Experiences with Calcium Channel Blockers for Hypertension?

[Lily]

My cardiologist may change my hypertension medication from an Angiotensin Receptor Blocker to a Calcium Channel Blocker.

Does anyone have any experience or knowledge or opinion that they care to share about this class of medication?

Thank you :smile2:

 

[Bill B]

As a class, they have been around for over 30 years and are very effective antihypertensives, especially against systolic hypertension. As the name denotes, they interfere with calcium transport across cell membranes into cells, and this causes relaxation of vascular smooth muscle (vasodilation). Some of the older agents, like verapamil and diltiazem, have more effect on heart muscle contraction, as well, slowing heart rate and force. Many of the newer agents do not have much cardiac effect, which may be a good thing in heart failure, but it also makes them somewhat less effective as antihypertensives and may require other measure to reduce heart rate response to vasodilation. In my experience, the most common side effect is foot swelling.

Bill, retired pharmacist

 

[Duff Man]

i tried them... most notable side effects for me were constipation and heart burn.

 

[Lily]

Thank you Bill. I appreciate the info. The swelling is exactly what the cardio told me to keep an eye out for, though I thought he said to watch for it in the ankle. Or leg? Anyway, I'll read the sheet on it closely. He prescribed Norvasc.

Thank you Duff Man. I knew about the heartburn. My dad was on very high doses of Verapamil for several years because of genetic hypertrophic cardiomyopathy -- he felt like that med was what kept him alive -- but I later wondered if it had contributed to his adenocarcinoma of the esophagus, even though his serious heartburn was a lifelong issue.

I appreciate your replies.

Does anyone else take Calcium Channel Blockers? Or, specifically, Norvasc? One nice thing about having to change meds is that the Norvasc is dramatically less expensive than the previous hypertensive medication I've been on.

 

[Lily]

I wanted to bump this thread up.
Does anyone have any experience with Calcium Channel Blockers, or Norvasc specifically?

There have been so few comments.
And so now I'm wondering: Is a Calcium Channel Blocker fairly unusual to prescribe for a valve replacement patient with hypertension?

Then I searched around and found this on Wikipedia and wondered further:

Contraindications:
breast feeding
cardiogenic shock
unstable angina
aortic stenosis: amlodipine causes vasodilation, which can result in reduced cardiac output in patients with severe aortic stenosis.

Thanks :smile2:

 

[Bill B]

CCBs, like Norvasc (generically amlodipine), are quite commonly used for HTN in patients like you or me. Hopefully you don't have AS any more since your valve was replaced, but even if you did, that caution about reducing CO in AS is, as far as I can determine, incorrect. In the face of AS, CCBs can cause too far of a drop in BP not CO, which would be hypotension, and this would only be in rather severe AS. If anything, amlodipine may raise CO slightly in you or me as it does not blunt the cardiac response to lowering blood pressure. I don't think there is a concern there for you or me.

The edema associated with CCBs is foot, ankle, lower extremity. Perhaps people notice it more in the ankle. Some even see it in their hands.

See how it goes. Although, like most drugs, there are a huge variety of possible side effects, like Duffman had, these are usually well-tolerated, very effective drugs for HTN.

I'm currently on metoprolol, lisinopril and very low dose hydrochlorthiazide for HTN. Generally I decry "polypharmacy" like this, but over all these combinations work very well for me and others. I'm losing weight and exercising more and hope to drop the hydrochlothiazide soon, and maybe the whole bunch later. Exercise has a profound affect on my blood pressure, so I need to keep that up.

 

[Mentu]

Several months ago, my cardiologist had me begin taking Verapamil (Brand names: Calan, Covera, Isoptin or Verelan) chemical name "Iproveratril Hydrochloride". The primary side effect has been extreme constipation - the kind where you consider going to the emergency room. After my initial brush with it, my family doctor stressed the need to take a daily dose of Benefiber & Miralax. I take 2 teaspoons of each in the evening and as I have discovered it is essential to do so. Skipping a dose is not a problem if you've been taking the two regularly.

Larry

 

[Bill B]

I should add I did take amlodipine for a month or so but had to stop due to foot and ankle swelling. I did not experience constipation, like Larry and Duff, but I eat a large bowl of raisin bran at least once a day.

 

[Adrienne]

I took Cardazem (sp) for about 7 weeks before and 5 weeks after my surgery. I also experienced extreme constipation.

 

[Lily]

Very helpful information -- all.

Thank you again, Bill. And thank you, Larry and Adrienne.

 

[Bill B]

Iron binds me up, but I did not notice constipation with amlodipine. Just to put it in perspective, constipation is not even in the top 10 of reported side effects, and diarrhea is almost as common. Edema (swelling) is number one and it is uncommon except on higher doses. So, although we have constipation at 3 for 3 here with CCBs, that doesn't mean you should expect it.

 

[Lily]

An observation, and an update, and a question, and a disclaimer --

Over the years I've noticed that some medication side effects seem to go away. With the ARBs, however, their side effects gradually manifested themselves and then became much worse -- for me.

I'm not aware of any severe side effects with the CCB. Swollen ankles come and go each day. My weight hasn't changed.

However, I've very strangely bitten the inside of my mouth twice since I started Norvasc, and yesterday I badly bit the back of my tongue and it is still very painful; and I wasn't eating. This is unusual for me. I'm wondering if this a side effect that might go away or a side effect that might get worse?

Yes, I know: "Call your doctor!" But he's a new cardiologist to me and he's hard to get ahold of and he didn't want to switch me from Avapro anyway. So I'd rather not call him, unless I have to :eek2: but of course I will if necessary.

 

[Lily]

Well, that's the end of that, and after only two weeks. My tongue swelling issue seemed to have resolved but my feet and ankles started swelling worse and then suddenly swelled up in a shocking way last evening. And so after a Sunday call to the cardiology group, no more CCB for me. I've had my feet elevated half the day and they're still huge. And uncomfortable past my knees. Ugh.