Calcium Channel Blocker
Generic and Trade Names:
| Amlodipine Norvasc | ||
| Bepridil | Vascor | |
| Diltiazem | Cardizem, Cartia XT, Dilacor, Tiazac | |
| Felodipine | Plendil | |
| Isradipine | Dynacirc | |
| Nicardipine | Cardene | |
| Nifedipine | Adalat, Procardia | |
| Nimodipine Nimotop | ||
| Nisoldipine | Sular | |
| Verapamil | Calan, Covera HS, Isoptin, Verelan |
Description
Calcium channel blockers work by slowing the movement of calcium ions across the cell membrane, thereby reducing the force of mechanical contraction of smooth muscle, and reducing the impulse formation and conduction velocity. Different agents work to different degrees of specificity on cardiac smooth muscle to produce their effects. They are primarily used for angina, hypertension and arrhythmias.(Facts and Comparisons 1999)
Nutritional Considerations
A low sodium, low calorie diet may be prescribed. (Pronsky 1999)
Excess calcium and vitamin D may interfere with the action of Verapamil (Kuhn, Threlkeld 1992).
Grapefruit juice may enhance the effects of some of these drugs, possibly causing an excessive lowering of blood pressure. Avoid within 2 hours of medication. (Holt 1998)(Pronsky 1999).
Verapamil may cause a deficiency in vitamin B6 (Graedon 1995).
Avoid alcohol (Andersson 1984).
Limit caffeine. (Pronsky 1999)
Electrolytes should be maintained
Limit coffee and tea. (Rachima-Maoz, 1998)
The use of magnesium sulfate intravenously with nifedipine can result in severe hypotension. (Martindale 1999)
Herbal Considerations:
Cocoa, cola nut, guarana and mate all interact with verapamil. The drug inhibits the metabolism, and clearance of these herbs,increasing their effects. (Brinker 1998)
Avoid natural licorice products (Pronsky 1999).
The following herbs may have diuretic properties, which may increase the effects of some calcium channel blockers and possibly lead to an excessive lowering of blood pressure (Newall):
Black Radish, Blue Cohosh, Cleavers, Cornsilk, Couchgrass, Elder, Hops, Horsetail, Juniper, Pleurisy Root, Prickly Ash, Pulsatilla, Black Safflower, Sassafras, Saw Palmetto, or Yerba Mate. (Newall 1996)
Garlic may have an additive effect on some calcium channel blockers due to its lipid-lowering effects (PDR for Herbal Medicines 1998).
Guggal may lower the availability of cardizem and reduce its effects. (Dalvi 1994)
Melatonin's effect may be decreased if used together with verapamil. (Wikner 1997)
St. John's Wort may interact with some calcium channel blockers due to the use of similar pathways (eg. cytochrome P450) to metabolize the drugs and herb. (Lancet 2000)
References
Andersson O: The use of diuretics in modern antihypertensive therapy, Acta Pharmacol Toxicol, 1984:54 (suppl. 1): 79-82
Bailey, DG et al., Interaction of citrus juices with Felodipine and Nifedipine. Lancet, 1991, 337:268-270.
Brinker, Francis Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1998.
Dalvi SS, Nayak VK, Pohujani SM, et al. Effect of gugulipid on bioavailability of diltiazem and propranolol. J Assoc Physicians India, 1994;42(6):454-5.
Edgar, B et al: Acute effects of drinking grapefruit juice on the pharmacokinetics and dynamics of Felodipine - and its potential clinical relevance. Eur. J. Clin. Pharm. 1992, 42:313-317.
Elliott HL & Meredith PA: The clinical consequences of the absorption, distribution, metabolism and excretion of amlodipine. Postgrad Med J 1991; 67(Suppl 3):S20-S23.
Endersby CA, Brown EG & Perelman MS: Safety profile of lacidipine: a review of clinical data. J Cardiovasc Pharmacol 1991; 17(suppl 4):S45-S47.
Farese, RV et al., Licorice-induced hypermineralcorticoidism. NEJM. 1991, 325:1,1223-1,227.
Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.
Graedon J, Graedon, T: The People's Guide to Deadly Drug Interactions, 1995, p89
Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 274-75
Kuhn M, Schriger DL. Low-dose calcium pretreatment to prevent verapamil-induced hypotension. Am Heart J 1992;124:231-32.
Levenson JL & Kennedy K: Dysosmia, dysguesia, and nifedipine. Ann Intern Med 1985; 102:135-136.
Martindale W. Martindale the Extra Pharmacopoeia. Pharmaceutical Press, 1999
Medical Letter Handbook of Adverse Drug Reactions. 1995.
Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.
Physicians Desk Reference for Herbal Medicines, Medical Economics Company, 1998.
Product Information: Norvasc(R), amlodipine besylate. Pfizer Labs, New York, NY, 1996.
Rachima-Maoz C, Peleg E, Rosenthal T. The effect of caffeine on ambulatory blood pressure in hypertensive patients. Am J Hypertens 1998;11:1426-32.
Reid JL, Meredith PA, Donnelly R et al: Pharmacokinetics of calcium antagonists. J Cardiovasc Pharmacol 1988; 12(Suppl 7):S22-S26.
Saltiel E, Ellrodt, AG, Monk JP et al: Felodipine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension. Drugs 1988; 36:387-428.
Threlkeld DS, ed. Diuretics and Cardiovasculars, Calcium Channel Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Nov 1992
Yue QY, Bergquist C, GerdÈn B. Safety of St John's wort (Hypericum perforatum). Lancet 2000;355(9203).
www.fda.gov/cder/drug/advisory/stjwort
Wikner J, Wetterberg L, Rojdmark S. "Does hypercalcemia or calcium antagonism affect human melatonin secretion or renal excretion?" Eur J Clin Invest, May 1997; 27(5):374-79.
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