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Side Effects and Contraindications Drug Interactions and Combinations

  • Lionel H. Opie
  • William A. Coetzee

Summary

With the correct selection of drug and patient, the calcium antagonists as a group can be remarkably effective at relatively low cost of serious side effects. Almost all side effects are dose related. Minor side effects include those caused by vasodilation (flushing and headaches), constipation (verapamil), and ankle edema. Serious side effects are rare and result from improper use of these agents, as when intravenous verapamil (or diltiazem) is given to patients with sinus or atrioventricular nodal depression from drugs or disease, or nifedipine to patients with aortic stenosis. The potential of a marked negative inotropic effect is usually offset by afterload reduction, especially in the case of nifedipine which actually has the most marked negative inotropic effect. Yet caution is required when even calcium antagonists, especially verapamil, are given to patients with myocardial failure unless caused by hypertensive heart disease. Drug interactions of calcium antagonists occur with other cardiovascular agents such as α-adrenergic blockers, β-adrenergic blockers, digox in, quinidine, and disopyramide. The most marked interaction with digoxin is that with verapamil, which may raise digoxin levels by over 50%. Combination therapy of calcium antagonists with β-blockers is increasingly common, and is probably safest in the case of dihydropyridines. Other combinations being explored are those with angiotensin-converting enzyme inhibitors and diuretics.

Keywords

Angina Pectoris Calcium Antagonist Aortic Stenosis Calcium Channel Antagonist Isosorbide Dinitrate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Lionel H. Opie
    • 1
    • 2
  • William A. Coetzee
    • 3
  1. 1.University of Cape TownCape TownSouth Africa
  2. 2.Division of CardiologyStanford University Medical CenterStanfordUSA
  3. 3.Heart Research UnitUniversity of Cape TownSouth Africa

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