6); the longer-acting formulation is also used for Calcium-channel blockers

2.6.2 2.6); the longer-acting formulation is also used for Calcium-channel blockers

hypertension. It may be used in patients for whom beta-blockers are contra-indicated or ineffective. It has

Calcium-channel blockers (less correctly called ‘cal-

a less negative inotropic effect than verapamil and

cium-antagonists’) interfere with the inward displace- significant myocardial depression occurs rarely. Never- ment of calcium ions through the slow channels of

theless because of the risk of bradycardia it should be

ardiov

active cell membranes. They influence the myocardial used with caution in association with beta-blockers.

cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the

Unstable angina Calcium-channel blockers do not ascular

formation and propagation of electrical impulses within reduce the risk of myocardial infarction in unstable the heart may be depressed, and coronary or systemic

angina. The use of diltiazem or verapamil should be vascular tone may be diminished.

reserved for patients resistant to treatment with beta-

syst

blockers.

Calcium-channel blockers differ in their predilection for

em

the various possible sites of action and, therefore, their therapeutic effects are disparate, with much greater

Withdrawal There is some evidence that sudden variation than those of beta-blockers. There are impor-

withdrawal of calcium-channel blockers may be asso- tant differences between verapamil, diltiazem, and the

ciated with an exacerbation of angina. dihydropyridine calcium-channel blockers (amlodipine, felodipine, isradipine, lacidipine, lercanidipine, nicar- dipine, nifedipine, and nimodipine). Verapamil and dilti- azem should usually be avoided in heart failure because

AMLODIPINE

they may further depress cardiac function and cause Indications hypertension, prophylaxis of angina clinically significant deterioration.

Cautions hepatic impairment (Appendix 2); pregnancy Verapamil is used for the treatment of angina (section

(Appendix 4); interactions: Appendix 1 (calcium- 2.6), hypertension (section 2.5), and arrhythmias (sec-

channel blockers)

tion 2.3.2). It is a highly negatively inotropic calcium Contra-indications cardiogenic shock, unstable channel-blocker and it reduces cardiac output, slows the

angina, significant aortic stenosis; acute porphyria heart rate, and may impair atrioventricular conduction.

(section 9.8.2); breast-feeding (Appendix 5) It may precipitate heart failure, exacerbate conduction

disorders, and cause hypotension at high doses and abdominal pain, nausea; palpitation, should not be used with beta-blockers (see p. 118).

Side-effects

flushing, oedema; headache, dizziness, sleep distur- Constipation is the most common side-effect.

bances, fatigue; less commonly gastro-intestinal dis- turbances, dry mouth, taste disturbances, hypo-

Nifedipine relaxes vascular smooth muscle and dilates tension, syncope, chest pain, dyspnoea, rhinitis, mood coronary and peripheral arteries. It has more influence

changes, asthenia, tremor, paraesthesia, urinary dis- on vessels and less on the myocardium than does verap-

turbances, impotence, gynaecomastia, weight amil, and unlike verapamil has no anti-arrhythmic activ-

changes, myalgia, muscle cramps, back pain, arthr- ity. It rarely precipitates heart failure because any nega-

algia, visual disturbances, tinnitus, pruritus, rashes tive inotropic effect is offset by a reduction in left

(including isolated reports of erythema multiforme), ventricular work. Short-acting formulations of nifedipine

sweating, alopecia, purpura, and skin discolouration; are not recommended for angina or long-term manage-

very rarely gastritis, pancreatitis, hepatitis, jaundice, ment of hypertension; their use may be associated with

cholestasis, gingival hyperplasia, myocardial infarc- large variations in blood pressure and reflex tachy-

tion, arrhythmias, tachycardia, vasculitis, coughing, cardia. Nicardipine has similar effects to those of nife-

peripheral neuropathy, hyperglycaemia, thrombocy- dipine and may produce less reduction of myocardial

topenia, angioedema, and urticaria

2.6.2 Calcium-channel blockers BNF 57 Dose

Tildiem c (Sanofi-Synthelabo) A . Hypertension or angina, initially 5 mg once daily;

