Pharm

Dihydropyridine Calcium Channel Blocker

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Dihydropyridine Calcium Channel Blocker, Amlodipine, Norvasc, Dihydropyridine

  • See Also
  1. Calcium Channel Blocker
  2. Calcium Channel Blocker Overdose
  3. Nifedipine
  4. Diltiazem
  5. Verapamil
  6. Mibefradil
  7. Nicardipine
  8. Clevidipine
  9. Nimodipine (Nymalize)
  • Mechanism
  1. Dihydropyridine Calcium Channel Blockers
    1. Dihydropyridines are primarily active at vascular smooth muscle
    2. Contrast with Non-Dihydropyridines which are also active at cardiac smooth muscle
  2. Nifedipine (Procardia) is prototype for class
  • Contraindications
  1. Avoid in Diabetes Mellitus (may increase Proteinuria)
  • Drug Interactions
  1. Clarithromycin
    1. Increases Calcium Channel Blocker levels via CYP3A4 inhibition especially with Dihydropyridines and over age 65 years
      1. Provokes Hypotension and Bradycardia
      2. Risk of Acute Kidney Injury (often requiring hospitalization)
    2. References
      1. Gandhi (2013) JAMA 310(23):2544-53 [PubMed]
  • Preparations
  • Oral
  1. Nifedipine (Procardia)
  2. Amlodipine (Norvasc)
    1. Dosing
      1. 2.5-5mg PO qd (MAX 10mg qd)
    2. Advantages
      1. Does not exacerbate Left Ventricular Dysfunction
  3. Felodipine
  4. Nimodipine (Nymalize)
  1. Background
    1. Counter Cerebral Vessel spasm (e.g. early Subarachnoid Hemorrhage, CVA)
  2. Clevidipine (Cleviprex)
  3. Nicardipine
  • Adverse Effects
  1. See Calcium Channel Blocker
  2. Peripheral Edema (Norvasc)
    1. Occurs more commonly in women
    2. Occurs more commonly on Norvasc doses >5 mg
    3. Adding ACE Inhibitor to regimen decreases edema