD events. Based on the random effect model, participants in the CCB group experienced a risk reduction of 30% (95% CI, 14%-42%; P <.001) compared with the control group. "Our findings suggest that calcium channel blockers can be effective in preventing PAD in hypertensive patients," the researchers concluded.

Calcium channel blockers and cancer: a risk analysis using the UK Clinical Practice Research Datalink (CPRD)

This large population-based study provides strong evidence that CCB use is not associated with an increased risk of cancer. The analyses yielded robust results across all types of cancer and different durations of exposure to CCBs.

Calcium channel blockers caught in the act at atomic level

Atomic level analysis has revealed how two classes of calcium channel blockers, widely prescribed for heart disease patients, produce separate therapeutic effects by acting at different sites on the calcium channel molecule. The study looked at the anti-arrhythmia drug verapamil, and the hypertension and angina drug amlodipine.

Calcium channel blockers for stable SVT: A first line agent over adenosine?

CCBs by IV bolus or slow infusion are equally efficacious to adenosine in hemodynamically stable patients with SVT.

Deja Vu All Over Again: Study Links Calcium-Channel Blockers To Breast Cancer

A new observational study raises the possibility that calcium-channel blockers (CCBs) may be associated with a higher risk for breast cancer. Although previous studies examining this relationship have failed to turn up convincing evidence of a link, the authors of a paper published in JAMA Internal Medicine state that their study is the first to look at long-term use of CCBs in a contemporary population.

Let’s recap on calcium channel blockers for hypertension

Some calcium channel blockers are affected by grapefruit juice — it is advised that patients on felodipine or lercanidipine do not consume grapefruit or grapefruit juice. Although with amlodipine any increased bioavailability caused by grapefruit appears to be minimal, there have been isolated reports of problems and some manufacturers still warn against grapefruit or grapefruit juice consumption.

Magnificent Magnesium

Magnesium operates as a natural calcium channel blocker and is responsible for relaxation—counter to calcium’s contraction. Thus magnesium is pivotally important to the healthy functioning of our parasympathetic nervous system. It may be hard to believe, but our bodies were actually designed to operate for the most part in a calm, relaxed parasympathetic state, rather than in the heart-pounding, stress- and adrenaline-driven mode of sympathetic nervous system dominance that is nearly constant for many of us today, and which uses up great quantities of magnesium.

Nasal spray shows potential for quickly treating arrhythmia

A calcium-channel blocker delivered as a nasal spray rapidly restored individuals with paroxysmal supraventricular tachycardia (SVT) to normal sinus rhythm in a phase 2 study, raising the possibility that the drug could be self-administered in a real-world setting and prevent trips to the emergency department.

No, Pharmascolds Are Not Worse Than The Pervasive Conflicts Of Interest They Criticize

CCBs, you will recall, were among the most successful drugs in the golden age of pharma in the 1980s and 1990s. An enormous controversy– one that served as a prototype for the more recent Vioxx and Avandia episodes– exploded when several prominent “pharmascolds” questioned the safety of CCBs and claimed that these safety concerns had been hidden by investigators with COIs with the CCB manufacturers.

The Magic of Magnesium: A Mighty Mineral Essential to Health

Did you know that this mighty mineral may be even more essential for health? Here’s what I recommend: Keep your calcium intake between 800-1,400 mg per day, adding enough magnesium to balance it. For example, if you take 1,000 mg of calcium per day, you need at least 500-800 mg of magnesium.

Urgent Warning For Those Taking Calcium Channel Blockers

Usually when you leave your doctor’s surgery with a new prescription, it’s very seldom that you’ll walk out knowing exactly what the side effects of the drug you are about to take are. Doctors just don’t explain the dangers of pharmaceutical drugs in detail with their patients. Instead, they rely on patients to read the information leaflet, or at the very least hope that your pharmacist will warn you about any potentially dangerous side effects.

Calcium Channel Blocker Toxicity

Calcium channel blockers are not all born the same. Some produce severe cardiotoxic effects which in the past has caused significant mortality and others cause severe peripheral vasodilatation. Find out how identify which is which, the nuances of management and what antidote has changed our management.

AMBOSS

Calcium channel blockers (CCBs) are drugs that bind to and block the L-type calcium channel. The L-type channels are the predominant calcium channels in the myocardium and the vascular smooth muscles. By blocking these channels, CCBs cause peripheral arterial vasodilation and myocardial depression, which leads to a drop in blood pressure and negative chronotropic, inotropic, and dromotropic effects on the myocardium.

FP Notebook

Extensive resource...

Heart Matters

There are two distinct chemical classes of CCBs: the dihydropyridines (such as nifedipine and amlodipine) and the nondihydropyridines (diltiazem and verapamil). The two classes both help to relax and widen arteries but non-dihydropyridines have an additional effect on the heart’s conduction system and can help to control certain fast heart rhythms (such as atrial fibrillation).

Patient

Calcium-channel blockers (CCBs) were developed in the 1970s and are now widely used. CCBs all inhibit inward movement of calcium ions through the slow channels of active membranes

Amlodipine (Norvasc)

The usual initial antihypertensive oral dose of NORVASC is 5 mg once daily with a maximum dose of 10 mg once daily.