Tablets , m/r (but see note above), off-white, diltiazem max. 10 mg once daily

hydrochloride 60 mg, net price 90-tab pack = £8.28. Note Tablets from various suppliers may contain different salts

Label: 25

(e.g. amlodipine besilate, amlodipine maleate, and amlodipine mesilate) but the strength is expressed in terms of amlodipine (base); tablets containing different salts are considered inter-

Longer-acting formulations changeable

Note Different versions of modified-release preparations may

Amlodipine not have the same clinical effect. To avoid confusion between

(Non-proprietary) A these different formulations of diltiazem, prescribers should Tablets , amlodipine (as maleate or as mesilate) 5 mg,

specify the brand to be dispensed net price 28-tab pack = £1.12; 10 mg, 28-tab pack =

Adizem-SR £1.29 c (Napp) A Brands include Amlostin

Capsules , m/r, diltiazem hydrochloride 90 mg

c Istin (white), net price 56-cap pack = £8.98; 120 mg (Pfizer) A (brown/white), 56-cap pack = £9.98; 180 mg (brown/ Tablets , amlodipine (as besilate) 5 mg, net price 28-

white), 56-cap pack = £14.95. Label: 25 tab pack = £13.04; 10 mg, 28-tab pack = £19.47

tem , m/r, f/c, scored, diltiazem hydrochloride Tablets 120 mg, net price 56-tab pack = £14.72. Label: 25

sys

With valsartan Note

For hypertension in patients stabilised on the individual Dose mild to moderate hypertension, usually 120 mg twice daily components in the same proportions. For cautions, contra-

(dose form not appropriate for initial dose titration) indications, and side-effects of valsartan, see section 2.5.5.2

Angina, initially 90 mg twice daily (elderly, dose form not appro- priate for initial dose titration); increased to 180 mg twice daily if

ascular Exforge c (Novartis) TA

required

diov

Tablets 5/80 , f/c, dark yellow, amlodipine 5 mg, Adizem-XL valsartan 80 mg, net price 28-tab pack = £16.44 c (Napp) A

C ar

Capsules , m/r, diltiazem hydrochloride 120 mg Tablets 5/160 , f/c, dark yellow, amlodipine 5 mg,

(pink/blue), net price 28-cap pack = £9.66; 180 mg

2 valsartan 160 mg, net price 28-tab pack = £21.66

(dark pink/blue), 28-cap pack = £10.96; 200 mg Tablets 10/160 , f/c, light yellow, amlodipine 10 mg,

(brown), 28-cap pack = £6.66; 240 mg (red/blue), 28- valsartan 160 mg, net price 28-tab pack = £21.66

cap pack = £12.17; 300 mg (maroon/blue), 28-cap pack = £9.66. Label: 25 Dose angina and mild to moderate hypertension, initially 240 mg

DILTIAZEM HYDROCHLORIDE

once daily, increased if necessary to 300 mg once daily; in elderly and in hepatic or renal impairment, initially 120 mg daily

Indications prophylaxis and treatment of angina; hypertension c Angitil SR (Trinity-Chiesi) A

Cautions reduce dose in hepatic and renal impair- Capsules, m/r, diltiazem hydrochloride 90 mg ment; heart failure or significantly impaired left

(white), net price 56-cap pack = £7.86; 120 mg ventricular function, bradycardia (avoid if severe), first

(brown), 56-cap pack = £8.73; 180 mg (brown), 56-cap degree AV block, or prolonged PR interval; interac-

pack = £14.08. Label: 25 tions: Appendix 1 (calcium-channel blockers)

Dose angina and mild to moderate hypertension, initially 90 mg Contra-indications

twice daily; increased if necessary to 120 mg or 180 mg twice daily severe bradycardia, left ventri- cular failure with pulmonary congestion, second- or

Angitil XL c (Trinity-Chiesi) A third-degree AV block (unless pacemaker fitted), sick

Capsules , m/r, diltiazem hydrochloride 240 mg sinus syndrome; acute porphyria (but see section

(white), net price 28-cap pack = £9.44; 300 mg (yel- 9.8.2); pregnancy; breast-feeding (Appendix 5)

low), 28-cap pack = £8.57. Label: 25 Side-effects bradycardia, sino-atrial block, AV block,

