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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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Related Disease Conditions
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.
The First Signs of 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.
Congestive Heart Failure (CHF)
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.
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Low Potassium (Hypokalemia)
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What Causes Swollen Feet and Swollen Ankles?
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Heart Attack (Myocardial Infarction)
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Mitral Valve Prolapse
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Palpitations are uncomfortable sensations of the heart beating hard, rapidly, or irregularly. Some types of palpitations are benign, while others are more serious. Palpitations are diagnosed by taking the patient history and by performing an EKG or heart monitoring along with blood tests. An electrophysiology study may also be performed. Treatment of palpitations may include lifestyle changes, medication, ablation, or implantation of a pacemaker. The prognosis if palpitations depends on the underlying cause.
Arrhythmias (Heart Rhythm Disorders)
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.
Atrial Fibrillation (AFib)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm, which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
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Atrial Fibrillation (AFib) Treatment Drugs
Atrial fibrillation (AFib) is a heart rhythm disorder that causes irregular and often rapid heartbeat. The medications to treat AFib include beta-blockers, blood thinners, and heart rhythm drugs. Atrial fibrillation drugs can cause serious side effects like seizures, vision changes, shortness of breath, fainting, other abnormal heart rhythms, excessive bleeding while coughing or vomiting, blood in the stool, and bleeding into the brain.
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Cluster headaches are a type of headache that recurs over a period. Episodes can last one to three times a day during this time, which may last from 2 weeks to 3 months. The three main types of treatments for cluster headaches are, 1) Abortive medications that work to stop the process in the brain that causes migraines and stops the symptoms too. 2) Preventive prescription medications, or 3) surgery which involves blocking the trigeminal nerve.
Migraine and Stroke
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Paroxysmal Supraventricular Tachycardia (PSVT)
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Pulmonary hypertension is elevated pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur. As pulmonary hypertension worsens, some people with the condition have difficulty performing any activities that require physical exertion. While there is no cure for pulmonary hypertension, it can be managed and treated with medications and supplemental oxygen to increase blood oxygen levels.
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Hypertensive Kidney Disease
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
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.
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.
Dilated Cardiomyopathy is a condition where the heart's ability to pump blood is decreased because the heart's main pumping chamber is enlarged and weakened. Symptoms of dilated cardiomyopathy include chest pain, heart failure, swelling of the lower extremities, fatigue, weight gain, fainting, palpitations, dizziness and blood clots.
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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