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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 commonly prescribed to manage 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.

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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 muscle cells of the artery and the smooth muscle cells of the heart need calcium to contract. Calcium passes into these cells via tiny 'channels'. Therefore calcium-channel blockers tend to relax the wall of the heart and blood vessels.

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 treat 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 heart rate. This helps to prevent angina, including the associated chest pain.

When a pregnant woman goes into labour too early, calcium-channel blockers stop the muscles of the womb (uterus) from contracting.

Types of calcium channel blockers

Different types of calcium channel blockers differ in the main sites of action in the body:

Dihydropyridine calcium-channel blockers

These include:

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 have very little effect on the special conducting cells in the heart, this type of calcium-channel blocker is not useful for arrhythmias. It is unlikely to make heart failure worse. It is safe to take with a beta-blocker.

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What conditions do calcium channel blockers treat?

Calcium channel blockers are most often used for treating high blood pressure (hypertension) or angina. If you need more than one blood pressure medication, a doctor may prescribe a calcium channel blocker in combination with one or two other medicines, such as an ACE inhibitor or diuretic.

If you’ve been prescribed a calcium channel blocker for angina, you may also receive other medications, such as a beta-blocker or nitrate, to help control your symptoms.

As a rule, you should not take verapamil or diltiazem if you have heart disease or heart failure. This is because they have an effect on the heart muscle that makes it 'relax' and can make heart failure worse.

Are calcium channel blockers safe?

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.

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Calcium channel blockers side-effects

Some calcium channel blockers react with grapefruit juice to increase the amount of medicine in your blood and so increase the risk of side-effects. This particularly applies to amlodipine, felodipine, lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine and verapamil. Always read the information provided with your medicine and check with your pharmacist or doctor if you have any concerns.

Constipation is quite a common side-effect of calcium channel blockers, 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:

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 with your doctor.

How long can you take calcium channel blockers for?

Hypertension is generally treated for life, as the medications only work while you are taking them. However, if you can change a significant risk factor, then your blood pressure might fall naturally and you might not need the drugs any more. So, for example, if you drink a lot of alcohol and manage to stop, or you have obesity and manage to lose a lot of weight, you might be able to come off the medications. If you do have a lifestyle change like this and start to feel dizzy then get your blood pressure checked, both sitting and standing, as it may be that it is now too low and you need to stop some of the tablets. It is probably less common to be able to stop calcium channel blockers which are taken for angina.

Further reading and references

Article history

The information on this page is written and peer reviewed by qualified clinicians.

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