2.6.2 Calcium-channel blockers

General guidance

• Calcium-channel blockers differ in their predilection for the various possible sites of action and, therefore, their therapeutic effects are disparate.
• Amlodipine may be a useful option in the presence of left ventricular dysfunction.
• Diltiazem or verapamil are useful options in angina or as adjuvants to beta-blockers in angina in secondary prevention after non-Q wave myocardial infarction (in the absence of LV dysfunction) or if beta-blockers are contra-indicated.
• Once daily drugs should be preferred to twice daily agents
• Short acting formulations such as nifedipine capsules are not recommended
• Modified release preparations should be prescribed by brand name and not written generically in order to ensure that patients continue to receive the brand they have been stabilised on. There is a significant difference in cost between different brands of the same preparation.
• Verapamil is contraindicated with beta-blockers.

Recommended drugs

Amlodipine maleate £

Felodipine ££

Nifedipine  (prescribe as Adipine MR bd and Coracten XL for od dosing) ££

Verapamil ££

Diltiazem MR (prescribe by brand as Angitil MR twice daily or Viazem XL/Zemtard XL once daily for dosing) ££

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low