Dose angina and mild to moderate hypertension, initially 240 mg palpitation, dizziness, hypotension, malaise, asthenia,

once daily (elderly and in hepatic and renal impairment, dose headache, hot flushes, gastro-intestinal disturbances,

form not appropriate for initial dose titration); increased if oedema (notably of ankles); rarely rashes (including necessary to 300 mg once daily

erythema multiforme and exfoliative dermatitis), Calcicard CR c (IVAX) A photosensitivity; hepatitis, gynaecomastia, gum

Tablets , m/r, both f/c, diltiazem hydrochloride 90 mg, hyperplasia, extrapyramidal symptoms, depression

net price 56-tab pack = £6.33; 120 mg, 56-tab pack = reported

£7.04. Label: 25

Dose Dose mild to moderate hypertension, initially 90 mg or 120 mg . Angina, 60 mg 3 times daily (elderly initially twice

twice daily; up to 360 mg daily may be required: ELDERLY and in daily); increased if necessary to 360 mg daily

hepatic and renal impairment, initially 120 mg once daily; up to 240 mg daily may be required

. Longer-acting formulations, see under preparations Angina, initially 90 mg or 120 mg twice daily; up to 480 mg daily in below

divided doses may be required; ELDERLY and in hepatic and renal impairment, dose form not appropriate for initial dose titration; up

Standard formulations to 240 mg daily may be required Note These formulations are licensed as generics and there is

Dilcardia SR no requirement for brand name dispensing. Although their c (Generics) A means of formulation has called for the strict designation

Capsules , m/r, diltiazem hydrochloride 60 mg (pink/ ‘modified-release’ their duration of action corresponds to that

white), net price 56-cap pack = £8.31; 90 mg (pink/ of tablets requiring administration 3 times daily

yellow), 56-cap pack = £10.33; 120 mg (pink/orange), Diltiazem (Non-proprietary)

A 56-cap pack = £11.49. Label: 25 Tablets Dose , m/r (but see note above), diltiazem hydro- angina and mild to moderate hypertension, initially 90 mg twice daily; increased if necessary to 180 mg twice daily; ELDERLY chloride 60 mg, net price 84 = £3.34. Label: 25

and in hepatic or renal impairment, initially 60 mg twice daily, Brands include Optil

max. 90 mg twice daily

BNF 57

2.6.2 Calcium-channel blockers 115

Dilzem SR c (Cephalon) A Zemtard 300XL capsules , m/r, white/blue, diltiazem Capsules , m/r, all beige, diltiazem hydrochloride

hydrochloride 300 mg, net price 28-cap pack = £7.45.

60 mg, net price 56-cap pack = £6.40; 90 mg, 56-cap

Label: 25

pack = £9.59; 120 mg, 56-cap pack = £10.95. Label: 25 Dose angina and mild to moderate hypertension, 180–300 mg Dose angina and mild to moderate hypertension, initially 90 mg

once daily, increased if necessary to 360 mg once daily in hyper- twice daily (elderly 60 mg twice daily); up to 180 mg twice daily

tension and to 480 mg once daily in angina; ELDERLY and in may be required

hepatic or renal impairment, initially 120 mg once daily Dilzem XL c (Cephalon) A

Capsules , m/r, diltiazem hydrochloride 120 mg, net price 28-cap pack = £6.61; 180 mg, 28-cap pack =

FELODIPINE

£9.81; 240 mg, 28-cap pack = £11.70. Label: 25 Indications hypertension, prophylaxis of angina Dose angina and mild to moderate hypertension, initially 180 mg

Cautions withdraw if ischaemic pain occurs or existing once daily (elderly and in hepatic and renal impairment, 120 mg once daily); if necessary may be increased to 360 mg once daily

pain worsens shortly after initiating treatment or if cardiogenic shock develops; severe left ventricular Slozem c (Merck) A dysfunction; avoid grapefruit juice (may affect

Capsules , m/r, diltiazem hydrochloride 120 mg metabolism); reduce dose in hepatic impairment; (pink/clear), net price 28-cap pack = £7.00; 180 mg

breast-feeding (Appendix 5); interactions: Appendix (pink/clear), 28-cap pack = £7.80; 240 mg (red/clear),

