Angiotensin-Related Drugs

 Calcium Channel Blockers (CCBs)


Drug Class

Used for high blood pressure and for urinary protein reduction. 


Mechanism of Action

CCBs relax heart and blood vessel smooth muscle by blocking the influx of calcium into calcium channels.  CCBs also improve oxygen delivery to the heart muscle.  In addition to high blood pressure, they are also used to treat angina (chest pain) and/or some arrhythmias (abnormal heart rhythms). 


Contraindications to Therapy:

  • Allergy to CCBs

  • History of heart block

Side Effects

  • Headache
  • Leg swelling
  • Dizziness
  • Low blood pressure
  • Nausea

 

Information about the specific CCBs

Drug Dosage Regimen Drug Interactions

Amlodipine
(Norvasc®)

Oral: 2.5-5 mg once daily
Maximum dose: 10 mg once daily

Benazepril - increased risk of low blood pressure.
Increased cyclosporine levels
Antifungal agents – Increased CCB blood levels
Beta blockers - increased cardiac depression
Rifamprin-decreased blood levels of CCBs
Sildenafil – Decreased blood pressure

Bepridil
(Vascor®)

Oral: 200 mg/day,
Maximum daily dose: 400 mg

Increased cyclosporine blood levels
Increased digoxin blood levels
Amprenavir, ritonavir or sparfloxacin-increased risk of bepridil toxicity, especially cardiotoxicity

Diltiazem
(Cardizem®, Dilacor™, Tiamate®, Tiazac®)

30 mg 4 times daily; dosage increased gradually at 1-2 day intervals.

Moricizine-May decrease diltiazem blood concentrations
Increased cyclosporine levels
Beta-Blockers-may increase cardiac depression

Felodipine
(Plendil®)

2.5-10 mg once daily; usual initial dose is 5 mg;
Increased by 5 mg at 2-week intervals

Anitfungals - may increase blood levels of CCBs
Cyclosporine-increased felodipine blood concentrations

Isradipine
(DynaCirc®)

Initial Dose: 2.5 mg twice daily; increase dose at 2 to 4-week intervals; usual dose range: 5-20 mg/day

Beta-blockers-increased cardiac effects with isradipine
Antifungals-may increase blood levels of isradipine

Nicardipine
(Cardene®)

Oral: initial-20 mg 3 times a day
Usual-20-40 mg 3 times a day

Increased cyclosporine levels in the blood
Antifungals - may increase CCB blood levels
Rifampin- Decreased blood levels of CCBs

Nifedipine
(Adalat®; Procardia®)

Initial: 30 mg once daily as sustained release
Maximum dose: 120-180 mg/day

Beta-blockers - increased cardiac interactions with nifedipine
Antifungals-may increase blood levels of CCBs
Rifampin – decreased blood levels of CCBs

Nisoldipine
(Sular®)

Oral: Initial-20 mg once daily; increased by 10 mg/week to adequately control blood pressure.

Beta-blockers - increased cardiac effects with nisoldipine
Antifungals-may increase blood levels of CCBs
Rifampin – decreased blood levels of CCBs

Verapamil
(Calan®; Isoptin®; Verelan®)

Oral: Initial-120 to 480 mg/day

Beta-blockers - increased cardiac effects with verapamil
Antifungals - may increase blood levels of CCBs
Iincreased cyclosporine blood levels