Major side effects and safety of calcium channel blockers
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
Calcium channel blockers are widely used in the treatment of hypertension, angina pectoris, cardiac arrhythmias, and other disorders, and the longer-acting preparations have been prescribed with increasing frequency. A review of the major side effects associated with these agents and the previous 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".)
TYPES OF CALCIUM CHANNEL BLOCKERS
While all 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 vasodilator and generally have neutral or increased effects on vascular permeability; and the non-dihydropyridines, such as verapamil and diltiazem, which reduce vascular permeability and affect cardiac contractility and conduction .
Dihydropyridines — The dihydropyridines are potent vasodilators that have little or no negative effect upon cardiac contractility or conduction. They can be further divided into three categories based upon half-life and effect on contractility:
●Short-acting (capsule containing liquid) nifedipine
●Longer-acting formulations with little cardiac depressant activity – felodipine, isradipine, nicardipine, nifedipine GITS and CC, and nisoldipine
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- TYPES OF CALCIUM CHANNEL BLOCKERS
- KNOWN SIDE EFFECTS
- Effects on cardiac function
- - Use in heart failure
- POSSIBLE SERIOUS ADVERSE EFFECTS
- Increased mortality after acute MI
- Proposed but unproven serious adverse effects
- - Possible increased risk for acute MI with short-acting agents
- - Possible increased cancer risk
- - Possible increased gastrointestinal bleeding risk in older adults
- INFORMATION FOR PATIENTS