page153
Coracten XL
c
(UCB Pharma) A
Capsules
,
m/r,
nifedipine 30 mg (brown),
net price
28-cap pack = £4.89;
60 mg (orange),
28-cap pack =
£7.34.
Label:
25
Dose
hypertension and angina prophylaxis, 30 mg once daily,
increased if necessary;
max.
90 mg once daily
Fortipine LA 40
c
(Goldshield) A
Tablets
,
m/r,
red,
nifedipine 40 mg,
net price 30-tab
pack = £9.60.
Label:
21,
25
Dose
hypertension and angina prophylaxis, 40 mg once daily,
increased if necessary to 80 mg daily in 1–2 divided doses
Hypolar
c
Retard 20
(Sandoz) A
Tablets
, m/r, red, f/c, nifedipine 20 mg, net price 56-
tab pack = £5.75.
Label:
25
Dose
hypertension and angina prophylaxis, 20 mg twice daily,
increased if necessary to 40 mg twice daily
Nifedipress
c
MR
(Dexcel) A
Tablets
, m/r, pink, nifedipine 10 mg, net price 56-tab
pack = £9.23; 20 mg,
56-tab pack = £10.06.
Label: 25
Dose
hypertension and angina prophylaxis, initially 10 mg twice
daily adjusted according to response to 40 mg twice daily
Note
Also available as
Calchan
c
MR
,
Kentipine
c
MR
Tensipine MR
c
(Genus) A
Tablets
,
m/r,
pink-grey,
nifedipine 10 mg,
net price
56-tab pack = £4.30;
20 mg,
56-tab pack = £5.49.
Label:
21,
25
Dose
hypertension and angina prophylaxis, initially 10 mg twice
daily adjusted according to response to 40 mg twice daily
Valni XL
c
(Winthrop) A
Tablets
,
m/r,
red,
nifedipine 30 mg,
net price 28-tab
pack = £7.29;
60 mg,
28-tab pack = £9.13.
Label:
25
Cautions
dose form not appropriate for use in hepatic impair-
ment,
or where there is a history of oesophageal or gastro-intes-
tinal obstruction,
decreased lumen diameter of the gastro-intes-
tinal tract,
inflammatory bowel disease, or ileostomy after
proctocolectomy
Dose
severe hypertension and prophylaxis of angina,
30 mg
once daily,
increased if necessary to max.
90 mg once daily
With atenolol
Section 2.4
NIMODIPINE
Indications
prevention and treatment of ischaemic
neurological deficits following aneurysmal subarach-
noid haemorrhage
Cautions
cerebral oedema or severely raised intra-
cranial pressure;
hypotension;
avoid concomitant
administration of nimodipine tablets and infusion,
other calcium-channel blockers,
or beta-blockers;
concomitant nephrotoxic drugs; avoid grapefruit juice
(may affect metabolism);
interactions: Appendix 1
(calcium-channel blockers,
alcohol (infusion only))
Contra-indications
within 1 month of myocardial
infarction;
unstable angina;
acute porphyria (section
9.8.2)
Hepatic impairment
elimination reduced in cirrh-
osis—monitor blood pressure
Renal impairment
manufacturer advises monitor
renal function closely with intravenous administration
Pregnancy
manufacturer advises use only if potential
benefit outweighs risk
Breast-feeding
manufacturer advises avoid—present
in milk
Side-effects
hypotension, variation in heart-rate,
flushing,
headache,
gastro-intestinal disorders,
nausea,
sweating and feeling of warmth;
thrombocy-
topenia and ileus reported
Dose
. Prevention,
by mouth,
60 mg every 4 hours, starting
within 4 days of aneurysmal subarachnoid haemorr-
hage and continued for 21 days
. Treatment,
by intravenous infusion via central
catheter,
initially 1 mg/hour (up to 500 micrograms/
hour if body-weight less than 70 kg or if blood pres-
sure unstable), increased after 2 hours to 2 mg/hour if
no severe fall in blood pressure; continue for at least 5
days (max.
14 days); if surgical intervention during
treatment,
continue for at least 5 days after surgery;
max.
total duration of nimodipine use 21 days
Nimotop
c
(Bayer Schering) A
Tablets
, yellow, f/c, nimodipine 30 mg, net price 100-
tab pack = £33.60
Intravenous infusion
,
nimodipine 200 micrograms/
mL;
also contains ethanol 20% and macrogol ‘400’
17%. Net price 50-mL vial (with polyethylene infusion
catheter) = £11.46
Note
Polyethylene,
polypropylene,
or glass apparatus should be
used;
PVC should be avoided
VERAPAMIL HYDROCHLORIDE
Indications
see under Dose and preparations
Cautions
first-degree AV block;
acute phase of myo-
cardial infarction (avoid if bradycardia,
hypotension,
left ventricular failure);
patients taking beta-blockers
(important: see below); avoid grapefruit juice (may
affect metabolism); interactions: Appendix 1 (cal-
cium-channel blockers)
Verapamil and beta-blockers
Verapamil injection should
not be given to patients recently treated with beta-blockers
because of the risk of hypotension and asystole.
The sug-
gestion that when verapamil injection has been given first, an
interval of 30 minutes before giving a beta-blocker is suffi-
cient has not been confirmed.
It may also be hazardous to give verapamil and a beta-
blocker together by mouth (should only be contemplated if
myocardial function well preserved).
Contra-indications
hypotension, bradycardia, sec-
ond- and third-degree AV block, sick sinus syndrome,
cardiogenic shock,
sino-atrial block;
history of heart
failure or significantly impaired left ventricular func-
tion,
even if controlled by therapy;
atrial flutter or
fibrillation associated with accessory conducting
pathways (e.g. Wolff-Parkinson-White syndrome);
acute porphyria (section 9.8.2)
Hepatic impairment
oral dose may need to be
reduced
Pregnancy
may reduce uterine blood flow with fetal
hypoxia; manufacturer advises avoid in first trimester
unless absolutely necessary;
may inhibit labour
Breast-feeding
amount too small to be harmful
Side-effects
constipation;
less commonly nausea,
vomiting, flushing, headache, dizziness, fatigue, ankle
oedema; rarely allergic reactions (erythema, pruritus,
urticaria,
angioedema,
Stevens-Johnson syndrome);
myalgia,
arthralgia,
paraesthesia, erythromelalgia;
increased prolactin concentration;
rarely gynaeco-
mastia and gingival hyperplasia after long-term
treatment;
after intravenous administration or high
doses,
hypotension,
heart failure,
bradycardia, heart
block,
and asystole
Dose
. By mouth,
supraventricular arrhythmias (but see also
Contra-indications),
40–120 mg 3 times daily
Angina,
80–120 mg 3 times daily
Hypertension, 240–480 mg daily in 2–3 divided doses
BNF 61
2.6.2 Calcium-channel blockers
133
2
Cardiovascular system