2.6 Nitrates and other vasodilators and calcium channel blockers
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2.6.1 Nitrates |
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Glyceryl trinitrate tabs S/L 500mcg |
F |
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Glyceryl trinitrate spray 400mcg |
F |
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Glyceryl trinitrate buccal tabs 1mg, 2mg, 3mg, 5mg |
F |
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Glyceryl trinitrate inj 25mg/5ml |
F |
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Glyceryl trinitrate patch 5mg/24hr |
F |
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Glyceryl trinitrate patch 10mg/24h |
F |
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Isosorbide mononitrate CR tabs 60mg |
F |
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Isosorbide mononitrate tabs 10mg, 20mg |
F |
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Isosorbide mononitrate tabs 40mg |
F |
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2.6.2 Calcium-channel blockers |
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Amlodipine tablets 5mg, 10mg |
F |
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Diltiazem tablets CR 60mg |
F |
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F |
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Nifedipine capsules 5mg, 10mg |
F |
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F |
(See notes) |
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Nimodipine injection 10mg/50ml |
R |
Subarachnoid Haemorrhage - Give injection via central line. |
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Nimodipine tablets 30mg |
R |
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Verapamil tablets SR 120mg, 240mg |
F |
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Verapamil injection 5mg/2ml |
F |
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Verapamil tablets 40mg, 80mg, 120mg |
F |
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The calcium channel blockers have pharmacological profiles which are reflected in their indications for use and adverse effects.
The bradycardic properties of diltiazem may be of benefit in the treatment of angina. Verapamil is of most use as an antiarrhythmic agent due to its blocking action at the AV node. The nodal blocking properties of both diltiazem and verapamil mean that conduction disturbances may occur. Constipation is the commonest side effect reported with verapamil.
Nifedipine and amlodipine are licensed for use in the management of both angina and hypertension. Amlodipine can be given in a once-daily dosage due to its long half-life, and 5mg daily would be an effective antihypertensive dose for most patients. Flushing, headache and ankle oedema occur more commonly with nifedipine than amlodipine.
N.B. A number of controlled or modified release preparations of diltiazem are now available. These should be prescribed by brand name, e.g. Tildiem LA 300mg o.d., to avoid confusion.
Adalat LA produces less fluctuation in plasma levels and switching from Adalat Retard is recommended.
* Tildiem Retard 90mg b.d. is bioequivalent to Tildiem LA 200mg o.d. and Tildiem Retard 120mg b.d. is bioequivalent to Tildiem LA 300mg o.d.
Diltiazem and Verapamil should be used with caution when co-administered with beta-blockers due to the risk of bradycardia and AV block. They should also be avoided in PR with heart failure.
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2.6.3 Potassium-channel activators |
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Nicorandil tablets 10mg, 20mg |
F |
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2.6.4 Peripheral and cerebral vasodilators and related drugs |
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These drugs are not established as being effective,although they may increase blood flow at rest |
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