PSYchology
Many cardiovascular diseases can be controlled with calcium channel blockers. The editors of the KP found out what these drugs are and why they are so popular

Calcium channel blockers (CCBs) are used to treat cardiovascular diseases: coronary heart disease, arterial hypertension and arrhythmias1. These drugs have been known since the 60s and have proven themselves in clinical practice. Together with experts cardiologist Victoria Starosvetskaya and cardiologist, Ph.D. Tatyana Chernushenko we understand how the latest generation calcium channel blockers work, how they differ from each other and in what cases they are prescribed.

What are calcium channel blockers

Calcium plays an important role in the human body. This macronutrient is necessary for the contraction of muscle cells, including blood vessel cells and heart muscle. But in some diseases, the intake of calcium into the cells needs to be limited – this is what calcium channel blockers do. They slow down the movement of calcium ions through special calcium channels, which are present in large quantities in the heart and blood vessels.1,2. Therefore, another name for CCBs is calcium antagonists.

After taking calcium channel blockers, blood pressure decreases, the frequency and strength of heart contractions decrease, which means that the load on the heart and blood vessels decreases1,2.

Tatyana Chernushenko, a cardiologist, comments: “According to the chemical structure, all calcium channel blockers are divided into several groups. Drugs from different groups differ in their effect on the cardiovascular system:

  • dihydropyridine derivatives (nifedipine, felodipine, amlodipine, lercanidipine) help lower blood pressure, but practically do not affect the functioning of the heart muscle;
  • derivatives of phenylalkylamine (verapamil) reduce the frequency and strength of heart contractions, but almost do not reduce pressure;
  • benzodiazepine derivatives (diltiazem) equally affect the heart and blood vessels, therefore, reduce pressure and heart rate;
  • diphenylpiperazine derivatives (cinnarizine) dilate the vessels of the brain and at the same time do not affect the heart and other vessels, therefore they are prescribed for violations of cerebral circulation1.

There is another classification of calcium channel blockers – not by chemical structure, but by duration of action and specificity, that is, the ability to block only certain calcium channels.

According to this classification, 3 generations of BCC are distinguished:

  • 1st generation – these are short-acting drugs that are taken 3 or even 4 times a day to maintain a constant effect (nifedipine, corinfar, cordaflex, verapamil, diltiazem);
  • 2nd generation – drugs with a more selective effect on calcium channels, as well as prolonged dosage forms of the same nifedipines that have the ability to gradually enter the body (nifedipine SR, nifedipine-GITS, nifecard-XL, diltiazem SR, verapamil SR, isoptin SR):
  • 3rd generation – these are dihydropyridines with a different molecular structure (felodipine, lercanidipine, amlodipine)2.

Preparations of the 2nd and 3rd generations have a longer duration of action (they are not taken 3-4 times a day, like 1st generation drugs, but only 1-2 times), they act on various organs more specifically and give fewer side effects.3. The fact is that drugs of the second and third generations create a more uniform concentration in the blood and therefore less often have a negative effect on the body.

List of Top 7 Inexpensive and Effective Calcium Channel Blockers for Adults by KP

Together with experts, we have compiled a ranking of the best calcium channel blockers that are most popular with doctors and patients. However, “best” does not mean “universal”. Each drug has indications, contraindications and side effects.

For example, 2nd and 3rd generation calcium channel blockers are used for the permanent treatment of hypertension, but are not suitable for the relief of a hypertensive crisis.3. Therefore, with a sharp increase in blood pressure, an effective calcium channel blocker of the 1st generation, nifedipine, comes to the rescue. Half an hour after taking 1 tablet of nifedipine, blood pressure decreases by 20%3.

Only two CCBs are suitable for the treatment of arrhythmias – verapamil and diltiazem. These simple examples show that in each case, an effective calcium channel blocker must be selected by a doctor.

1. Amlodipine

Amlodipine is the most commonly prescribed CCB drug. The drug belongs to the latest generation of calcium channel blockers, it lowers blood pressure very well even with a single dose.

Amlodipine does not affect the conduction and contractility of the heart, and also reduces the frequency of angina attacks.4.

Contraindications to the use of Amlodipine: severe arterial hypotension, pregnancy, lactation, age up to 18 years, hypersensitivity to the drug, cardiogenic shock4.

Amplodipine is available under different trade names: Amlotop, Norvasc, Normodipin, Omelar Cardio, Amlovas, Tenox. Therefore, the price of the drug varies over a wide range and largely depends on the manufacturer.

Advantages and disadvantages

efficacy, few contraindications.
may cause swelling of the feet and legs, especially when the dosage is increased.

