II. Indications

III. Mechanism

  1. Blocks Calcium influx at 2 types of Calcium channels
    1. L-type (long-acting) channels
      1. Blocked by standard Calcium Channel Blockers
    2. T-type (transient) channels
      1. Blocked uniquely by Mibefradil
      2. Activated at lower voltages
      3. Present in:
        1. Vascular Smooth Muscle
        2. Myocardial conduction system
      4. Absent in
        1. Ventricular Myocardium
  2. Effect of Mibefradil
    1. Produces coronary and peripheral vasodilatation
    2. Does not result in reflex Tachycardia

IV. Efficacy

  1. Antihypertensive
    1. More effective then Diltiazem
    2. As effective as Amlodipine and Nifedipine
    3. Synergistic effect with ACE Inhibitors
  2. Anti-Anginal
    1. Delays onset of ischemia during Exercise
    2. Increases Exercise tolerance

V. Contraindications

VI. Drug Interactions

  1. Fatal Arrhythmia risk with
    1. Terfenadine
    2. Astemizole
    3. Cisapride
  2. Increases levels of
    1. Tricyclic Antidepressant
    2. Cyclosporine

VII. Adverse Effects

  1. See Calcium Channel Blocker
  2. Dizziness
  3. Fatigue
  4. Light headedness
  5. Peripheral Edema LESS common than others in class

VIII. Dosing

  1. 50 mg orally daily (up to 100 mg orally daily)

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