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Side-effects
abdominal pain,
nausea;
palpitation,
flushing,
oedema;
headache,
dizziness,
sleep distur-
bances,
fatigue;
less commonly
gastro-intestinal dis-
turbances,
dry mouth,
taste disturbances,
hypo-
tension, syncope, chest pain, dyspnoea, rhinitis, mood
changes,
asthenia,
tremor,
paraesthesia, urinary dis-
turbances,
impotence,
gynaecomastia,
weight
changes,
myalgia,
muscle cramps,
back pain,
arthr-
algia,
visual disturbances,
tinnitus,
pruritus,
rashes
(including isolated reports of erythema multiforme),
sweating,
alopecia,
purpura,
and skin discolouration;
very rarely
gastritis,
pancreatitis,
hepatitis,
jaundice,
cholestasis,
gingival hyperplasia, myocardial infarc-
tion,
arrhythmias,
tachycardia, vasculitis,
coughing,
peripheral neuropathy,
hyperglycaemia, thrombocy-
topenia,
angioedema,
and urticaria
Dose
. Hypertension or angina,
initially 5 mg once daily;
max.
10 mg once daily
Note
Tablets from various suppliers may contain different salts
(e.g. amlodipine besilate,
amlodipine maleate,
and amlodipine
mesilate) but the strength is expressed in terms of amlodipine
(base);
tablets containing different salts are considered inter-
changeable
Amlodipine
(Non-proprietary) A
Tablets
, amlodipine (as maleate or as mesilate) 5 mg,
net price 28-tab pack = £1.05;
10 mg,
28-tab pack =
£1.20
Brands include
Amlostin
c
Istin
c
(Pfizer) A
Tablets
,
amlodipine (as besilate) 5 mg,
net price 28-
tab pack = £11.08;
10 mg,
28-tab pack = £16.55
With valsartan
Note
For hypertension in patients stabilised on the individual
components in the same proportions.
For prescribing infor-
mation on valsartan,
see section 2.5.5.2
Exforge
c
(Novartis) T A
Tablets 5/80
,
f/c,
dark yellow,
amlodipine 5 mg,
valsartan 80 mg,
net price 28-tab pack = £13.97
Tablets 5/160
,
f/c,
dark yellow,
amlodipine 5 mg,
valsartan 160 mg,
net price 28-tab pack = £18.41
Tablets 10/160
,
f/c,
light yellow,
amlodipine 10 mg,
valsartan 160 mg,
net price 28-tab pack = £18.41
DILTIAZEM HYDROCHLORIDE
Indications
prophylaxis and treatment of angina;
hypertension
Cautions
heart failure or significantly impaired left
ventricular function, bradycardia (avoid if severe), first
degree AV block,
or prolonged PR interval; interac-
tions: Appendix 1 (calcium-channel blockers)
Contra-indications
severe bradycardia, left ventri-
cular failure with pulmonary congestion,
second- or
third-degree AV block (unless pacemaker fitted),
sick
sinus syndrome; acute porphyria (section 9.8.2)
Hepatic impairment
reduce dose
Renal impairment
start with smaller dose
Pregnancy
avoid
Breast-feeding
significant amount present in milk—
no evidence of harm but avoid unless no safer alter-
native
Side-effects
bradycardia, sino-atrial block,
AV block,
palpitation,
dizziness,
hypotension,
malaise,
asthenia,
headache,
hot flushes,
gastro-intestinal disturbances,
oedema (notably of ankles);
rarely rashes (including
erythema multiforme and exfoliative dermatitis),
photosensitivity;
hepatitis,
gynaecomastia,
gum
hyperplasia,
extrapyramidal symptoms,
depression
reported
Dose
. Angina,
60 mg 3 times daily (elderly initially twice
daily); increased if necessary to 360 mg daily
. Longer-acting formulations,
see under preparations
below
Standard formulations
Note
These formulations are licensed as generics and there is
no requirement for brand name dispensing. Although their
means of formulation has called for the strict designation
‘modified-release’ their duration of action corresponds to that
of tablets requiring administration 3 times daily
Diltiazem
(Non-proprietary) A
Tablets
,
m/r (but see note above), diltiazem hydro-
chloride 60 mg,
net price 84 = £2.93.
Label:
25
Brands include
Optil
c
Tildiem
c
(Sanofi-Aventis) A
Tablets
, m/r (but see note above), off-white, diltiazem
hydrochloride 60 mg,
net price 90-tab pack = £7.96.
Label:
25
Longer-acting formulations
Note
Different versions of modified-release preparations con-
taining more than 60 mg diltiazem hydrochloride may not have
the same clinical effect. To avoid confusion between these
different formulations of diltiazem,
prescribers should specify
the brand to be dispensed
Adizem-SR
c
(Napp) A
Capsules
,
m/r,
diltiazem hydrochloride 90 mg
(white),
net price 56-cap pack = £8.45;
120 mg
(brown/white), 56-cap pack = £9.40; 180 mg (brown/
white),
56-cap pack = £14.08.
Label:
25
Tablets
,
m/r,
f/c,
scored,
diltiazem hydrochloride
120 mg,
net price 56-tab pack = £14.72.
Label:
25
Dose
mild to moderate hypertension, usually 120 mg twice daily
(dose form not appropriate for initial
dose titration)
Angina,
initially 90 mg twice daily (elderly,
dose form not appro-
priate for initial dose titration); increased to 180 mg twice daily if
required
Adizem-XL
c
(Napp) A
Capsules
,
m/r,
diltiazem hydrochloride 120 mg
(pink/blue),
net price 28-cap pack = £9.09;
180 mg
(dark pink/blue),
28-cap pack = £10.32;
200 mg
(brown), 28-cap pack = £6.66; 240 mg (red/blue), 28-
cap pack = £11.46;
300 mg (maroon/blue), 28-cap
pack = £9.09.
Label:
25
Dose
angina and mild to moderate hypertension, initially 240 mg
once daily, increased if necessary to 300 mg once daily; in elderly
and in hepatic or renal
impairment,
initially 120 mg daily
Angitil SR
c
(Chiesi) A
Capsules,
m/r,
diltiazem hydrochloride 90 mg
(white),
net price 56-cap pack = £7.03;
120 mg
(brown), 56-cap pack = £6.91; 180 mg (brown), 56-cap
pack = £13.27.
Label:
25
Dose
angina and mild to moderate hypertension,
initially 90 mg
twice daily; increased if necessary to 120 mg or 180 mg twice daily
Angitil XL
c
(Chiesi) A
Capsules
,
m/r,
diltiazem hydrochloride 240 mg
(white),
net price 28-cap pack = £7.94;
300 mg (yel-
low), 28-cap pack = £6.98.
Label:
25
Dose
angina and mild to moderate hypertension, initially 240 mg
once daily (elderly and in hepatic and renal
impairment,
dose
form not appropriate for initial dose titration);
increased if
necessary to 300 mg once daily
BNF 61
2.6.2 Calcium-channel blockers
129
2
Cardiovascular system