Calcium-channel blockers are used to treat various conditions of the heart and blood vessels. For example, they are used in the treatment of angina, high blood pressure and Raynaud's phenomenon.
What are calcium-channel blockers?
Calcium-channel blockers (sometimes called calcium antagonists) are a group of medicines that affect the way calcium passes into certain muscle cells. They are used to treat various conditions, including high blood pressure, angina, Raynaud's phenomenon and some abnormal heart rhythms (arrhythmias). They are also used to try to stop premature labour in pregnancy.
A calcium-channel blocker can be used alone. However, one is often combined with another medicine to treat high blood pressure or angina, when one medicine alone has not worked so well.
How do calcium-channel blockers work?
The heart is mainly made of special muscle cells which contract to pump blood into the blood vessels (arteries). The walls of the arteries also contain 'smooth' muscle cells. When these contract, the artery narrows. The heart muscle cells and smooth muscle cells need calcium to contract. Calcium passes into these cells via tiny 'channels'.
Calcium-channel blockers reduce the amount of calcium that goes into these muscle cells. This causes these muscle cells to relax. So, the effects of these medicines are:
- To widen the arteries, which:
- Reduces the blood pressure.
- Helps to ease angina by widening the coronary arteries.
- Can ease symptoms of Raynaud's phenomenon. In this condition you have cold and painful fingers and toes caused by narrowing of the arteries in the hands and feet.
- To reduce the force and rate of the heartbeat. This helps to prevent angina pains.
When a pregnant woman goes into labour too early, calcium-channel blockers stop the muscles of the womb (uterus) from contracting.
Different types of calcium-channel blockers
Different types of calcium-channel blockers differ in the main sites of action in the body. Therefore, different types are used for different conditions.
Angina and high blood pressure are commonly treated with verapamil. It is also used to treat certain abnormal heart rhythms (arrhythmias). This is because it also blocks calcium going into the special conducting cells in the heart and so it can slow the heart rate. You should not take verapamil in addition to a beta-blocker medicine.
Angina and high blood pressure are treated with diltiazem. It is sometimes used to treat arrhythmias, such as atrial fibrillation. It can be used in addition to a beta-blocker if this combination is necessary.
As a rule, you should not take verapamil or diltiazem if you have heart failure. This is because they 'relax' the heart and can make heart failure worse.
Dihydropyridine calcium-channel blockers
These include amlodipine, felodipine, lacidipine, lercanidipine, nicardipine, nifedipine and nimodipine. These have more effect on relaxing blood vessels and less effect on relaxing the heart muscle than verapamil or diltiazem. Most are used to treat high blood pressure or angina. (Lacidipine and lercanidipine are only used to treat high blood pressure.) Nifedipine is also used to treat Raynaud's phenomenon.
As they do not affect the special conducting cells in the heart much, dihydropyridine calcium-channel blockers are not useful for arrhythmias. They are also unlikely to make heart failure worse. They are safe to take with a beta-blocker. In fact, a dihydropyridine calcium-channel blocker plus a beta-blocker medicine are commonly taken together to prevent angina pains, if one or the other does not work well enough alone.
What are the possible side-effects?
Most people who take calcium-channel blockers have no side-effects, or only minor ones. Because their action is to relax and widen blood vessels (arteries), some people develop flushing and headache. These tend to ease over a few days if you continue to take the tablets. Mild ankle swelling is also quite common, particularly with dihydropyridine calcium-channel blockers.
Constipation is quite a common side-effect, especially with verapamil. You can often deal with this by increasing the amount of fibre that you eat and increasing the amount of water and other fluids that you drink.
Other side-effects are uncommon and include feeling sick, palpitations, tiredness, dizziness and rashes. This is not a complete list of all possible known side-effects. Read the information leaflet that comes with your particular brand for a full list of possible side-effects. However, be optimistic - don't necessarily be put off taking these tablets. Serious side-effects are rare and it's wise not to stop calcium-channel blockers without speaking to your doctor.
Some people who suddenly stop taking a calcium-channel blocker have a 'rebound' flare-up of angina. Therefore, it is best not to stop taking these medicines without first consulting a doctor.
If you are taking a calcium-channel blocker, do not drink grapefruit juice. This can interact with the medicine and alter its effect.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.
Further reading & references
- British National Formulary; NICE Evidence Services (UK access only)
- Raynaud's phenomenon; NICE CKS, April 2014 (UK access only)
- Angina; NICE CKS, October 2015 (UK access only)
- Hypertension - not diabetic; NICE CKS, October 2015 (UK access only)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Jacqueline Payne
Dr Helen Huins