Preventive Cardiology: Calcium Channel Blocking Agents

Hypertension (high blood pressure)

Calcium channel blocking agents are not usually the first drugs prescribed for the management of ]]>hypertension]]> . In cases of uncomplicated hypertension, physicians often prescribe a diuretic, beta-blocking agent, or acetylcholinesterase (ACE)-inhibitor first. If hypertension cannot be controlled with one of these drugs or you are unable to tolerate the medication, your physician may recommend a calcium channel blocking agent. Data from the 1990s suggested that short acting calcium blockers, such as nifedipine, may possibly increase the risk of heart attacks, but more recent studies clearly show that, properly selected, calcium channel blockers can effectively control hypertension and decrease associated mortality.

Angina pectoris

]]>Angina]]> is not a disease itself but is the primary symptom of coronary artery disease. It is typically experienced as chest pain, which can be mild, moderate, or severe, but is often reported as a dull, heavy pressure that may resemble a crushing object on the chest. Pain often radiates to the neck, jaw, or left shoulder and arm. Calcium blockers may relieve symptoms associated with angina, but they probably do not improve long-term outcomes or prevent death.

Check your other medications

If you are taking a calcium channel blocking agent to treat high blood pressure, tell your doctor about any other drugs or supplements, both prescription and over-the-counter (nonprescription), that you are taking or considering taking. Some drugs may contain ingredients that cause an increase in your blood pressure. These include: over-the-counter medicines for appetite control, ]]>asthma]]> , ]]>colds]]> , cough, ]]>hay fever]]> , or sinus problems.

Report grapefruit intake

Grapefruit juice or grapefruit, when taken with some calcium channel blocking agents, can increase the absorption of the drug and therefore its level in your blood. The largest effect is seen with the felodipine (Plendil) family of calcium channel blockers. If you regularly eat or drink grapefruit and are taking one of the following medications, or indeed any calcium channel blocker, tell your doctor so that he or she can factor that in to your dosage:

• Felodipine (Plendil)
• Nisoldipine (Sular)
• Verapamil (Calan, Isoptin, Verelan)
• Nifedipine (Adalat, Adalat CC, Procardia, Procardia XL)
• Amlodipine (Norvasc)

Don't stop suddenly

If you have been using this medication regularly, do not stop taking it suddenly, as this may lead to a return and/or worsening of your angina or high blood pressure. Instead, check with your doctor on how best to gradually wean yourself off of this drug.

Go easy on the exercise

Calcium channel blocking agents can reduce or prevent chest pain that occurs with exercise and physical exertion, making it easy to overdo it on exercise. Therefore, before beginning or changing your exercise program, discuss with your doctor an appropriate level of physical activity for you.

Mind your head

After taking a dose of this medicine, you may get a temporary headache. This is more common if you are taking felodipine, isradipine, or nifedipine. This headache should occur less often once you have taken the medication for awhile. However, if it continues or if the headaches are severe, alert your doctor.

Care for your teeth and gums

Upon starting treatment with a calcium channel blocking agent, some people notice tenderness, swelling, or bleeding of their gums. To help prevent this, brush and floss regularly and carefully, and massage your gums. Also, have your teeth professionally cleaned regularly and discuss such problems with your doctor or dentist.

Be cautious with certain medical conditions

The presence of other medical problems may affect the use of the calcium channel blocking agents. Make sure you tell your doctor if you have any other medical problems, especially:

• Heart rhythm problems, ]]>congestive heart failure]]> , or blood vessel disorders (or a history of) – Calcium channel blocking agents may make some heart conditions worse. Bepridil can cause serious heart rhythm problems.
• Kidney disease or liver disease – The effects of the calcium channel blocking agent may be increased.
• ]]>Depression]]> (or a history of)
• ]]>Parkinson's disease]]> (or similar problems)

Manage your medications

Tell your doctor about all the medications you take; some should not be taken with calcium channel blocking agents, while others may require a different dosage level.