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.
