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Major side effects and safety of calcium channel blockers

Michael J Bloch, MD, FACP, FASH, FSVM, FNLA
Jan Basile, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Deputy Editor
John P Forman, MD, MSc


Calcium channel blockers are widely used in the treatment of hypertension, angina pectoris, cardiac arrhythmias, and other disorders. The longer-acting preparations have been prescribed with increasing frequency. According to recommendations from the Eighth Joint National Committee (JNC 8) members, calcium channel blockers are a recommended choice for initial management of hypertension, either as monotherapy or as part of antihypertensive combination therapy. There are robust data suggesting that their use reduces the risk of subsequent cardiovascular events [1]. In addition, some meta-analyses have suggested that calcium channel blockers may be more effective than other drugs in reducing stroke risk [2-6]. (See "Choice of drug therapy in primary (essential) hypertension".)

A review of the major side effects associated with these agents and the controversy concerning their effect on coronary events, mortality, gastrointestinal bleeding, and the development of cancer are presented here. The management of calcium channel intoxication is presented separately. (See "Calcium channel blocker poisoning".)


While all approved calcium channel blockers inhibit the L-type calcium channel on cells, they are divided into two major categories based upon their predominant physiologic effects: the dihydropyridines, which are predominantly vasodilators and generally have chronotropic and inotropic effects, and the non-dihydropyridines, which are less potent vasodilators and also slow cardiac contractility and conduction [7].

Dihydropyridines — The dihydropyridines, including nifedipine, isradipine, felodipine, nicardipine, nisoldipine, lacidipine, and amlodipine, are potent vasodilators that have little or no negative effect upon cardiac contractility or conduction. They are typically used to treat hypertension and chronic stable angina. Different agents and preparations have different durations of action. Longer-acting agents are generally safer and are increasingly preferred.

Non-dihydropyridines — The non-dihydropyridines, including verapamil and diltiazem, are used in the management of hypertension, chronic stable angina, cardiac arrhythmias, and for proteinuria reduction. They are somewhat less potent vasodilators compared with dihydropyridines, but they have a greater depressive effect on cardiac conduction and contractility. (See "Calcium channel blockers in the treatment of cardiac arrhythmias" and "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults", section on 'Calcium channel blockers'.)

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Literature review current through: Nov 2017. | This topic last updated: Feb 14, 2017.
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