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Which Calcium Channel Blocker?


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  • Which Calcium Channel Blocker?

    My doctor's getting ready to add a Calcium Channel Blocker to my diet and i'm shopping around for one that's cheap and works well with Atenolol. I know we're 'all different', but if the majority of HCM'ers here are taking a certain combination with success, then i should think that's a good place to start.

    Which Calcium Channel Blocker are you taking with your Atenolol?

    "Some days you're the dog... some days you're the hydrant."

  • #2
    Re: Which Calcium Channel Blocker?

    I’m on 50mg of Atenolol of late, along with 360mg of Verapamil HCL SR. Just this year I went from 240mg to 360mg (with the diagnoses of HCM) but I’ve been mostly on both drugs for years. For me the mix seems to work very well together.

    At my insurance’s discount pharmacy, ninety 240mg tablets cost $29.84 – This is outside the insurance’s price which is less. If you care to buy from them yourself, they are at www.rxsolutions.com and they include the cost of postage in their prices. They’re located at;
    Prescription Solutions
    P. O. Box 509075
    San Diego, CA 92150-9075

    Once you have a prescription on file you can reorder by phone – 1(800)562-6223 – 24 hours a day – or through the website. They claim a turnaround time of ten days from receipt of the order, but for me, they always seem to beat that time – sometimes by a week. I believe they wish to fill 90 day orders to save postage, and would prefer to have the prescriptions with refills indicated.

    Hope this is of help to you, or anybody else who might be able to save some money on their drugs.


    • #3
      Re: Which Calcium Channel Blocker?

      Thanks Burton,

      That's great info!

      Seems like a lot of folks are taking Verapamil with their Atenolol, and if it seems to be a good combination for most people, i want to suggest it to my doctor. He talked about starting me on 180mg of a Calcium Channel Blocker and backing me down to 100mg of Atenolol. When i meet with him again next week i want to have some options ready. Granted he has the last word, but i don't have prescription coverage, and i want to steer him away from anything too expensive if possible.

      Which Calcium Channel Blocker is everyone else taking?

      "Some days you're the dog... some days you're the hydrant."


      • #4
        Re: Which Calcium Channel Blocker?

        Hey Jim,
        What do you mean about your doctor that, “Granted he has the last word.” I would never grant any of my doctors the last word. They are there to suggest any tests they feel are warranted, and using their expertise, to make diagnoses and suggest courses of action. Once agreed to, they are there to implement the action or actions selected.

        If it’s my life involved, I make the final selection. It may turn out to be my last word, but its mine to give or not give. I strongly suspect that you were just using a figure of speech, since he is the trained specialist and should be given heed. However if it were me, I would take the approach that, “A number of my HCM friends have suggested I try Verapamil with the Atenolol. What are your views on the matter?” If he did not agree, I would want to know the reason why. (It might in fact be valid in your particular case.)

        Just thought I’d do a little nit picking while contemplating my navel.


        • #5
          Re: Which Calcium Channel Blocker?

          Now Burton... let's not get too nitpicky here

          Since i'm paying a specialist to manage my care, i should hope that he is better trained than i am to make decisions concerning my meds. Also, i am not licensed to write my own prescriptions, so he really does technically have the final word. He certainly seems like the kind of guy who listens to his patients concerns, and i'm sure the dialogue concerning my meds will be an open one. I just want to do my homework so i'm prepared.

          So to repeat my original question:

          Would anyone mind telling me what Calcium Channel Blockers they're taking with their Atenolol?

          "Some days you're the dog... some days you're the hydrant."


          • #6
            Re: Which Calcium Channel Blocker?

            Hi Jim,
            To make up for nit picking on you, here are the list of calcium channel blockers I was able to find. Maybe it will help you in your research.

            Drug-Specific Effects (also see Table 1)
            • Dihydropyridines (e.g. nifedipine, nicardipine, and nimodipine)
            o Vasodilatation of arterial resistance vessels causes a reflex increase in sympathetic response
             Because the dihydropyridines have very weak effects on the SA node and AV junction, there is an increase in heart rate due to the increase in sympathetic tone
             Any weak direct negative inotropic effect of the drug is overwhelmed by the strong reflex sympathetic response
            o The overall hemodynamic effect is a drop in blood pressure, an increase in heart rate and contractility, and an increase in cardiac output
            • Verapamil
            o At doses that cause peripheral vasodilatation, verapamil has greater direct negative chronotropic, dromotropic (conduction), and inotropic effects than the dihydropyridines
            o The drug's direct negative chronotropic and dromotropic effects are able to overcome any reflex sympathetic response to the lowering of blood pressure, resulting in a drop in heart rate
            o The drug's direct negative inotropic effects can also overcome the reflex sympathetic response, resulting in a lowering of myocardial contractility
            o In patients with left ventricular dysfunction where sympathetic tone may already be high, the drug can can cause a dangerous decrease in contractility
            • Diltiazem
            o The hemodynamic effects of diltiazem are intermediate between the dihydropyridines and verapamil
            o The drug causes a modest lowering of heart rate and modest decrease in myocardial contractility, both of which are less than verapamil for a given drop in blood pressure
            • Mibrefradil
            o This agent is a potent peripheral and coronary vasodilator. Its chronic effects on blood pressure, heart rate, and cardiac conduction velocity (PQ interval) are comparable to those of verapamil and diltiazem
            o In contrast to verapamil and diltiazem, this agent appears to have negligible negative inotropic effects
            o In contrast to the dihydropyridines, reflex tachycardia does not occur with mibefradil
            o This drug was voluntarily withdrawn from the market by Roche on June 8, 1998 less than one year after its introduction due to interactions with a variety of commonly used drugs

            Table 1. Relative Cardiovascular Effects of Prototypical Calcium Channel Blockers (adapted from Goodman and Gilman (9th ed.) and Massie, Am. J. Cardiol. 80(9A)23I-32I(1997)).
            Compound Coronary Vasodilation Suppresion of Cardiac Contractility Suppresion of SA Node Suppression of AV Node
            Verapamil ++++ ++++ +++++ +++++
            Diltiazem +++ ++ +++++ ++++
            Nifedipine +++++ + + 0
            Nicardipine +++++ 0 + 0
            Bepridil (+++) (+++) (+++++) (++++)
            Mibefradil (++++) (0) (++++) (++++)
            The relative effects are ranked from no effect (0) to most prominent (+++++). Effects indicated in parentheses are estimated effects.

            Hope this is of some help. The table seems to have suffered from the boards’ compression algorithm, but hopefully you can still make it out. Take care, and let us know how things work out.