Johns Hopkins Diabetes GuideMedicationsHypertensionCalcium Channel Blockers

Calcium Channel Blockers

Brian Pinto, Pharm.D.
Calcium Channel Blockers is a topic covered in the Johns Hopkins Diabetes Guide.

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INDICATIONS

FDA

  • Hypertension
  • See table below for calcium channel blocker - specific indications

Dihydropyridine

FDA indication

Pharmacokinetics

Pregnancy Risk Category/ Breastfeeding Risk

Cost and Formulation

Amlodipine

Treatment of HTN; treatment of chronic stable angina

A: ~ 65% oral

M: extensive oxidative metabolism

E: 60% renal, 25% fecal

t1/2 = 30- 50 hours

Category C

Excretion in breast milk unknown

Generic available

2.5 mg (30 tab): $5.69

5mg (30 tab): $7.67

10mg (30 tab): $8

Nifedipine (extended-release)

Treatment of HTN

A: 65-90%

M: Hepatic via CYP3A4

E: urine 60-80%

t1/2 = 7 hrs

Category C

Enters breast milk (AAP considers compatible)

Generic extended-release

30 mg (30 tab): $38

60 mg (30 tab): $60

90 mg (30 tab) $68

Felodipine

Treatment of HTN

A: 100%

M: CYP3A4 substrate, extensive first-pass

E: urine 70% as metabolites

t1/2 = 10-16 hours

Category C

Enters breast milk/ not recommended

Generic available

2.5 mg (30 tab): $43

5 mg (30 tab): $50

10 mg (30 tab) $ 57.72

Non-

dihydropyridine

Verapamil

Treatment of HTN, angina pectoris, supraventricular tachyarrhythmia

A: 90%

M: extensive first-pass via multiple CYP isoenzymes

E: urine 70% as metabolites

t1/2: 5-12 hours, 14-16 hours (severe hepatic impairment)

Category C

Enters breast milk

WHO Rating: compatible

AAP Rating: usually compatible

Generic available

Verapamil, 24 hr capsule
100 mg (100): $149.98
120 mg (30): $27.31
180 mg (30): $26.99
200 mg (30): $72.91
240 mg (30): $27.43
300 mg (30): $104.09
360 mg (30): $62.99

Diltiazem

Treatment of HTN, chronic stable angina or angina from coronary spasm

A: ~95%

M:extensive first-pass metabolism

E: urine 35%

t1/2: 5-10 hours

Category C

Enters breast milk

AAP Rating: compatible

Generic capsule available
120mg(30): $23.99
180mg(30): $27.99
240mg(30): $43.99
300mg(30): $75.99

**Patient Assistant Programs:
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** Information gathered by Heather Tran and Gladimir Elysee

A = absorption; M = metabolism; E = excretion; AAP = American Academy of Pediatrics

NON-FDA APPROVED USES

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Last updated: September 26, 2013