Calcium channel antagonists. Part II: Use and comparative properties of the three prototypical calcium antagonists in ischemic heart disease, including recommendations based on an analysis of 41 trials.

Abstract

An analysis of 41 trials of angina of all varieties confirms that calcium antagonists are an important advance and are now established therapy for these syndromes. In effort angina, verapamil in a dose of 360-480 mg daily is better than propranolol in standard doses. Although nifedipine is highly effective against vasospastic angina, its use in threatened myocardial infarction or severe unstable angina is not supported by recent studies, unless combined with a beta-blocker. Diltiazem has recently been tested with apparent benefit in non-Q-wave myocardial infarction. Otherwise, these calcium antagonist agents all seem to have approximate equipotency in clinical ischemic syndromes including effort and vasospastic angina. Subjective side effects seem most troublesome in the case of nifedipine. All three calcium antagonists, especially nifedipine, have been successfully combined with beta-blocker therapy, yet occasional additive negative inotropic or chronotropic or dromotropic interactions may occur when verapamil or diltiazem is added to beta-blockade, and occasionally the direct negative inotropic potential of nifedipine may become evident. The choice between the calcium antagonists is determined not only by the clinical picture but also by the anticipated side effects in a given patient and by the overall cardiovascular status. In patients with supraventricular tachycardias or sinus tachycardia, verapamil or diltiazem is preferred, whereas in patients with a resting bradycardia or borderline heart failure nifedipine is likely to be chosen.

• Authors: L H Opie
• Journal: Cardiovascular drugs and therapy (Cardiovasc Drugs Ther) Vol. 1 Issue 5 Pg. 461-91 (Jan 1988) ISSN: 0920-3206 [Print] United States
• PMID: 3154677 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Calcium Channel Blockers
• Propranolol
• Verapamil
• Diltiazem
• Nifedipine

Topics

• Angina Pectoris (drug therapy)
• Angina, Unstable (drug therapy)
• Calcium Channel Blockers (pharmacology, therapeutic use)
• Coronary Disease (drug therapy)
• Diltiazem (therapeutic use)
• Drug Therapy, Combination
• Humans
• Meta-Analysis as Topic
• Myocardial Infarction (drug therapy)
• Nifedipine (therapeutic use)
• Propranolol (therapeutic use)
• Verapamil (therapeutic use)