Oral Calcium Channel Blocker Comparison

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Oral Calcium Channel Blocker Comparison Various calcium channel blockers (CCBs) have been periodically shorted. Below is a table of dosing comparisons. General notes: No dose equivalencies among the CCBs have been established; estimate an approximate dose using the dosing ranges. The contraindications and adverse effects of non-dihydropyridine (DHP) CCBs (diltiazem and verapamil) are quite different from DHP CCBs (amlodipine, felodipine, nifedipine). Consider staying with the same type of CCB if possible unless other considerations warrant changing types. Be sure to check for drug interactions if switching agents. Calcium Channel Blocker Comparisons1,2 Doses CCB Contraindications Hypertension Stable angina DHP Adverse Effects: pedal edema, flushing, palpitations, headache Nifedipine MR 30-60 mg up to 90 mg daily 2.5-5 mg to 10 mg Amlodipine 5-10 mg daily daily severe aortic stenosis 2.5-10 mg to May be useful but Felodipine 20 mg daily not indicated Non-DHP Adverse Effects: angina, heart failure; constipation, especially with verapamil 120-240 mg post myocardial infarction with 120-180 mg to 360 Diltiazem MR to 360 mg ejection fraction (EF) <40% mg daily daily 2nd or 3rd degree AV block, or sick sinus syndrome (unless functioning ventricular pacemaker) atrial flutter/atrial fibrillation and accessory bypass tract (e.g. Wolff- 80-240 mg Parkinson-White syndrome, Lown- 180 mg to 480 mg once daily to Ganong-Levine syndrome) Verapamil MR daily in one or two 180-240 mg combination with ivabradine doses BID Verapamil extreme bradycardia severe heart failure and or EF<40% combination with drugs that affect cardiac conduction CCB= calcium channel blocker; DHP= dihydropyridine; MR=modified release such as XL, CD, SR, etc. medSask | 30 Aug 2018 References: 1. Regier L, Jensen B. Calcium channel blocker: comparison chart. RxFiles drug comparison charts. Saskatoon, SK: Saskatoon Health Region. [updated 01 May 2018; accessed 29 Aug 2018]. Available from: www.RxFiles.ca 2. RxTx [Internet]. Ottawa (ON): Canadian Pharmacists Association; 2018. CPS online: CPhA Calcium Channel Blockers; [updated May 2018; cited 29 Aug 2018]. Available from: https://www.e-therapeutics.ca/ .

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