CCB

Question 1

List the CCB.

Answer 1

Dihydropyridine CCB:
Amlodipine
Felodipine
Lercanidipine
Nifedipine
Nimodipine

Non-dihydropyridine CCB:
Diltiazem
Verapamil

Question 2

What are the indications of CCB?

Answer 2

• HTN
• angina (amlodipine, nifedipine, diltiazem, verapamil)
• AF for ventricular rate control (diltiazem, verapamil)
• arterial flutter (verapamil)
• supraventricular tachycardia ie. SVT (verapamil)
• pre-term labour (Nifedipine)
• prevention & tx of ischaemic neurological deficits following subarachnoid haemorrhage (nimodipine)

Question 3

What are the dose ranges of CCB?

Answer 3

2.5mg d
> 10mg d - amlodipine
> 20mg d - felodipine

Lercanidipine 10-20mg d

Nifedipine
CR: 20mg-90mg(angina)/120mg(HTN) d
Conventional tablet: 10mg bd-40mg bd

Verapamil
CR: 120mg d - 240 d/bd
Conventional tablet: 80mg bd/tds - 160mg bd/tds

Diltiazem
CR: 180mg d - 360mg d
Conventional tablet: 30mg tds/qid - 360mg d (3/4doses)

Question 4

What are the AEs of CCB?

Answer 4

Common (especially dihydropyridines):

• headache
• flushing
• peripheral oedema
• palpitations
• bradycardia (diltiazem, verapamil)
• constipation (verapamil)

Note: dihydropyridine-induced peripheral oedema does not require tx with diuretics, which may put patient at risk of volume depletion

Question 5

What are the counseling points of CCB?

Answer 5

• avoid grapefruit juice as it may increase the risk of side effects with this medication. (felodipine, nimodipine)
• swallow whole (felodipine, nifedipine CR, verapamil CR)
  Verapamil:
• swallow controlled release products whole; do not crush or chew. If necessary, the capsules may be opened and the contents sprinkled onto apple sauce and taken immediately.
• verapamil may increase the effects of alcohol so that you are more easily affected and the effects last longer. Limit your alcohol intake until you know whether you are affected like this.