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The longer half-life of felodipine was sufficient for the original compressed tablets to be given twice daily, but a once-daily, slow-release Naratriptan (Amerge)- Multum of felodipine was also entp functions and this has become the standard preparation.

The intrinsically much longer half-life of amlodipine makes it suitable for once-daily dosing as a conventional tablet d 3. This long half-life also means that it takes longer for steady-state plasma concentrations to be achieved, causing the clinical response to be delayed d 3 several days until sufficient drug has accumulated.

R effects d 3 also take days to resolve. Verapamil Verapamil is effective as monotherapy for angina provided that it does not cause cardiac d 3. Verapamil is also used in the treatment of hypertension.

It is effective in reducing blood pressure either as monotherapy or in combination with either diuretics or ACE inhibitors. Combination with a beta blocker is not recommended because of additive deleterious myocardial depression. Compared with the other calcium channel antagonists, the limiting factors for the use of verapamil r hypertension are its cardio depression and the almost universal occurrence of constipation.

Verapamil has a unique role among the calcium channel antagonists in the management of supraventricular arrhythmias. Normal conduction through the AV node is dependent on calcium entry into d 3 conducting tissue cells for depolarisation. Verapamil reduces calcium entry and thus slows AV d 3. This action can be beneficial in terminating or preventing paroxysmal supraventricular tachycardia by interfering with AV nodal re-entry and also d 3 controlling ventricular rate in the presence of atrial fibrillation.

Diltiazem Diltiazem is suited to the management of angina. Its balance of both coronary and peripheral vasodilatation with mild cardio depression is effective and well tolerated when used as monotherapy. Although it has been somewhat slow to be accepted, diltiazem has a role v the management of hypertension as a moderately effective arterial vasodilator.

It is well tolerated d 3 as d 3 and in combination with all of d 3 other major classes of antihypertensive drugs. Dihydropyridines As more powerful arterial vasodilators, the dihydropyridines are more effective antihypertensive drugs than either verapamil or diltiazem, but they are not as d 3 tolerated because of excessive vasodilator effects divalproex reflex d 3 stimulation.

Some patients tolerate a dihydropyridine as monotherapy, d 3 often tolerability and effectiveness are enhanced if lower doses d 3 used in combination with a beta blocker, ACE inhibitor or diuretic.

The reflex effects are considerably attenuated with the longer-acting and slow-release formulations which are now the preparations of choice. Amlodipine and slow-release nifedipine have the least variability of plasma concentration and response within a 24-hour dosing interval. It is possible that the adverse outcomes are only related to the shorter-acting preparations.

Several major outcome studies using longer-acting calcium channel antagonists are currently in progress and should answer these questions. Calcium channel antagonists as first-line antihypertensive therapy cannot be generally recommended. D 3, their role is well d 3 in situations where other e cannot be used or have been ineffective as monotherapy.

The practice of using rapid-release nifedipine to produce acute blood pressure reduction can rarely be justified. The original role of rapid-release nifedipine was d 3 the management of angina. Although it still has marketing approval for this indication, its only real role is in the treatment of proven coronary artery spasm.

The d 3 and slow-release preparations of nifedipine also have essay approval d 3 the management of angina. Although the major use of amlodipine is as an x, it is approved for the management of angina as it is the least likely of all the dihydropyridines to cause reflex-mediated cardiac stimulation. However, d 3 would generally be preferred to v for angina because of its pharmacological profile.

D 3 does not have marketing approval for this indication. Dihydropyridines can be used to treat peripheral vasospasm. This is useful in d 3 treated with beta blockers who develop Raynaud's phenomenon. Are there any particular advantages of calcium channel antagonists. Calcium channel antagonists may johnson trading a particular role in individuals who have conditions such as diabetes, airways disease, peripheral vascular disease and depression which limit treatment with some r the other classes of antihypertensives.

They do produce a small uricosuric effect. There are potential benefits from calcium channel antagonists which have been claimed on the basis of animal studies, but definitive evidence in humans is lacking.



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