Drug Comparisons

The calcium channel blockers (CCBs) are one of several classes of medications used in the treatment of hypertension (high blood pressure). The CCBs work to lower blood pressure by interfering with the normal role of calcium in the heart and blood vessels. By blocking calcium's entry into the heart muscle and blood vessels, CCBs cause blood vessels to dilate and contraction of the heart to slow, and thus, blood pressure is lowered.

Because of slight variations in how various CCBs work in the body, the CCBs can be further categorized into one of two subclasses--the Dihydropyridine (pronounced "die-hi-dro-pie-rih-deen") CCBs and the Non-dihydropyridine CCBs.

The dihydropyridine CCB subclass includes amlodipine, bepridil, felodipine, isradipine, nicardipine, nifedipine, and nisoldipine.

The non-dihydropyridine CCB subclass includes verapamil and diltiazem.

Drugs in this Class
Nifedipine ER (Adalat CC, Afeditab CR, Nifediac CC, Procardia XL)
Nisoldipine (Sular)
Diltiazem Hydrochloride Extended-Release Tablets (Cardizem LA)
Amlodipine (Norvasc)
Isradipine Capsules ()
Verapamil Extended-Release Capsules (Verapamil Sustained-Release Capsule, Verelan Sustained-Release Capsule)
Felodipine Extended-Release Tablets (Plendil Extended-Release Tablets)
Diltiazem Tablets (Cardizem)
Verapamil Tablets (Calan Tablets)
Nicardipine SR (Cardene SR)

Summarizing the Evidence

• The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) recommends thiazide-type diuretics as the initial drug choice in most patients with high blood pressure. JNC 7 also recommends that CCBs be considered in patients with high blood pressure in addition to coronary heart disease (chronic stable angina -- chest pain during activity) and diabetes. However, the drug selected to lower blood pressure often depends on numerous factors including other diseases or conditions you may have, other medications you may be taking, and medication costs. Your doctor is the best person to decide what medicine is best to lower your blood pressure.

• Studies have compared the CCBs to each other and to drugs in other drug classes for the treatment of hypertension. All CCBs have been shown to be effective in lowering blood pressure and as effective as drugs in other drug classes in lowering blood pressure. Nicardipine is sometimes used to treat severe hypertension.

• CCBs are generally well tolerated with mild side effects. Several of the CCBs are associated with a higher incidence of side effects than the others. For example, verapamil is associated with more constipation than the other CCBs. Swelling of the ankles and feet has been associated with higher doses of dihydropyridine CCBs (not diltiazem and verapamil). Excessive growth of the gums (gingival hyperplasia) has been most commonly documented with diltiazem and nifedipine but may occur with any of the CCBs.

Dosing and Administration

• Some products (nifedipine, verapamil, diltiazem, nicardipine) can be dosed up to three or four times daily. Sustained release formulations (nicardipine SR, isradipine, verapamil SR) are typically dosed twice daily, while extended-release formulations (nifedipine, nisoldipine, amlodipine, felodipine, isradipine, extended-release verapamil) can often be dosed once daily. Once daily dosing is especially important when CCBs are used to treat individuals with high blood pressure and angina (chest pain) because abrupt changes in blood pressure and heart rate may occur if a dose is missed of a drug taken two or three times daily.

Generic Availability

• Many formulations and strengths of amlodipine, diltiazem, verapamil, felodipine, nicardipine, and nifedipine immediate release and extended-release formulations have generic equivalents available for a lower cost than the brand name formulations. CCBs that do not yet have generic equivalents are controlled-release isradipine (Dynacirc CR), sustained release nicardipene (Cardene SR), and nisoldipine (Sular).