1 (calcium-channel blockers) 28-cap pack = £8.20; 300 mg (red/white), 28-cap pack

Contra-indications unstable angina, uncontrolled = £8.50. Label: 25

heart failure; significant aortic stenosis; within 1 Dose angina and mild to moderate hypertension, initially 240 mg

month of myocardial infarction; acute porphyria once daily (elderly and in hepatic and renal impairment, 120 mg

(section 9.8.2); pregnancy (Appendix 4) once daily); if necessary may be increased to 360 mg once daily

Side-effects flushing, headache, palpitation, dizziness, Tildiem LA c (Sanofi-Synthelabo)

A fatigue, gravitational oedema; rarely rash, pruritus, Capsules , m/r, diltiazem hydrochloride 200 mg

cutaneous vasculitis, gum hyperplasia, urinary fre- (pink/grey, containing white pellets), net price 28-cap

quency, impotence, fever Dose

pack = £6.66; 300 mg (white/yellow, containing white pellets), 28-cap pack = £7.51. Label: 25

. Hypertension, initially 5 mg (elderly 2.5 mg) daily in

Dose angina and mild to moderate hypertension, initially 200 mg the morning; usual maintenance 5–10 mg once daily;

ardiov

once daily before or with food, increased if necessary to 300– doses above 20 mg daily rarely needed 400 mg daily, max. 500 mg daily; ELDERLY and in hepatic or renal impairment, initially 200 mg daily, increased if necessary to

. Angina, initially 5 mg daily in the morning, increased if

ascular

300 mg daily necessary to 10 mg once daily Tildiem Retard c (Sanofi-Synthelabo) A Felodipine (Non-proprietary) A

Tablets , m/r, diltiazem hydrochloride 90 mg, net price Tablets , m/r, felodipine 2.5 mg, net price 28-tab pack

syst

56-tab pack = £8.55; 120 mg, 56-tab pack = £9.53. = £6.70; 5 mg, 28-tab pack = £8.93; 10 mg, 28-tab pack = £12.01, 30-tab pack = £12.87. Label: 25

em

Label: 25 Counselling Tablet membrane may pass through gastro-intestinal

Brands include Cardioplen XL , Felogen XL , Felotens XL , Keloc tract unchanged, but being porous has no effect on efficacy

SR , Neofel XL , Parmid XL , Vascalpha Dose mild to moderate hypertension, initially 90 mg or 120 mg

twice daily; increased if necessary to 360 mg daily in divided Plendil (AstraZeneca) A

doses; ELDERLY and in hepatic or renal impairment, initially Tablets , m/r, f/c, felodipine 2.5 mg (yellow), net price 120 mg once daily; increased if necessary to 120 mg twice daily

28-tab pack = £6.70; 5 mg (pink), 28-tab pack = £4.47; Angina, initially 90 mg or 120 mg twice daily; increased if neces-

10 mg (brown), 28-tab pack = £6.01. Label: 25 sary to 480 mg daily in divided doses; ELDERLY and in hepatic or renal impairment, dose form not appropriate for initial titration;

up to 120 mg twice daily may be required

ISRADIPINE

Viazem XL c (Genus) A Indications hypertension Capsules , m/r, diltiazem hydrochloride 120 mg

(lavender), net price 28-cap pack = £6.60; 180 mg Cautions sick sinus syndrome (if pacemaker not (white/blue-green), 28-cap pack = £7.36; 240 mg

fitted); avoid grapefruit juice (may affect metabolism); (blue-green/lavender), 28-cap pack = £7.74; 300 mg

poor cardiac reserve; reduce dose in hepatic or renal (white/lavender), 28-cap pack = £8.03; 360 mg (blue-

impairment; pregnancy (Appendix 4); interactions: green), 28-cap pack = £14.70. Label: 25

Appendix 1 (calcium-channel blockers) Dose angina and mild to moderate hypertension, initially 180 mg

