Calcium channel blockers for coronary artery disease

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Calcium channel blockers help treat coronary artery disease by:

• Increasing blood flow to the heart muscle by expanding (dilating) the coronary arteries.
• Possibly help to prevent a spasm of the coronary arteries.
• Lowering blood pressure and the workload on the heart, which allows the heart muscle to function with less oxygen and blood flow.
• Sometimes slowing a rapid heart rate and controlling irregular heart rhythms.

Calcium channel blockers are commonly used in people with coronary artery disease who have one or more of the following conditions:¹

• Stable angina
• Episodes of spasm affecting the coronary arteries
• Inability to take beta-blockers, or beta-blockers are ineffective in controlling a rapid heart rhythm

Calcium channel blockers can help reduce the severity and frequency of chest pain when beta-blockers cannot be used.¹ Unlike beta-blockers, however, these medications do not reduce your risk of a future heart attack.

Side effects vary depending on the drug, but may include:

• Slowed heart rate or irregular heart rhythm.
• Flushing, a pounding sensation in the head, dizziness, headache.
• Leg swelling.
• Decreased blood pressure.
• Tingling sensations in the arms or legs.
• Weakness.
• Constipation.

Nifedipine, verapamil, and diltiazem may cause skin rash or breast enlargement.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Calcium channel blockers are most effective when they are combined with nitrates and beta-blockers, but their dosage must be monitored carefully to prevent side effects. Nifedipine, nicardipine, amlodipine, and felodipine are used most commonly in people already taking beta-blockers. You can also take amlodipine in a combination dose with the statin atorvastatin, which treats high cholesterol. Therefore, this combination helps reduce chest pain and treats high cholesterol at the same time.

In general, the long-acting forms (taken once a day) of calcium channel blockers are preferred over the short-acting forms (taken 2 to 4 times per day).

Verapamil, diltiazem, and nifedipine may worsen heart failure. Amlodipine, felodipine, and nisoldipine do not appear to worsen heart failure.

Verapamil or diltiazem sometimes are used when a person cannot take beta-blockers.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Snow V, et al. (2004). Primary care management of chronic stable angina and asymptomatic suspected or known coronary artery disease: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 141(7): 562–567. Also available online: http://www.annals.org/cgi/reprint/141/7/562.pdf.