Calcium Channel Blockers

amlodipine (Norvasc®):

Adult (usual) Angina: 5-10 mg po qd.
Hypertension initial: 5 mg po qd; maintenance 5-10 mg po qd.
FDA labeled indications: Angina, stable or unstable; Hypertension. Small, fragile, or elderly individuals, or patients with hepatic insufficiency may be started on 2.5 mg once daily and this dose may be used when adding Norvasc® to other antihypertensive therapy.

Titration: In general, titration should proceed over 7 to 14 days so that the physician can fully assess the patient's response to each dose level.
[Supplied: 2.5, 5, 10mg tab]

Studies in Patients with Congestive Heart Failure:

Study: (PRAISE-2) randomized patients with NYHA class III (80%) or IV (20%) heart failure without clinical symptoms or objective evidence of underlying ischemic disease, on stable doses of ACE inhibitor (99%), digitalis (99%) and diuretics (99%), to placebo (n=827) or NORVASC (n=827) and followed them for a mean of 33 months. There was no statistically significant difference between NORVASC and placebo in the primary endpoint of all cause mortality (95% confidence limits from 8% reduction to 29% increase on NORVASC). With NORVASC there were more reports of pulmonary edema.

bepridil (Vascor®):

Adult (usual) Angina: 200-300 mg po qd; Maximum 400 mg once daily. [Supplied: 200, 300 mg tab] FDA labeled indications: Angina (second-line therapy)

diltiazem (Cardizem ®):

Adult (usual) Oral:
Angina: (regular release tablets) initial 30 mg po qid; usual dose 180-360 mg po daily (maximum 360 mg daily). Angina: (extended release capsule; Dilacor(R) XR), initial 120 mg po qd; usual dose 120-480 mg once daily, maximum 540 mg/day. Hypertension: (Cardizem SR), initial 60-120 mg po q12h.; usual dose 120-180 mg bid, maximum 360 mg/day. Hypertension: ( Dilacor(R) XR): initial, 120-240 mg orally once daily; titrate after 14 days; usual dose, 240-360 mg orally once daily, maximum 540 mg/day.

Arrhythmia: (IV bolus), initial 0.25 mg/kg (or 20 mg) IV over 2 minutes; if inadequate response, may give second bolus 0.35 mg/kg (25 mg) after 15 min Arrhythmia: (IV continuous infusion), initial 5-10 mg/hr; increase in 5 mg/hr increments up to 15 mg/hr maintained for up to 24 hr.

Higher doses - Continuous infusion ??:

Crit Care Med. 2001 Jun;29(6):1149-53. Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias.
Group 1 received diltiazem in a 25-mg bolus followed by a continuous infusion of 20 mg/hr for 24 hrs, group 2 received amiodarone in a 300-mg bolus, and group 3 received amiodarone in a 300-mg bolus followed by 45 mg/hr for 24 hrs. CONCLUSION: Sufficient rate control can be achieved in critically ill patients with atrial tachyarrhythmias using either diltiazem or amiodarone. Although diltiazem allowed for significantly better 24-hr heart rate control, this effect was offset by a significantly higher incidence of hypotension requiring discontinuation of the drug. Amiodarone may be an alternative in patients with severe hemodynamic compromise.

Conversion from I.V. diltiazem to oral diltiazem: Start oral approximately 3 hours after bolus dose. Oral dose (mg/day) is approximately equal to [rate (mg/hour) x 3 + 3] x 10.
5 mg/hour = 180 mg/day;
7 mg/hour = 240 mg/day
11 mg/hour = 360 mg/day

[Supplied: Immediate release tablets: 30, 60, 90, 120 mg. Sustained released capsules (SR): 60, 90, 120mg. Extended release capsules (CD): 120,180,240,300,360 mg. Vials (IV): 25, 50, 125 mg (5 mg/ml) ]

felodipine (Plendil®):

Adult (usual) Angina: 2.5-5 mg po bid. CHF: initial, 5 mg po qd (Maint: 5 mg po bid). HTN: initial, 5 mg po qd. (Maint: 2.5-10 mg po qd.) Raynaud's phenomenon: 10-20 mg po qd.

