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AI-Generated response:

What are some side effects of Calcium Channel Blockers?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Calcium channel blockers (CCBs) can cause peripheral edema, headache, dizziness, and constipation, with dihydropyridines primarily causing vasodilatory side effects and non-dihydropyridines affecting cardiac conduction and contractility.[1-3]

  • Peripheral edema is reported in up to 32.4% of patients using dihydropyridine CCBs, such as amlodipine.[1]

  • Headache can occur in up to 23% of patients, particularly with dihydropyridine CCBs.[1]

  • Dizziness is another common side effect, occurring in up to 27% of patients.[1]

  • Constipation is particularly associated with verapamil, affecting 7.3% to 11.7% of users.[2]

  • Non-dihydropyridines like verapamil and diltiazem can depress AV node conduction and increase the risk of heart failure exacerbation, bradycardia, and AV block.[1]

Additional info

It is important to note that the side effects of calcium channel blockers can vary significantly between the dihydropyridine and non-dihydropyridine classes. Dihydropyridines, such as amlodipine and nifedipine, primarily cause peripheral vasodilation leading to side effects like headache, dizziness, and peripheral edema. Non-dihydropyridines, such as verapamil and diltiazem, have more pronounced effects on the heart, potentially leading to bradycardia, AV block, and heart failure exacerbation. This distinction is crucial for clinical decision-making, especially in patients with existing cardiac conditions. Additionally, verapamil's unique side effect of constipation, particularly in the elderly, requires consideration of patient comfort and quality of life when prescribing this medication. Monitoring and managing these side effects are essential for optimizing therapeutic outcomes and minimizing patient discomfort.

References

Reference 1

1.

Elsevier ClinicalKey Drug Class Overview

Content last updated: July 4, 2012.

Adverse Reactions / Side Effects Table Adverse Reactions / Side Effects | Amlodipine Besylate | Clevidipine | Diltiazem Hydrochloride | Felodipine | Isradipine | Nicardipine Hydrochloride | Nifedipine | Nimodipine | Nisoldipine | Verapamil Hydrochloride ---|---|---|---|---|---|---|---|---|---|--- nausea | 2.9% | 4.8 - 21% | <2.2% | Reported | 1.2 - 1.8% | 1.9 - 5% | 2 - 11% | 1.2% | 2% | 0.9 - 2.7% diarrhea | <1% | | <2% | Reported | 1.1% | Reported | <3% | 1 - 10% | <1% | <2.4% flushing | 0.7 - 4.5% | | <1.7% | Reported | 1.9 - 2.6% | 5.6 - 9.7% | <25% | <1% | 4% | 0.6 - 0.8% headache | | 6.3% | <8.9% | 10.6 - 14.7% | 13% | 6.2 - 15% | 10 - 23% | 1.2% | 22% | 1.2 - 12.1% heart failure | | Reported | <2% | Reported | <1% | Reported | 2 - 6.7% | Reported | Reported | 1.8% palpitations | 0.7 - 3.3% | | <2% | 0.4 - 2.5% | 1.2 - 4% | 2.8 - 4.1% | <7% | <1% | 3% | Reported peripheral edema | 13.6 - 32.4% | | <15% | Reported | 7.2 - 15.2% | 4.4 - 8% | 4 - 30% | Reported | 7 - 29% | 3.7%

| 4 - 30% | Reported | 7 - 29% | 3.7% dizziness | | | <10% | 2.7 - 3.7% | 4.7 - 7.3% | 1.6 - 6.9% | 4 - 27% | <1% | 3 - 7% | 1.2 - 4.7% atrial fibrillation | <1% | 21% | <2% | | <1% | <1% | <1% | | <1% | constipation | <1% | | <3.6% | Reported | 1.7% | 0.6% | <3.3% | | | 7.3 - 11.7% angina | | | <2% | 0.5 - 1.5% | 2.4% | 6 - 7% | <1% | | | muscle cramps | <2% | | <2% | | | | <8% | | <1% | <2% myocardial infarction | | <1% | | | <1% | Reported | 4 - 6.7% | | <1% | tremor | <1% | | <2% | | | 0.6% | <8% | | | <2% edema | 1.8 - 14.6% | | | | | 0.6 - 1% | | | | 1.7 - 3% infection | | | <6% | 1 - 10% | | <1% | | | | rhinitis | | | <9.6% | | | <1% | <3% | | | pyrosis (heartburn) | | | | Reported | | | 11% | | | renal failure (unspecified) | | 9% | <2% | | | | | | | weakness | | | | | 1.2% | | 10 - 12% | | |

Headache and postural or orthostatic hypotension, along with dizziness, are relatively common adverse effects associated with DHP calcium channel blocker therapy[66459].

* In general, calcium channel blockers (CCBs) are used most often for the management of hypertension and angina. * There are 2 classes of CCBs: the dihydropyridines (DHPs), which have greater selectivity for vascular smooth muscle cells than for cardiac myocytes, and the non-DHPs, which have greater selectivity for cardiac myocytes and are used for cardiac arrhythmias. * The DHPs cause peripheral edema, headaches, and postural hypotension most commonly, all of which are due to the peripheral vasodilatory effects of the drugs in this class of CCBs. * The non-DHPs are negative inotropes and chronotropes; they can cause bradycardia and depress AV node conduction, increasing the risk of heart failure exacerbation, bradycardia, and AV block. * Clevidipine is a DHP calcium channel blocker administered via continuous IV infusion and used for rapid blood pressure reductions. * All CCBs are substrates of CYP3A4, but both diltiazem and verapamil are also inhibitors of 3A4 and have an increased risk of drug interactions. Verapamil also inhibits CYP2C9, CYP2C19, and CYP1A2.

Reference 2

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: May 4, 2024.

Adverse Reactions Constipation (7.3—11.7%) is the most common adverse gastrointestinal (GI) effect of verapamil therapy. This reaction appears to occur more frequently with verapamil than with other calcium-channel blockers. Less frequent GI effects include nausea (0.9—2.7%), dyspepsia (<= 2.7%), diarrhea (<= 2.4%), xerostomia (<= 2%), and abdominal pain (<= 2%). Gingival hyperplasia has been reported with verapamil (<= 2%, chronic use). Good dental hygiene may decrease its incidence and severity.

Reference 3

3.

Morrow, David A., de Lemos, James (2022). In Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (pp. 739). DOI: 10.1016/B978-0-323-72219-3.00040-2

These occur in 15% to 20% of patients and require discontinuation of medication in approximately 5%. Most adverse effects are related to systemic vasodilation and include headache, dizziness, palpitations, flushing, hypotension, and leg edema (unrelated to heart failure). In rare cases in patients with extremely severe fixed coronary obstructions, nifedipine aggravates angina, presumably by lowering arterial pressure excessively with subsequent reflex tachycardia. For this reason, combined treatment of angina with nifedipineand a beta-blocking agent is particularly effective and superior to nifedipine alone. Nifedipine has been reported to worsen heart failure in patients with preexisting chronic heart failure and is contraindicated in patients who are hypotensive or have severe aortic valve stenosis.

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