Calcium channel blockers side effects

ACE inhibitors can be administered with diuretics (qv), cardiac glycosides, -adrenoceptor blockers, and calcium channel blockers. Clinical trials indicate they are generally free from serious side effects. The effectiveness of enalapril, another ACE inhibitor, in preventing patient mortaUty in severe (Class IV) heart failure was investigated. In combination with conventional dmgs such as vasodilators and diuretics, a 40% reduction in mortaUty was observed after six months of treatment using 2.5—40 mg/d of enalapril (141). However, patients complain of cough, and occasionally rash and taste disturbances can occur. 

The calcium channel blockers have been associated with both prolonged pregnancy and decreased neonatal morbidity.36,42 when compared with P-mimetics (e.g., terbutaline) and magnesium, they show better neonatal outcome and a lower incidence of serious maternal side effects.42 Potential minor maternal adverse effects include headache, flushing, dizziness, and transient hypotension.41... 

Many different drug classes have shown to cause hypotension and orthostatic reactions and drugs for cardiovascular conditions, psychoactive medicines and polypharmacy, can all have this side effect (Box 5.15). Among the most frequently used drugs in the elderly are diuretics, ACE-inhibitors, angiotensin II antagonists, calcium channel blockers and antidepressants. 

Co-codamol is a combination of paracetamol (nonnapioid analgesic) and codeine (opioid analgesic). One of the side-effects of opioids is constipation. Naprosyn is a proprietary (trade name) preparation of the non-steroidal antiinflammatory drug naproxen Adalat is a proprietary preparation of the calcium-channel blocker nifedipine Amoxil is a proprietary preparation of the beta-lactam amoxicillin and Dulco-lax is the brand name of the stimulant laxative bisacodyl. 

Calcium-channel blockers such as amlodipine can be used in patients receiving angiotensin-receptor blockers such as valsartan for the treatment of hypertension and angina. Side-effects common to both drugs include dizziness and hypotension. 

There are some prophylactic treatments which are very individualized. Propanolol (p-blocker) has been used at 80-160 mg/day for up to 12 months. Methylsergide and dihydroergotamine(DHE), relatives of ergotamine, are used but have some serious side effects. Antihistamines such as cyproheptadine (Periactin ) have also been found to have tryptaminergic and anticholinergic activity in the CNS and can be used prophylactically. Calcium channel blockers have also been mentioned in an experimental vein. 

Other concerns related to side effects are fairly minor. Hypotension may occur with some agents, especially with bretylium (class III) and calcium channel blockers (class IV). Therapists should be aware that patients may become dizzy, especially after sudden changes in posture. 

Verapamil (Calan and others) is a calcium channel blocker used for the treatment of cardiac disorders that has also been used off-label as a mood leveler. It can produce a variety of cardiovascular side effects. 

CALCIUM CHANNEL BLOCKERS SIROUMUS Plasma concentrations of sirolimus are t when given with diltiazem. Plasma levels of both drugs are t when verapamil and sirolimus are coadministered Diltiazem and verapamil inhibit intestinal CYP3A4, which is the main site of sirolimus metabolism Watch for side-effects of sirolimus when it is co-administered with diltiazem or verapamil monitor renal and hepatic function. Monitor PR and BP closely when sirolimus is given with verapamil... 

CALCIUM CHANNEL BLOCKERS TACROLIMUS Plasma concentrations of tacrolimus are t when given with diltiazem, felodipine or nifedipine however, they appear to protect renal function Uncertain, but presumed to be due to inhibition of CYP3A4-mediated tacrolimus metabolism Watch for side-effects of tacrolimus monitor ECG, blood count and renal and hepatic function... 

CALCIUM CHANNEL BLOCKERS LITHIUM Small number of cases of neurotoxicity when co-administered with diltiazem or verapamil Uncertain, but thought to be due to an additive effect on neurotransmission Monitor closely for side-effects... 

CALCIUM CHANNEL BLOCKERS MAOIs t antihypertensive effect of calcium channel blockers when co-administered with MAOIs Additive hypotensive effects postural 1 BP is a side-effect of MAOIs Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (light-headedness, dizziness on standing, etc.)... 

CALCIUM CHANNEL BLOCKERS CLOZAPINE Plasma concentrations of clozapine may be t by diltiazem and verapamil Diltiazem and verapamil inhibit CYP1 A2-mediated metabolism of clozapine Watch for side-effects of clozapine... 

CALCIUM CHANNEL BLOCKERS DUTASTERIDE Plasma concentrations of dutasteride may t when co-administered with diltiazem or verapamil Uncertain, but postulated that it may be due to inhibition of CYP3A4-mediated metabolism of dutasteride Watch for side-effects of dutasteride... 

CALCIUM CHANNEL BLOCKERS STATINS t plasma levels of atorvastatin, lovastatin and simvastatin case reports of myopathy when atorvastatin and simvastatin are co-administered with diltiazem or verapamil Uncertain, but postulated to be due to inhibition of CYP3A4-mediated metabolism of statins in the intestinal wall. Also, diltiazem and verapamil inhibit intestinal P-gp, which may t the bioavailability of statins Watch for side-effects of statins. It has been suggested that the dose of simvastatin should not exceed 20 mg when given with verapamil, and 40 mg when given with diltiazem... 

Single oral or sublingual dose of a calcium channel blocker (e.g., nifedipine) for urgent treatment of hypertension due to drug interaction or dietary tyramine Many side effects cannot be improved with an augmenting agent... 

Calcium antagonists L-type calcium channel blocker, decreases Angina pectoris. Side effects include... 

H. E Dustan, Calcium channel blockers potential medical benefits and side effects, Ht/pertension, 13 (Suppi. I) I137-I140 (1989). 

What are the common side effects of calcium channel blockers ... 

Most side effects of the calcium channel blockers are related to their mechanism of action. Verapamil and diltiazem can both cause sinus bradycardia and may worsen CHF. Constipation has been associated with verapamil use. The dihydropyridines often cause symptoms associated with vasodilatation, such as facial flushing, peripheral edema, hypotension, and headache. Because dihydropyridines are potent vasodilators, they can cause reflex tachycardia, which may precipitate palpitations, worsening angina, or Ml. Lastly, all calcium channel blockers can cause Gl complaints and fatigue. 

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