Contra-indications cardiogenic shock; symptomatic once daily, adjusted according to response to 240 mg once daily;

or tight aortic stenosis; during or within 1 month of max. 360 mg once daily; ELDERLY and in hepatic or renal impair-

myocardial infarction; unstable angina; acute por- ment, initially 120 mg once daily, adjusted according to response

phyria (section 9.8.2); breast-feeding (Appendix 5)

c Zemtard Side-effects (Galen) abdominal discomfort; tachycardia, pal- A Zemtard 120XL capsules , m/r, brown/orange, dilti-

pitation, flushing, peripheral oedema; dyspnoea; azem hydrochloride 120 mg, net price 28-cap pack =

headache, fatigue, dizziness; polyuria; rash; less com- £6.40. Label: 25

monly hypotension, weight gain; very rarely vomiting, nausea, gum hyperplasia, anorexia, drowsiness,

Zemtard 180XL capsules , m/r, grey/pink, diltiazem arrhythmia, bradycardia, heart failure, cough, hydrochloride 180 mg, net price 28-cap pack = £6.50

depression, paraesthesia, anxiety, erectile dysfunc- Label: 25

tion, blood disorders (such as thrombocytopenia, Zemtard 240XL capsules , m/r, blue, diltiazem

leucopenia, anaemia), arthralgia, visual disturbance, hydrochloride 240 mg, net price 28-cap pack = £6.60.

hypersensitivity reactions; hepatitis and gynaeco- Label: 25

mastia also reported

2.6.2 Calcium-channel blockers BNF 57 Dose

or increasing dose; congestive heart failure or signif- .

2.5 mg twice daily, increased if necessary after 3–4 icantly impaired left ventricular function; elderly; weeks to 5 mg twice daily (exceptionally up to 10 mg

avoid grapefruit juice (may affect metabolism); twice daily); ELDERLY (or in hepatic or renal impair-

hepatic impairment (Appendix 2); renal impairment ment) 1.25 mg twice daily, increased if necessary after

(Appendix 3); pregnancy (Appendix 4); interactions: 3–4 weeks according to response, maintenance dose

Appendix 1 (calcium-channel blockers) of 2.5 mg or 5 mg once daily may be sufficient

Contra-indications cardiogenic shock; advanced aor- Prescal c (Novartis) A tic stenosis; unstable or acute attacks of angina; avoid

Tablets , yellow, scored, isradipine 2.5 mg, net price within 1 month of myocardial infarction; acute por- 56-tab pack = £16.54

phyria (section 9.8.2); breast-feeding (Appendix 5) Side-effects dizziness, headache, peripheral oedema, flushing, palpitation, nausea; also gastro-intestinal

disturbances, drowsiness, insomnia, tinnitus, hypo- Indications hypertension

LACIDIPINE

tension, rashes, dyspnoea, paraesthesia, frequency of Cautions cardiac conduction abnormalities; poor car-

micturition; thrombocytopenia, depression and diac reserve; avoid grapefruit juice (may affect

impotence reported

tem

metabolism); hepatic impairment (Appendix 2);

Dose

sys

interactions: Appendix 1 (calcium-channel blockers) . Initially 20 mg 3 times daily, increased, after at least Contra-indications cardiogenic shock, unstable

three days, to 30 mg 3 times daily (usual range 60– angina, aortic stenosis; avoid within 1 month of

120 mg daily)

ascular

myocardial infarction; acute porphyria (section 9.8.2); Nicardipine (Non-proprietary) A pregnancy (Appendix 4); breast-feeding (Appendix 5)

, nicardipine hydrochloride 20 mg, net price diov Side-effects

Capsules

flushing, palpitation, oedema; headache, 56-cap pack = £3.09; 30 mg, 56-cap pack = £4.93 ar C dizziness; rarely gastro-intestinal disturbances, gum hyperplasia, aggravation of angina, mood distur-

Cardene c (Astellas) A

2 bances, asthenia, polyuria, muscle cramps, skin rash

Capsules , nicardipine hydrochloride 20 mg (blue/ (including pruritus and erythema)

white), net price 56-cap pack = £8.57; 30 mg (blue/ Dose

pale blue), 56-cap pack = £9.95 . Initially 2 mg as a single daily dose, preferably in the

morning; increased after 3–4 weeks to 4 mg daily, then Modified release Cardene SR if necessary to 6 mg daily c (Astellas) A

c Capsules Motens , m/r, nicardipine hydrochloride 30 mg, net (Boehringer Ingelheim) A price 56-cap pack = £10.21; 45 mg (blue), 56-cap pack Tablets , both f/c, lacidipine 2 mg, net price 28-tab