2. Lercanidipine

Lercanidipine is a latest generation calcium channel blocker used to treat grade 1-2 hypertension (mild to moderate)5. It is prescribed once a day, well tolerated by patients and very rarely gives such a side effect as swelling of the feet and legs.

Contraindications for use: untreated heart failure, individual intolerance, unstable angina pectoris, severe renal and hepatic failure, pregnancy, lactation, age up to 18 years5.

Other trade names for Lercanidipine are Lerkamen, Lercanorm, Lernikor. The price of the drug depends on the manufacturer and dosage.

Advantages and disadvantages

well tolerated, rarely causes swelling.
quite a wide range of contraindications.

3. Verapamil

Verapamil is the very first calcium channel blocker, which was synthesized in 1961 and still has not lost its relevance. The drug reduces the heart’s need for oxygen by reducing myocardial contractility and reducing heart rate, dilates the heart vessels and increases coronary blood flow6.

Verapamil is actively prescribed to patients with supraventricular arrhythmias, and is also used for the treatment and prevention of chronic stable angina pectoris.6.

Contraindicated in severe bradycardia, acute heart failure, chronic heart failure stages 2 and 36.

Verapamil is produced by domestic and foreign manufacturers. The drug is considered budgetary – a package of 30 tablets with a dosage of 80 mg can be bought for 50 rubles.

Advantages and disadvantages

well-studied drug with proven efficacy, affordable price in the segment.
like other CCBs of the 1st generation, the drug must be taken 3-4 times a day (prolonged forms of Verapamil are deprived of this drawback).

4. Nifedipine

Nifedipine belongs to the 1st generation calcium channel blockers, reduces blood pressure and myocardial oxygen demand, but does not have an antiarrhythmic effect.7. The drug is used to treat Prinzmetal’s angina and arterial hypertension.7.

There are also long-acting Nifedipine preparations that are prescribed once a day to control blood pressure (in particular, Nifecard XL belongs to them). Short-acting drugs are designed to quickly lower blood pressure: the well-known Corinfar is an example.

Contraindications for use: individual intolerance, hypotension, cardiogenic shock, severe aortic stenosis, severe heart failure7.

The pharmacy chain sells various drugs based on nifedipine. Most of them are budget. For example, Nifedipine in 10 mg tablets costs about 40–60 rubles (for a pack of 50 tablets).

Advantages and disadvantages

an inexpensive calcium channel blocker, there are drugs with short and prolonged action, which are suitable for the rapid reduction of blood pressure and the permanent treatment of hypertension.
can cause tachycardia, swelling of the legs, constipation, diarrhea, heartburn, headache.

5. Diltiazem

Diltiazem has almost the same effects as Verapamil. It can be used in the treatment of arterial hypertension, for the prevention of angina pectoris and supraventricular arrhythmia.8. However, Diltiazem is worse tolerated by patients and therefore less commonly used in medical practice.

The drug is contraindicated in acute heart failure, chronic heart failure stages 2 and 3, hypotension, cardiogenic shock, pregnancy, lactation, impaired liver and kidney function8.

Pharmacies sell Diltiazem of Russian and foreign production. The drug belongs to inexpensive calcium channel blockers – a package of 30 tablets of prolonged action costs about 200 rubles.

Advantages and disadvantages

There are prolonged dosage forms that are enough to take 1-2 times a day.
may cause side effects: drowsiness, headache, anxiety, dry mouth, nausea.

6. Felodipine

The 2nd generation calcium channel blocker Felodipine has a pronounced hypotensive effect. The drug lowers blood pressure 15-45 minutes after administration, and the effect lasts up to 24 hours9.

Felodipine is used to treat hypertension and stable angina9. It has been proven that its effectiveness does not depend on the age of the patient and the presence of chronic diseases. The drug does not affect metabolism, therefore it is suitable for patients with type 2 diabetes.

Felodipine is contraindicated in case of individual intolerance, pregnant women, children and adolescents under 18 years of age. You can not take the drug in acute myocardial infarction, stenosis of the heart valves, decompensated heart failure9.

Felodipine is more expensive than other drugs in the ranking. The average price for a pack of 30 tablets is 600 rubles.

Advantages and disadvantages

persistent hypotensive effect, well tolerated.
high price in the segment.

7. Cinnarizine

Cinnarizine in therapeutic doses has an expanding effect on the vessels of the brain and does not significantly affect the functioning of the heart and blood pressure.10. This drug is used for disorders of cerebral circulation, migraine, vestibular disorders (dizziness, tinnitus, sea and air sickness)10.

Cinnarizine is not prescribed for pregnant and lactating women, people with individual intolerance to the drug, children under 12 years of age.

Cinnarizine is inexpensive – for a pack of 50 tablets you need to pay 70-80 rubles. There are other cinnarizine preparations on sale, the most famous among them is Stugeron.

