II. Indications
- Chronic Stable Angina
- Hypertension
III. Contraindications
- Sick Sinus Syndrome
- AV Block without a Pacemaker
IV. Mechanism
- Blocks Calcium influx at 2 types of Calcium channels
- L-type (long-acting) channels
- Blocked by standard Calcium Channel Blockers
- T-type (transient) channels
- Blocked uniquely by Mibefradil
- Activated at lower voltages
- Present in:
- Vascular Smooth Muscle
- Myocardial conduction system
- Absent in
- Ventricular Myocardium
- L-type (long-acting) channels
- Effect of Mibefradil
- Produces coronary and peripheral vasodilatation
- Does not result in reflex Tachycardia
V. Dosing
- 50 mg orally daily (up to 100 mg orally daily)
VI. Efficacy
-
Antihypertensive
- More effective then Diltiazem
- As effective as Amlodipine and Nifedipine
- Synergistic effect with ACE Inhibitors
- Anti-Anginal
VII. Drug Interactions
- Fatal Arrhythmia risk with
- Terfenadine
- Astemizole
- Cisapride
- Increases levels of
VIII. Adverse Effects
- See Calcium Channel Blocker
- Dizziness
- Fatigue
- Light Headedness
- Peripheral Edema LESS common than others in class