Toxicity

The common side effects seen in chronic therapy (Table 19.3) are mostly related to vasodilation—headaches, dizziness, facial flushing, hypotension, and so forth. High doses of verapamil in elderly patients are known to cause constipation. Serious side effects, especially following the intravenous use of verapamil, include marked negative inotropic effects and depression of preexisting sick sinus syndrome, A-V nodal disease, and enhancement of the action of other cardiodepressant drugs. Their use is generally contraindicated in obstructive conditions (e.g., aortic stenosis). No consistent or significant changes in lipid and glucose levels have been reported with chronic therapy. Non-sustained release formulations of nifedipine are contraindicated in hypertension because of sympathetic rebound that may aggravate existing left ventricular dysfunction.

TABLE 19.3 Adverse Effects of Calcium Channel Blockers

Verapamil Diltiazem Nifedipine

Tachycardia 0 0 +

Decreased heart rate* + + 0

Negative inotropy ++ + 0

Vasodilation (flushing, edema, hypotension, headaches) + +/0 + + +

*Marked effect in presence of sick sinus syndrome and A-V nodal disease.

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