Advantages and disadvantages

minimal number of contraindications, good tolerability.
not very convenient regimen – 1-3 tablets 3 times a day.
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How to choose calcium channel blockers

– The choice of an effective calcium channel blocker is the doctor’s task. The specialist focuses primarily on the clinical situation, that is, the initial data that we have. These are the symptoms and complaints of the patient, the level of blood pressure, the presence of concomitant diseases, age, cardiovascular risk, impaired liver function, an allergic history and other factors,” notes cardiologist Viktoria Starosvetskaya.

Reviews of doctors about calcium channel blockers

“Calcium channel blockers are a very commonly used group of drugs,” our expert continues. – In my 14 years of practice, I have been prescribing CCB daily in the treatment of arterial hypertension, cardiac arrhythmias, coronary heart disease, etc.

– Calcium antagonists have been used in cardiology since the mid-70s and are highly effective drugs with good tolerance, – says PhD, cardiologist Tatyana Chernushenko. – Of course, this group has gained popularity among doctors. But the presence of undesirable and side effects in calcium antagonists indicates the need for an individual approach both to the appointment of this group in general and to the choice of a specific drug.

Popular questions and answers

Calcium channel blockers are prescribed to many patients, but not everyone knows how these drugs work and what side effects they can cause. The most popular questions about calcium channel blockers are answered by our experts: cardiologist Viktoria Starosvetskaya and cardiologist, Ph.D. Tatyana Chernushenko.

Why are calcium channel blockers prescribed?

Calcium antagonists have a positive effect on myocardial ischemia and are therefore used to treat stable exertional angina. They increase the patient’s tolerance for physical activity, reduce the number of angina attacks, and allow less frequent use of nitroglycerin (nitrates) preparations. In terms of effectiveness, CCBs are practically not inferior to nitrates and are superior to beta-blockers.

Calcium channel blockers are actively used in the treatment of arterial hypertension, hypertension and hypertrophic cardiomyopathy.

How many generations of drugs are released from calcium channel blockers?

Three generations. The first includes short-acting drugs – Nifedipine, Corinfar, Cordaflex. The second group includes two types of CCBs – prolonged forms of 1st generation drugs (Nifekard-XL, Diltiazem SR, Verapamil SR) and drugs with a more selective effect on calcium channels. Third generation drugs are Amlodipine, Lercanidipine, Normodipin and others.

Why are calcium channel blockers dangerous?

Different BPCs have their own contraindications, they are determined only by a doctor. If we talk about the most common side effects, then these are swelling of the legs, feet, redness of the skin with a feeling of heat and burning, an excessive decrease in blood pressure, slowing of the pulse, and constipation.

To avoid negative effects, calcium channel blockers, like all other drugs, should be taken strictly according to the doctor’s prescription, taking into account indications and contraindications. Self-medication is unacceptable.

Sources of:

  1. Magazine “Provisor” No. 6 for 2004. “Calcium channel blockers in cardiology”. S. Yu. Shtrygal, Doctor of Medical Sciences, Professor. https://provisor.com.ua/archive/2004/N6/art_12.php
  2. Guide to cardiology. Textbook for 2009, edited by Storozhakov G. I., Gorbachenkov A. A. Chapter 7 “Calcium Antagonists”. http://vmede.org/sait/?id=Gospitalnaya_ter_card_storojakova_2009_t3&menu=Gospitalnaya_ter_card_storojakova_2009_t3&page=9#header
  3. Russian medical journal No. 2 dated 27.01.2007/2009/3. Krasnitsky V. B. «Slow calcium channel blockers and their role in the treatment of arterial hypertension». http://vmede.org/sait/?id=Gospitalnaya_ter_card_storojakova_2009_t3&menu=Gospitalnaya_ter_card_storojakova_9_tXNUMX&page=XNUMX#header
  4. Vidal. Reference book of medicines. Amlodipine. https://www.vidal.ru/drugs/amlodipine__13202
  5. Vidal. Reference book of medicines. Lercanidipine. https://www.vidal.ru/drugs/lercanidipine-sz-1
  6. Vidal. Reference book of medicines. Verapamil. https://www.vidal.ru/drugs/verapamil__3479
  7. Register of medicines of Russia. Nifedipine. https://www.rlsnet.ru/drugs/nifedipin-2205
  8. Vidal. Reference book of medicines. Diltiazem. https://www.vidal.ru/drugs/diltiazem__4614
  9. Vidal. Reference book of medicines. Felodipine. https://www.vidal.ru/drugs/felodipine
  10. ideal. Reference book of medicines. Cinnarizine. https://www.vidal.ru/drugs/cinnarizin__31241

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