= £14.86. Label: 25 pack = £9.92; 4 mg (scored), 28-tab pack = £13.48

Dose mild to moderate hypertension, initially 30 mg twice daily; usual effective dose 45 mg twice daily (range 30–60 mg twice

LERCANIDIPINE HYDROCHLORIDE daily)

Indications mild to moderate hypertension Cautions left ventricular dysfunction; sick sinus

NIFEDIPINE

syndrome (if pacemaker not fitted); avoid grapefruit Indications prophylaxis of angina; hypertension; juice (may affect metabolism); hepatic impairment

Raynaud’s phenomenon (Appendix 2); interactions: Appendix 1 (calcium-

Cautions see notes above; also withdraw if ischaemic channel blockers)

pain occurs or existing pain worsens shortly after Contra-indications aortic stenosis; unstable angina,

initiating treatment; poor cardiac reserve; heart failure uncontrolled heart failure; within 1 month of myo-

or significantly impaired left ventricular function cardial infarction; renal impairment; acute porphyria

(heart failure deterioration observed); severe hypo- (section 9.8.2); pregnancy (Appendix 4); breast-feed-

tension; elderly; diabetes mellitus; hepatic impairment ing

(Appendix 2); may inhibit labour; pregnancy (Appen- Side-effects flushing, peripheral oedema, palpitation,

dix 4); breast-feeding (Appendix 5); avoid grapefruit tachycardia, headache, dizziness, asthenia; also gas-

juice (may affect metabolism); interactions: Appen- tro-intestinal disturbances, hypotension, drowsiness,

dix 1 (calcium-channel blockers) myalgia, polyuria, rash

Contra-indications cardiogenic shock; advanced aor- Dose

tic stenosis; within 1 month of myocardial infarction; . Initially 10 mg once daily; increased, if necessary, after

unstable or acute attacks of angina; acute porphyria at least 2 weeks to 20 mg daily

(section 9.8.2)

c Side-effects Zanidip gastro-intestinal disturbance; hypo- (Recordati) A tension, oedema, vasodilatation, palpitation; head- Tablets , f/c, lercanidipine hydrochloride 10 mg (yel-

ache, dizziness, lethargy, asthenia; less commonly low), net price 28-tab pack = £5.80; 20 mg (pink), 28-

tachycardia, syncope, chills, nasal congestion, dys- tab pack = £11.00. Label: 22

pnoea, anxiety, sleep disturbance, vertigo, migraine, paraesthesia, tremor, polyuria, dysuria, nocturia,

NICARDIPINE HYDROCHLORIDE

erectile dysfunction, epistaxis, myalgia, joint swelling, visual disturbance, sweating, hypersensitivity reac-

Indications prophylaxis of angina; mild to moderate tions (including angioedema, jaundice, pruritus, urti- hypertension

caria, and rash); rarely anorexia, gum hyperplasia, Cautions withdraw if ischaemic pain occurs or existing

mood disturbances, hyperglycaemia, male infertility, pain worsens within 30 minutes of initiating treatment

purpura, and photosensitivity reactions; also reported

BNF 57

2.6.2 Calcium-channel blockers 117

dysphagia, intestinal obstruction, intestinal ulcer,

20 mg (pink/brown, enclosing yellow pellets), 60-cap bezoar formation (with some modified-release pre-

pack = £6.52. Label: 25 parations), gynaecomastia, agranulocytosis, and

Dose hypertension and angina prophylaxis, initially 10 mg twice anaphylaxis

daily, increased if necessary to max. 40 mg twice daily Dose

Coracten XL c (UCB Pharma) A . See preparations below

Capsules , m/r, nifedipine 30 mg (brown), net price

Nifedipine 28-cap pack = £5.89; 60 mg (orange), 28-cap pack =

(Non-proprietary) A £8.84. Label: 25

Capsules , nifedipine 5 mg, net price 84-cap pack = Dose hypertension and angina prophylaxis, 30 mg once daily, £2.84; 10 mg, 84-cap pack = £3.94

increased if necessary; max. 90 mg once daily Dose angina prophylaxis (but not recommended, see notes above) and Raynaud’s phenomenon, initially 5 mg 3 times daily,