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. Silvestry FE, St John Sutton MG. Sustained-release calcium channel antagonists in cardiovascular disease: pharmacology and current therapeutic use. Eur Heart J. 1998;19 (Suppl I):I8-I14.
2. Vascor. Raritan, NJ. Ortho-McNeil Pharmaceuticals, Inc: March 2000.
3. Verelan. Milwaukee, WI: Schwarz Pharma. May 2004.
4. Covera-HS [package insert]. Chicago, IL: G.D. Searle & Co.; May 2004.
5. Verelan PM [package insert]. Milwaukee, WI: Schwarz Pharma; May 2004.
6. Cardizem SR, Cardizem. Physicians Desk Reference. 53rd Ed. Montvale, NJ: Medical Economics Company, Inc. 1999:1314-1316, 1316-1318.
7. Cardizem CD [package insert]. Morrisville, NC: Biovail Pharmaceuticals, Inc.; August 2001.
8. Dilacor XR. Physicians Desk Reference. 54th Ed. Montvale, NJ: Medical Economics Company, Inc. 2000:3172-3174.
9. Tiazac [package insert]. St. Louis, MO: Forest Pharmaceuticals; April 2006.
10. Calan [package insert]. Chicago, IL: G.D. Searle LLC, A subsidiary of Pharmacia Corporation; July 2003.
11. Calan SR [package insert]. Chicago, IL: G.D. Searle LLC, A subsidiary of Pharmacia Corporation; July 2003.
12. Cardizem LA [package insert]. Bridgewater, NJ; April 2004.
13. Isoptin SR. Physicians Desk Reference. 55th Ed. Montvale, NJ: Medical Economics Company, Inc. 2001:1623-1625.
14. Adalat CC [package insert]. West Haven, CT: Bayer Corporation; August 2005.
15. Procardia [package insert]. New York, NY: Pfizer Labs; September 2000.
16. Procardia XL [package insert]. New York, NY: Pfizer Labs; August 2003.
17. Norvasc [package insert]. New York, NY: Pfizer Labs; September 2005.
18. Plendil[package insert]. Wilmington, DE: AstraZeneca LP; November 2003.
19. DynaCirc [package insert]. East Hanover, NJ: Sandoz Pharmaceuticals; March 1996.
20. DynaCirc CR [package insert]. East Hanover, NJ: Sandoz Pharmaceuticals; August 2005.
21. Cardene [package insert]. Nutley, NJ: Roche Laboratories; August 2000.
22. Cardene SR [package insert]. Nutley, NJ: Roche Laboratories; August 2000.
23. Sular [package insert]. Wilmington, DE: Zeneca Pharmaceuticals; January 2001.
24. Conlin PR, Williams GH. Use of calcium channel blockers in hypertension. Advanc Intern Med. 1998;43:533-562.
25. Abernathy DR, Schwartz JB. Calcium-antagonist drugs. NEJM. 1999;341:1447-1457.
26. Sasaguri M, Matsumoto N, Noda K, et al. Amlodipine lowers blood pressure without increasing sympathetic activity or activating the renin-angiotensin system in patients with essential hypertension. Eur J Clin Pharmacol. 1997;53:197-201.
27. Opie LH, Messerli FH. Nifedipine and mortality. Circulation. 1995;92:1068-1073.
28. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003; 285:2560-2572.
29. Fagan TC, Haggert BE, Liss C. Efficacy and tolerability of extended-release felodipine and extended-release nifedipine in patients with mild-to-moderate essential hypertension. Clin Ther. 1994;16:634-646.
30. Koenig W. Efficacy and tolerability of felodipine and amlodipine in the treatment of mild to moderate hypertension; a randomized double-blind multicenter trial. Drug Investigation. 1993;5:200-205.
31. Horwitz LD, Weinberger HD, Clegg L. Comparison of amlodipine and long-acting diltiazem in the treatment of mild or moderate hypertension. Am J Hypertens. 1997;10:1263-1269.
32. Leenan FHH, Wilson TW, Larochelle P, et al. Patterns of compliance with once versus twice daily antihypertensive drug therapy in primary care: a randomized clinical trial using electronic monitoring. Can J Cardiol. 1997;13:914-920.
33. Corea L, Cardoni O, Fogari R, et al. Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: a comparative study of the efficacy and safety against amlodipine. Clin Pharmacol Ther. 1996;60:341-346.
34. Omvik P, Thaulow E, Herland OB, et al. Double-blind, parallel, comparative study on quality of life during treatment with amlodipine or enalapril in mild or moderate hypertensive patients: a multicentre study. J Hypertens. 1993;11:103-113.
35. Grossman E, Messerli FJ, Grodzicki T et al. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996;276:1328-1331.
36. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350(9080):757-764.
37. Ellis JS, Seymour RA, Steele JG, et al. Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study. J Periodontol. 1999;70:63-67.
38. Tavassoli S, Yamalik N, Cagalyan F, et al. The clinical effects of nifedipine on periodontal status. J Periodontol. 1998;69:108-112.
39. The ALLHAT Officers and Coordinators for the ALLHAT Collaberative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288:2981-97.
40. Johnson JA, Parker RB, Patterson JH. Heart Failure. In DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 6th ed. New York: McGraw-Hill; 2005. p. 185-217.
41. Varon J. Treatment of acute severe hypertension: current and newer agents. Drugs 2008;68 (3):283-97.

Last Updated: April 2008
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.