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Back one screen: left arrow Back to main menu: ESC CALCIUM CHANNEL BLOCKERS : TOXICITY Adverse Reactions and Overdose Toxicity: * CV: Peripheral edema (especially with nifedipine), hypoten- sion, bradycardia (rare with nifedipine), congestive heart failure. Overdosage can produce marked hypotension and bradycardia (especially verapamil) and/or conduction block. * CNS: Dizziness and headache (especially nifedipine), sleep disturbances, blurred vision. * GI and metabolic: Nausea (especially nifedipine), constipation (especially verapamil). Exacerbation of noninsulin-dependent (Type II) diabetes has been reported. * Treatment of overdosage: Sympathomimetics and a transvenous pacemaker may be needed. Parenteral calcium may be tried cau- tiously. (PgDn key for more text) Interactions * CV Depressants: Additive effects on cardiac contractility, automaticity and AV conduction. * Pharmacokinetic: Verapamil and possibly nifedipine may in- crease digoxin blood levels, but the clinical significance of the effect is minimal. References: 1. Johnson SM et al: A controlled trial of verapamil for Prinzmetal's variant angina. N Engl J Med 1981; 304: 862. 2. Lindenberg BS et al: Efficacy and safety of incremental doses of diltiazem for the treatment of stable angina pectoris. J Am Coll Cardiol 1983; 2:1129. 3. McAllister RG, Hamann SR, Blouin RA: Pharmacokinetics of calcium-entry blockers. Am J Cardiol 1985; 55:30B. 4. Muller JE et al: Nifedipine and conventional therapy for un- stable angina pectoris: a randomized, double-blind com- parison. Circulation 1984; 69: 728. 5. Weiner DA et al: Efficacy and safety of verapamil in patients with angina pectoris after 1 year of continuous, high-dose therapy. Am J Cardiol 1983; 51:1251. (Home to return to top of file)

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