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ISRADIPINE
Indications
hypertension
Cautions
sick sinus syndrome (if pacemaker not
fitted); avoid grapefruit juice (may affect metabolism);
poor cardiac reserve;
interactions: Appendix 1 (cal-
cium-channel blockers)
Contra-indications
cardiogenic shock;
symptomatic
or tight aortic stenosis;
during or within 1 month of
myocardial infarction;
unstable angina;
acute por-
phyria (section 9.8.2)
Hepatic impairment
reduce dose
Renal impairment
reduce dose
Pregnancy
may inhibit labour;
risk to fetus should be
balanced against risk of uncontrolled maternal
hypertension
Breast-feeding
manufacturer advises avoid—present
in milk in
animal
studies
Side-effects
abdominal discomfort;
tachycardia,
pal-
pitation,
flushing,
peripheral oedema; dyspnoea;
headache,
fatigue,
dizziness;
polyuria; rash;
less com-
monly
hypotension, weight gain;
very rarely
vomiting,
nausea,
gum hyperplasia,
anorexia,
drowsiness,
arrhythmia, bradycardia,
heart failure,
cough,
depression,
paraesthesia,
anxiety,
erectile dysfunc-
tion,
blood disorders (such as thrombocytopenia,
leucopenia,
anaemia), arthralgia,
visual disturbance,
hypersensitivity reactions;
hepatitis and gynaeco-
mastia also reported
Dose
. 2.5 mg twice daily,
increased if necessary after 3–4
weeks to 5 mg twice daily (exceptionally up to 10 mg
twice daily);
ELDERLY
(or in hepatic or renal impair-
ment) 1.25 mg twice daily, increased if necessary after
3–4 weeks according to response,
maintenance dose
of 2.5 mg or 5 mg once daily may be sufficient
Prescal
c
(Novartis) A
Tablets
,
yellow,
scored,
isradipine 2.5 mg,
net price
56-tab pack = £16.54
LACIDIPINE
Indications
hypertension
Cautions
cardiac conduction abnormalities;
poor car-
diac reserve;
avoid grapefruit juice (may affect
metabolism); interactions: Appendix 1 (calcium-
channel blockers)
Contra-indications
cardiogenic shock,
unstable
angina,
aortic stenosis;
avoid within 1 month of
myocardial infarction;
acute porphyria (section 9.8.2)
Hepatic impairment
antihypertensive effect possibly
increased
Pregnancy
manufacturer advises avoid; may inhibit
labour
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
flushing,
palpitation,
oedema; headache,
dizziness;
rarely
gastro-intestinal disturbances,
gum
hyperplasia,
aggravation of angina,
mood distur-
bances,
asthenia,
polyuria, muscle cramps, skin rash
(including pruritus and erythema)
Dose
. Initially 2 mg as a single daily dose,
preferably in the
morning; increased after 3–4 weeks to 4 mg daily, then
if necessary to 6 mg daily
Motens
c
(Boehringer Ingelheim) A
Tablets
,
both f/c,
lacidipine 2 mg,
net price 28-tab
pack = £2.95;
4 mg (scored),
28-tab pack = £3.10
LERCANIDIPINE HYDROCHLORIDE
Indications
mild to moderate hypertension
Cautions
left ventricular dysfunction;
sick sinus
syndrome (if pacemaker not fitted);
avoid grapefruit
juice (may affect metabolism);
interactions: Appen-
dix 1 (calcium-channel blockers)
Contra-indications
aortic stenosis;
unstable angina,
uncontrolled heart failure;
within 1 month of myo-
cardial infarction;
acute porphyria (section 9.8.2)
Hepatic impairment
avoid in severe disease
Renal impairment
avoid if eGFR less than 30 mL/
minute/1.73 m
2
Pregnancy
manufacturer advises avoid—no informa-
tion available
Breast-feeding
manufacturer advises avoid
Side-effects
less commonly
flushing,
peripheral
oedema, palpitation, tachycardia, headache, dizziness;
rarely
gastro-intestinal disturbances, angina, asthenia,
drowsiness,
polyuria, myalgia,
rash;
very rarely
gin-
gival hyperplasia,
myocardial infarction,
hypotension
Dose
. Initially 10 mg once daily; increased, if necessary, after
at least 2 weeks to 20 mg daily
Lercanidipine Hydrochloride
(Non-proprietary) A
Tablets
,
lercanidipine hydrochloride 10 mg,
net price
28-tab pack = £5.32;
20 mg,
28-tab pack = £8.56.
Label:
22
Zanidip
c
(Recordati) A
Tablets
,
f/c,
lercanidipine hydrochloride 10 mg (yel-
low), net price 28-tab pack = £5.70; 20 mg (pink), 28-
tab pack = £10.82.
Label:
22
NICARDIPINE HYDROCHLORIDE
Indications
prophylaxis of angina;
mild to moderate
hypertension
Cautions
withdraw if ischaemic pain occurs or existing
pain worsens within 30 minutes of initiating treatment
or increasing dose;
congestive heart failure or signif-
icantly impaired left ventricular function;
elderly;
avoid grapefruit juice (may affect metabolism);
interactions: Appendix 1 (calcium-channel blockers)
Contra-indications
cardiogenic shock;
advanced aor-
tic stenosis; unstable or acute attacks of angina; avoid
within 1 month of myocardial infarction;
acute por-
phyria (section 9.8.2)
Hepatic impairment
half-life prolonged in severe
impairment—may need dose reduction
Renal impairment
start with small dose
Pregnancy
may inhibit labour;
toxicity in
animal
stu-
dies;
manufacturer advises avoid, but risk to fetus
should be balanced against risk of uncontrolled
maternal hypertension
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
dizziness,
headache,
peripheral oedema,
flushing,
palpitation,
nausea;
also gastro-intestinal
disturbances,
drowsiness,
insomnia,
tinnitus,
hypo-
tension,
rashes,
dyspnoea,
paraesthesia,
frequency of
micturition;
thrombocytopenia,
depression and
impotence reported
BNF 61
2.6.2 Calcium-channel blockers
131
2
Cardiovascular system