There are important differences between dihydropyridines and other classes of calcium channel blockers.
Avoid the combination of verapamil with a beta-blocker (including eye drops). The combination of diltiazem with beta-blockers should be used with caution.
Avoid verapamil and diltiazem in heart failure.
- Tablets 5mg, 10mg (£0.73 = 5mg daily)
- Initially 5mg once daily; maximum 10mg once daily
- Tildiem® tablets 60mg (£41.59 = 60mg three times daily)
- Twice daily, Adizem-SR® capsules 90mg, 120mg, 180mg (£14.72 = 120mg twice daily)
- Once daily, Adizem-XL® capsules 120mg, 180mg, 200mg, 240mg, 300mg (£9.14 = 300mg once daily)
- Please specify the brand when prescribing a modified release diltiazem preparation to ensure that the patient receives the same modified release preparation. Where a patient already receives a modified release diltiazem preparation the existing brand should be prescribed.
- Modified release tablets 2.5mg, 5mg, 10mg (£4.21 = 5mg daily)
- Hypertension, initially 5mg (elderly 2.5mg) daily in the morning; usual maintenance 5–10mg once daily; doses above 20mg daily rarely needed
- Angina, initially 5mg daily in the morning, increased if necessary to 10mg once daily
- Tablets 10mg, 20mg (£4.68 = 10mg daily)
- Initially 10mg once daily; increased, if necessary, after at least 2 weeks to 20mg daily
- Tablets 40mg, 80mg, 120mg, 160mg (£4.80 = 120mg three times a day)
- Half Securon SR® 120mg (£7.71)
- Securon SR® Modified release tablets 240mg (£5.55)
- Supraventricular arrhythmias
- Prophylaxis after myocardial infarction where beta-blockers not appropriate
- Supraventricular arrhythmias, 40–120mg 3 times daily
- Angina, 80–120mg 3 times daily
- Sustained release: 240 mg twice daily (may sometimes be reduced to once daily)
- Hypertension, 240–480mg daily in 2–3 divided doses
- Sustained release: 240mg daily (new patients initially 120mg), increased if necessary to maximum 480mg daily (doses above 240mg daily as 2 divided doses)
- Prophylaxis after myocardial infarction where beta-blockers not appropriate (started at least 1 week after infarction)
- Sustained release: 360mg daily in divided doses, given as 240mg in the morning and 120mg in the evening or 120mg 3 times daily
- Please specify the brand when prescribing modified release verapamil to ensure that the patient receives the same modified release preparation. Where a patient already receives a modified release verapamil preparation the existing brand should be prescribed.
- Nifedipine prolonged release tablets 20mg, 30mg, 60mg (£6.85 = 30mg)
- Capsules 30mg, 60mg (£4.89 = 30mg)
- Adalat LA® and Coracten XL® have been restricted in the formulary because of the availability of generic amlodipine which should result in long term cost savings and is not recommended for new patients. Patients stabilised on Adalat LA® and Coracten XL® do not need to be changed to a formulary calcium-channel blocker.
- Nifedipine modified release tablets 10mg, 20mg (£7.34 = 10mg twice daily)
- Nifedipine may be used in conjunction with methyldopa. Side effects include headaches, facial flushing and oedema. If it is used in conjunction with magnesium sulfate it may cause profound hypotension. Nifedipine should not be given sublingually.
- Capsules 5mg, 10mg (£19.14 = 5mg three times daily)
- Raynaud's phenomenon
- Oesophageal spasm (unlicensed indication)
- Raynaud's phenomenon, initially 5mg 3 times daily, adjusted according to response to 20mg 3 times daily
- Short acting nifedipine is not recommended for angina or long-term management of hypertension; their use maybe associated with large variations in blood pressure and reflex tachycardia.
- Tablets 30mg
- Infusion 200 micrograms/ml
- Nimodipine is included for the prevention and treatment of ischaemic neurological deficits following subarachnoid haemorrhage. The full course will be supplied by Secondary Care.
2. Cardiovascular >
2.6 Nitrates, calcium-channel blockers, and other antianginal drugs >
2.6.2 Calcium-channel blockers
- First line
- Second line