Fortipine LA 40 c (Goldshield) A adjusted according to response to 20 mg 3 times daily Hypertension, not recommended therefore no dose stated

Tablets , m/r, red, nifedipine 40 mg, net price 30-tab pack = £9.60. Label: 21, 25

Dose Adalat hypertension and angina prophylaxis, 40 mg once daily, c (Bayer) A Capsules increased if necessary to 80 mg daily in 1–2 divided doses , orange, nifedipine 5 mg, net price 90-cap

pack = £6.08; 10 mg, 90-cap pack = £7.74 Hypolar c Retard 20 (Sandoz) A Dose angina prophylaxis (but not recommended, see notes

Tablets , m/r, red, f/c, nifedipine 20 mg, net price 56- above) and Raynaud’s phenomenon, initially 5 mg 3 times daily,

tab pack = £5.75. Label: 25 adjusted according to response to max. 20 mg 3 times daily

Dose hypertension and angina prophylaxis, 20 mg twice daily, Hypertension, not recommended therefore no dose stated

increased if necessary to 40 mg twice daily Modified release c Nifedipress MR (Dexcel) A

Note Different versions of modified-release preparations may Tablets , m/r, pink, nifedipine 10 mg, net price 56-tab not have the same clinical effect. To avoid confusion between

pack = £9.23; 20 mg, 56-tab pack = £10.06. Label: 25 these different formulations of nifedipine, prescribers should

Dose hypertension and angina prophylaxis, initially 10 mg twice specify the brand to be dispensed. Modified-release formula-

daily adjusted according to response to 40 mg twice daily tions may not be suitable for dose titration in hepatic disease

Note Also available as Calchan MR , Kentipine MR

Adalat c LA (Bayer)

Tensipine MR A c (Genus) A C

LA 20 tablets , m/r, f/c, pink, nifedipine 20 mg, net Tablets , m/r, pink-grey, nifedipine 10 mg, net price

ardiov

price 28-tab pack = £5.27. Label: 25 56-tab pack = £4.30; 20 mg, 56-tab pack = £5.49. LA 30 tablets , m/r, f/c, pink, nifedipine 30 mg, net

Label: 21, 25

ascular

price 28-tab pack = £7.59. Label: 25 Dose hypertension and angina prophylaxis, initially 10 mg twice daily adjusted according to response to 40 mg twice daily

Valni XL c (Winthrop) A Counselling Tablet membrane may pass through gastro-intestinal

LA 60 tablets , m/r, f/c, pink, nifedipine 60 mg, net price 28-tab pack = £9.69. Label: 25

Tablets , m/r, red, nifedipine 30 mg, net price 28-tab

syst

tract unchanged, but being porous has no effect on efficacy pack = £9.89; 60 mg, 28-tab pack = £14.71. Label: 25 Dose severe hypertension and prophylaxis of angina, 30 mg

em

Dose hypertension, 20–30 mg once daily, increased if necessary to max. 90 mg once daily

once daily, increased if necessary to max. 90 mg once daily Angina prophylaxis, 30 mg once daily, increased if necessary to

Cautions dose form not appropriate for use in hepatic impair- max. 90 mg once daily

ment, or where there is a history of oesophageal or gastro-intes- Cautions dose form not appropriate for use in hepatic impair-

tinal obstruction, decreased lumen diameter of the gastro-intes- ment or where there is a history of oesophageal or gastro-intes-

tinal tract, inflammatory bowel disease, or ileostomy after tinal obstruction, decreased lumen diameter of the gastro-intes-

proctocolectomy

tinal tract, or inflammatory bowel disease (including Crohn’s disease)

With atenolol Adalat c Retard (Bayer) A Section 2.4

Retard 10 tablets , m/r, f/c, grey-pink, nifedipine

10 mg, net price 56-tab pack = £8.50. Label: 25 Retard 20 tablets , m/r, f/c, grey-pink, nifedipine

NIMODIPINE

20 mg, net price 56-tab pack = £10.20. Label: 25 Indications prevention and treatment of ischaemic Dose hypertension and angina prophylaxis, 10 mg twice daily,

neurological deficits following aneurysmal subarach- adjusted according to response to 40 mg twice daily

noid haemorrhage

A Cautions cerebral oedema or severely raised intra- Tablets , m/r, nifedipine 10 mg (apricot), net price 56-

cranial pressure; hypotension; avoid concomitant tab pack = £5.96; 20 mg (pink), 56-tab pack = £7.43.