Administration: avoid taking with grapefruit juice. Dose adjustments should be made at intervals of not less than 2 weeks.
[Supplied 2.5 mg, 5 mg, 10 mg ER tab]

isradipine (Dynacirc®):

Adult (usual) HTN: initial: 2.5 mg po bid (maintenance: 2.5-10 mg po bid); maximum 20 mg/day. HTN: (controlled release tablet) initial: 5 mg po qd, maintenance: 5-10 mg once daily; maximum 20 mg/day.
[Supplied: 2.5 mg, 5 mg capsule. 5 mg, 10 mg controlled release tablet]

nicardipine (cardene®):

Adult (usual) Oral: Angina, Hypertension: (immediate release): Initial, 20 mg po tid. Maintenance, 20-40 mg po tid. Hypertension: (sustained release capsule): Initial - 30 mg po bid. Maintenance: 30-60 mg po bid.

IV: Hypertension: initial, 5 mg/hr IV infusion. Titrate 2.5 mg/hr at 5-15 min intervals. Maximum rate of 15 mg/hr. Hypertension: maintenance (after reaching BP goal): 3 mg/hr IV .

[Supplied: 20, 30mg capsule. 2.5 mg/ml soln -inj. 30, 45, 60mg SR capsule.]

nifedipine (Procardia®):

Adult (usual) Angina: (immediate-release): Initial: 10 mg orally tid. Maintenance: 10-30 mg po 3-4 times daily - maximum 180 mg/day. Angina: (sustained-release): Initial 30-60 mg po qd. Maximum 120 mg/day.
Hypertension: sustained release tablet: initial 30-60 mg po qd. Maintenance: 30-90 mg po qd with a maximum dose of 120 mg/day.
Preeclampsia: (immediate-release): 10 mg po or SL q4h. May switch to sustained-release tablet for maintenance. Raynaud's Disease (immediate-release capsule): 10-20 mg orally tid or 30 to 60 mg (sustained-release) tablet orally once daily.

[Supplied: immediate release 10mg, 20mg capsule. Extended release tablet: 30, 60, 90mg]

nisoldipine (Sular®):

Adult (usual): Hypertension: initial: 20 mg po qd (Maint: 20-40 mg po qd - maximum 60 mg daily)
[Supplied: 10, 20, 30, 40mg ER Tablet]

verapamil (Isoptin ® )

Adult (usual):
Angina: (extended-release) initial: 180 mg po qd at bedtime. Titrate up to 480 mg at bedtime- maximum 540 mg at bedtime. (immediate release) initial: 80 mg po tid - may titrate at daily or weekly intervals to 360 mg daily.
Arrhythmias, supraventricular: (immediate-release) initial: 240-320 mg po daily in 3-4 divided doses. Non-digitalized patients may require up to 480 mg daily in 3-4 divided doses. Arrhythmias, supraventricular: 5-10 mg IV (0.075-0.15 mg/kg) IV bolus over 2 min. May give additional 10 mg after 30 minutes if no response.
Hypertension: (extended-release) initial, 180 mg tablet po qd at bedtime OR 200 mg capsule po qd at bedtime. Maintenance: titrate up to 480 mg TAB qd at hs or 400 mg capsule po qd at hs.
Hypertension: (immediate-release) initial- 80 mg po tid. May titrate at daily or weekly intervals to 360-480 mg daily. Hypertension: (sustained-release) initial: 240 mg orally once daily in the morning. Maintenance (based on response): titrate up to 240 mg bid (tablet) or 480 mg (capsule) once a day in the morning.
Migraine headache, prophylaxis: 80 mg po 3-4 times daily.

[Supplied:
Immediate release tablet: 40, 80, 120mg.
Sustained release tablets (SR): 120, 180, 240 mg.
Sustained released capsules (Verelan): 120,180,240,360mg.
Covera HS (extended release tab): 180,240mg.
Verelan PM (ER cap): 100,200,300mg. ]
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Dosing (Adults):
Angina: Oral: Initial: 80-120 mg twice daily (elderly or small stature: 40 mg twice
daily); range: 240-480 mg/day in 3-4 divided doses

Hypertension: Oral:
Immediate release: 80 mg 3 times/day; usual dose range (JNC 7): 80-320 mg/day in 2 divided doses.
Sustained release: 240 mg/day; usual dose range (JNC 7): 120-360 mg/day in 1-2 divided doses; 120 mg/day in the elderly or small patients (no evidence of additional benefit in doses >360 mg/day).
Extended release:
Covera-HS®: Usual dose range (JNC 7): 120-360 mg once daily (once-daily dosing is recommended at bedtime)
Verelan® PM: Usual dose range: 200-400 mg once daily at bedtime

Arrhythmia (SVT): I.V.: 2.5-5 mg (over 2 minutes); second dose of 5-10 mg (~0.15 mg/kg) may be given 15-30 minutes after the initial dose if patient tolerates, but does not respond to initial dose; maximum total dose: 20 mg

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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