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The use of selective calcium antagonism in variant (vasospastic) and classical (effort) angina pectoris

  • P. H. Kidner
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 40)

Summary

The calcium-entry blockers as a group are effective in the clinical management of both vasospastic and effort angina. Nifedipine and diltiazem are more effective for the former and diltiazem and verapamil for the latter. Lidoflazine is effective against effort angina. Diltiazem has the lowest incidence of side effects. Verapamil is contra-indicated in the presence of left ventricular dysfunction and high degree of atrio-venthcular block. It should be used with caution with the beta-adrenergic blocking agents. Lidoflazine and nifedipine can be combined with the beta-adrenergic blocking agents and can also be given to patients with left ventricular dysfunction. Lidoflazine must not be given to patients with pre-existing prolongation of the QT interval or with drugs likely to prolong it such as quinidine and disopyramide. The experience with diltiazem is not sufficient to comment usefully on drug combinations nor is it possible to say whether the calcium-entry blockers can be given together with added clinical efficacy or safety.

Keywords

Angina Pectoris Calcium Antagonist Myocardial Blood Flow Coronary Artery Spasm Effort Angina 
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.

Résumé

Les bloqueurs de l’entrée de calcium en tant que groupe sont efficaces dans le traitement clinique de l’angor vasospastique et de l’angor d’effort. La nifédipine et le diltiazem sont plus efficaces pour le premier et le diltiazem et le vérapamil le sont davantage pour le second. La lidoflazine est efficace contre l’angor d’effort. Le diltiazem comporte le moins d’effets secondaires. Le vérapamil est contre-indiqué dans le cas d’un dysfonctionnement ventriculaire gauche et d’un bloc auriculo-ventriculaire d’un degré élevé. Il faut être très prudent quand on associe le vérapamil avec agents bloquants bêta-adrénergiques. Quant à la lidoflazine et la nifédipine, elles peuvent être combinées avec des bloquants bêta-adrénergiques et elles peuvent être administrées à des patients présentant un dysfonctionnement ventriculaire gauche. La lidoflazine ne peut pas être administrée à des patients présentant une prolongation préexistante de l’intervalle QT ou recevant des substances susceptibles de le prolonger, comme la quinidine et le disopyramide. L’expérience menée avec le diltiazem n’est pas suffisante pour que l’on puisse se prononcer valablement sur les combinaisons de substances. Il n’est pas possible de dire si la combinaison de divers bloqueurs d’entrée de calcium peut augmenter leur efficacité clinique ou l’innocuité du traitement.

Resumen

Los inhibidores de la penetración intracelular de Ca2+ son generalmente eficaces en el tratamiento clínico de angina tanto vasoespástica como de esfuerzo. Nifedipino y diltiazem son más eficaces en la primera, y diltiazem y verapamilo en la segunda. Lidoflazina es eficaz contra angina de esfuerzo. Diltiazem tiene la incidencia más baja de efectos secundarios. Verapamilo está contraindicado en la presencia de disfunción del ventrículo izquierdo y en altos grados de obstrucción atrioventricular. Se debería emplearlo cuidadosamente con agentes bloqueadores beta-adrenérgicos. Nifedipino y lidoflazina pueden ser combinadas con estos ültimos, y también administradas a pacientes con disfunción del ventrículo izquierdo. No se puede administrar lidoflazina a pacientes con prolongación preexistente del intervalo QT o con drogas que tienden a prolongarlo, tales como quinidina y disopiramida. La experiencia con diltiazem no es suficiente para poder dar comentario útil en lo de las combinaciones de fármacos, tampoco es posible decir si inhibidores de la penetración intracelular de Ca2+ pueden ser ad-ministrados juntos para mejorar la eficacia clínica o la seguridad.

Zusammenfassung

Die Kalziumeinstromhemmer sind zur klinischen Behandlung vasospastischer wie auch klassischer Angina erfolgreich zu verwenden. Nifedipin und Diltiazem ergeben bei der erstgenannten, Diltiazem und Verapamil bei der letztgenannten Form die besten Ergebnisse. Lidoflazin ist mit Erfolg bei klassischer Angina zu verwenden. Diltiazem hat die wenigsten Nebenwirkungen. Verapamil ist bei linksventrikulärer Dysfunktion und bei ausgeprägtem Vorhofkammerblock kontraindiziert. Bei gemeinsamer Verabreichung mit Betabiockern ist es mit besonderer Vorsicht zu verwenden. Nifedipin oder Lidoflazin darf zusammen mit Betabiockern verabreicht werden und ist zur Behandlung von Patienten mit linksventrikulärer Dysfunktion geeignet. Der letztere Stoff darf nicht an Patienten mit verlängertem QT-Intervall oder zusammen mit Arzneimitteln, die voraussichtlich eine solche Wirkung hervorrufen, wie Chinidin und Disopyramid, verabreicht werden. Für Diltiazem besteht keine ausreichende Information, um über mögliche Arzneimittelkombinationen eine Aussage zu machen. Auch weiss man noch nicht, ob nach gleichzeitiger Verabreichung mehrerer Kalziumeinstromhemmer erhöhte klinische Wirksamkeit und Sicherheit bestehen.

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Copyright information

© Martinus Nijhoff Publishers, The Hague 1984

Authors and Affiliations

  • P. H. Kidner

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