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- What are calcium channel blockers and how do they work?
- What calcium channel blockers are available?
- Are there any differences among calcium channel blockers?
- For what conditions are calcium channel blockers used?
- What are the side effects of calcium channel blockers?
- Which drugs interact with calcium channel blockers?
What are calcium channel blockers and how do they work?
In order to pump blood, the heart needs oxygen. The harder the heart works, the more oxygen it requires. Angina (heart pain) occurs when the supply of oxygen to the heart is inadequate for the amount of work that the heart must do. By dilating the arteries, calcium channel blockers or CCBs reduce the pressure in the arteries. This makes it easier for the heart to pump blood, and, as a result, the heart needs less oxygen. By reducing the heart's need for oxygen, calcium channel blockers relieve or prevent angina. Calcium channel blockers also are used for treating high blood pressure because of their blood pressure-lowering effects. Calcium channel blockers decrease the excitability of heart muscle and are therefore used for treating certain types of abnormally rapid heart rhythms.
What calcium channel blockers are available?
Calcium channel blockers that have been approved for use in the US include:
- amlodipine (Norvasc)
- amlodipine and atorvastatin (Caduet)
- amlodipine and benazepril (Lotrel)
- amlodipine and valsartan (Exforge)
- amlodipine and telmisartan (Twynsta)
- amlodipine and olmesartan (Azor)
- amlodipine and olmesartan and hydroclorothiazide (Tribenzor)
- amlodipine and aliskiren and hydroclorothiazide
- amlodipine and perindopril (Prestalia)
- clevidipine (Cleviprex)
- diltiazem (Cardizem)
- felodipine (Cardene, Cardene SR)
- nisoldipine (Sular)
- verapamil (Calan)
Discontinued brands in the US:
Are there any differences among calcium channel blockers?
Calcium channel blockers differ in their duration of action, the process by which they are eliminated from the body, and, most importantly, in their ability to affect heart rate and contraction. Some calcium channel blockers (for example, amlodipine [Norvasc]) have very little effect on heart rate and contraction so they are safer to use in individuals who have heart failure or bradycardia (a slow heart rate). Verapamil (Calan, Isoptin) and diltiazem (Cardizem) have the greatest effects on the heart and reduce the strength and rate of contraction. Therefore, they are used in reducing heart rate when the heart is beating too fast.
For what conditions are calcium channel blockers used?
Calcium channel blockers are used for treating:
- High blood pressure
- Abnormal heart rhythms (for example, atrial fibrillation, and paroxysmal supraventricular tachycardia)
Calcium channel blockers are as effective as ACE inhibitors in reducing blood pressure, but they may not be as effective as ACE inhibitors in preventing the kidney failure caused by high blood pressure or diabetes.
Calcium channel blockers may be more effective for people of African descent than other blood pressure medications.
They also are used for treating:
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What are the side effects of calcium channel blockers?
The most common side effects of calcium channel blockers are:
- Edema (swelling of the legs and feet with fluid)
- Pulmonary edema
- Low blood pressure
- Muscle weakness
- Muscle cramps
- Abnormal heartbeats
Liver dysfunction and over growth of the gums also occurs.
When diltiazem (Cardizem) or verapamil (Calan, Isoptin) are given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood.
Like other blood pressure medications, calcium channel blockers are associated with sexual dysfunction.
Which drugs interact with calcium channel blockers?
Calcium channel blockers interact with verapamil (Calan, Isoptin) or diltiazem (Cardizem). The interaction occurs because verapamil and diltiazem decrease the elimination of a number of drugs by the liver. Through this mechanism, verapamil and diltiazem may reduce the elimination and increase the blood levels of carbamazepine (Tegretol), simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor). This can lead to toxicity from these drugs.
Grapefruit juice (approximately 200 ml) may elevate blood concentrations of felodipine (Plendil), verapamil (Calan, Isoptin), nisoldipine (Sular), nifedipine (Adalat, Procardia), nicardipine (Cardene), and possibly amlodipine (Norvasc). Grapefruit juice should not be consumed within 2 hours before or 4 hours after administration of affected calcium channel blockers.
Calcium channel blockers (CCBs) are a class of drugs that dilate the arteries, and are used for treating high blood pressure, abnormally rapid heart rhythms, pulmonary hypertension, Raynaud's syndrome, cardiomyopathy, and subarachnoid hemorrhage. Calcium channel blockers also are prescribed for the prevention of migraine headaches and angina, and may also be prescribed after a heart attack.
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Kidney (Renal) Failure
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, or medication. Some of the renal causes of kidney failure include sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones.Treatment options included diet, medications, or dialysis.
Congestive Heart Failure (CHF) Symptoms, Treatment, and Life Expectancy
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Fainting (Syncope) Symptoms, Causes, Treatment, and Prevention
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Kidney Stones (nephrolithiasis)
Kidney stones are solid masses of crystalline material that form in the kidneys. Symptoms of kidney stones can include pain, nausea, vomiting, and even fever and chills. Kidney stones are diagnosed via CT scans and specialized X-rays. Treatment of kidney stones involves drinking lots of fluids and taking over-the-counter pain medications to medical intervention including prescription medications, lithotripsy, and sometimes even surgery.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
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Swollen Ankles and Swollen Feet
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Low Potassium (Hypokalemia)
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Atrial Fibrillation (AFib, AF)
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Heart Attack (Myocardial Infarction)
A heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical instability of the heart.
Mitral Valve Prolapse
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Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus bradycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-Parkinson-White syndrome, brachycardia, or heart blocks. Treatment is dependent upon the type of heart rhythm disorder.
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Paroxysmal Supraventricular Tachycardia (PSVT)
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Migraine and Stroke
Migraine headache is a type of headache in which the exact cause is not known; however, they may be inherited, and certain foods and environmental factors can trigger and may contribute them. A stroke (brain attack) happens when a blood vessel in the brain leaks, bursts, or becomes blocked, which can be caused by many other health problems. Both migraines and strokes can can cause severe head pain (migraine pain usually is only on one side of the head). Migraine aura symptoms may mimic or feel like a stroke or mini-stroke (transient ischemic attack, TIA) because they have similar symptoms and signs like severe headache, numbness in the legs, feet, arms, hands, or face, nausea, vomiting, and dizziness. Other migraine aura symptoms include vision problems like flashing lights or blind spots in one eye. The main difference between migraine headache and stroke symptoms and signs is that a migraine headaches usually come on gradually while a stroke symptoms come on suddenly and unexpectedly.
Hypertensive Kidney Disease
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Heart Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
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Hypertrophic cardiomyopathy (HCM) affects many people today. Many people with HCM have no symptoms or only minor symptoms, and live a normal life. Other people develop symptoms, which progress and worsen as heart function worsens.
Diabetes and Kidney Disease
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Restrictive cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood. The pumping or systolic function of the ventricle may be normal but the diastolic function (the ability of the heart to fill with blood) is abnormal. Therefore, it is harder for the ventricles to fill with blood, and with time, the heart loses the ability to pump blood properly, leading to heart failure.
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- amlodipine (Norvasc)
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- amlodipine/atorvastatin - oral, Caduet
- nicardipine, Cardene, Cardene SR
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- nimodipine - oral, Nymalize
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- bepridil (Vascor)
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