[Are all calcium antagonists alike?].
The group of calcium channel blockers includes drugs with marked structural differences and hence different fundamental pharmacodynamic and pharmacokinetic properties. The combination of these properties characterizes the different hemodynamic and electrophysiological effects of individual calcium antagonists as well as their profile of adverse effects. In treatment of essential hypertension the most important criteria for choosing one of the calcium antagonists are the rate of adverse effects, which is different between individual drugs of this class, and the possibility of once-daily administration to improve compliance. The effect on blood pressure in contrast is comparable for all calcium antagonists. In ischemic heart disease with markedly reduced left-ventricular function verapamil, diltiazem, but also nifedipine should be avoided as these drugs have important negative inotropic effects which may induce congestive heart failure and adversely affect prognosis. For monotherapy in this indication verapamil and diltiazem are drugs of first choice in patients with normal left-ventricular function, whereas second generation calcium antagonists of the dihydropyridine class can be given also in patients with reduced left-ventricular function and in combination with beta-blockers. Dihydropyridine derivatives with reflectory increase of sympathetic tone, such as nifedipine, should be administered in combination with beta-blockers only. Whereas calcium antagonists are first-line drugs for antihypertensive and anti-ischemic treatment, results in secondary prevention after myocardial infarction are rather disappointing when compared with established alternatives.
Bertel
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Medizinische Klinik, Stadtspital Triemli, Zürich.
D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000493:pharmacokinetics*; D003327:Coronary Disease / Q000188:drug therapy*; D004110:Diltiazem / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D009543:Nifedipine / Q000009:adverse effects / Q000627:therapeutic use; D014700:Verapamil / Q000009:adverse effects / Q000627:therapeutic use
D002121:Calcium Channel Blockers; D014700:Verapamil; D004110:Diltiazem; D009543:Nifedipine
Sind alle Kalziumantagonisten gleich?