Adipine c MR (Trinity-Chiesi)

administration of nimodipine tablets and infusion, Label: 21, 25

other calcium-channel blockers, or beta-blockers; Dose hypertension and angina prophylaxis, 20 mg twice daily

concomitant nephrotoxic drugs; avoid grapefruit juice after food (initial titration 10 mg twice daily); max. 40 mg twice

(may affect metabolism); hepatic impairment daily

(Appendix 2); renal impairment (Appendix 3);

c Adipine pregnancy (Appendix 4); interactions: Appendix 1 XL (Trinity-Chiesi) A (calcium-channel blockers, alcohol (infusion only)) Tablets , m/r, red, nifedipine 30 mg, net price 28-tab

pack = £5.89; 60 mg, 28-tab pack = £8.84. Label: 25 Contra-indications within 1 month of myocardial Dose hypertension and angina prophylaxis, 30 mg once daily,

infarction; unstable angina; acute porphyria (section increased if necessary; max. 90 mg once daily

9.8.2) Side-effects

hypotension, variation in heart-rate, (UCB Pharma) A flushing, headache, gastro-intestinal disorders, Capsules , m/r, nifedipine 10 mg (grey/pink, enclos-

Coracten SR c

nausea, sweating and feeling of warmth; thrombocy- ing yellow pellets), net price 60-cap pack = £4.70;

topenia and ileus reported

2.6.2 Calcium-channel blockers BNF 57 Dose

ably with ECG monitoring); in paroxysmal tachyar- . Prevention, by mouth , 60 mg every 4 hours, starting

rhythmias a further 5 mg after 5–10 minutes if within 4 days of aneurysmal subarachnoid

required

haemorrhage and continued for 21 days . Treatment, by intravenous infusion via central

Verapamil (Non-proprietary) A catheter, initially 1 mg/hour (up to 500 micr-

Tablets , coated, verapamil hydrochloride 40 mg, net ograms/hour if body-weight less than 70 kg or if

price 84-tab pack = £1.54; 80 mg, 84-tab pack = £1.68; blood pressure unstable), increased after 2 hours to

120 mg, 28-tab pack = £1.41; 160 mg, 56-tab pack =

2 mg/hour if no severe fall in blood pressure; con-

tinue for at least 5 days (max. 14 days); if surgical Oral solution , verapamil hydrochloride 40 mg/5 mL, intervention during treatment, continue for at least

net price 150 mL = £36.90

5 days after surgery; max. total duration of nimo- Brands include Zolvera dipine use 21 days Nimotop c (Bayer) A Cordilox c (Dexcel) A Tablets , yellow, f/c, nimodipine 30 mg, net price 100-

Tablets , yellow, f/c, verapamil hydrochloride 40 mg, tab pack = £38.85

net price 84-tab pack = £1.50; 80 mg, 84-tab pack =

tem

Intravenous infusion , nimodipine 200 micrograms/ £2.05; 120 mg, 28-tab pack = £1.15; 160 mg, 56-tab

sys

mL; also contains ethanol 20% and macrogol ‘400’

pack = £2.80

17%, net price 50-mL vial (with polyethylene infusion Injection , verapamil hydrochloride 2.5 mg/mL, net catheter) = £13.24

price 2-mL amp = £1.11

ascular

Note Polyethylene, polypropylene, or glass apparatus should be used; PVC should be avoided

Securon c (Abbott) A

diov

Injection , verapamil hydrochloride 2.5 mg/mL, net

C ar VERAPAMIL HYDROCHLORIDE

price 2-mL amp = £1.08