Combination therapy with diltiazem and propranolol: Precipitation of congestive heart failure

Strauss, William; Egan, Thomas J.; McIntyre, Kevin M.; Parisi, Alfredf .

doi:10.1002/clc.4960080612

Cited by 17 publications

(5 citation statements)

References 13 publications

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“…The combined treatment with β-blockers and calcium channel blockers has additive effects on heart rate, cardiac conduction and cardiac contractility. Cases have been documented on concurrent treatment with these two classes of drugs leading to congestive heart failure, hypotension, bradycardia or even cardiogenic shock [ 71 , 72 ]. We identified that potential DDIs were common when Clopidogrel was used with Pantoprazole, and when Clopidogrel was used with Atorvastatin.…”

Section: Discussionmentioning

confidence: 99%

Patterns and Characteristics of Polypharmacy Among Elderly Residents in Danish Nursing Homes

et al. 2020

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Aim: To identify patterns and characteristics of polypharmacy among elderly residents in Danish nursing homes in the Northern region of Denmark. Materials & methods: Twenty-five nursing homes were contacted, where each supplied 20 randomly selected anonymized residents’ information. Residents were 65 years or older, concurrently taking five or more medications. Drug–drug interactions and potential adverse effects were investigated. Results: One hundred residents (68% females; 32% males) were included. The most prevalent co-morbid condition was cardiovascular disease, and the most prevalent medications were for gastrointestinal- and metabolism-related conditions. Age influenced the number of drugs (p = 0.013) and drug–drug interactions per resident (p = 0.039), with a positive correlation. Conclusion: Elderly residents of the studied nursing homes were potentially affected by an inappropriate polypharmacy.

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Section: Discussionmentioning

confidence: 99%

Patterns and Characteristics of Polypharmacy Among Elderly Residents in Danish Nursing Homes

et al. 2020

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“…In contrast to felodipine, calcium antagonists with no or low vascular selectivity have clinically important pharmacodynamic interactions with @-blockers, since both groups of drugs have significant inhibitory effects on cardiac contractility and conduction ( 3 3 1, 90,94,105,115). Additive cardiodepression resulting in severe conduction disturbances or heart failure has been reported with the combination of verapamil and a P-blocker (90,115).…”

Section: Pharmacokinetic and Pharmacodynamic Interactionsmentioning

confidence: 94%

“…Additive cardiodepression resulting in severe conduction disturbances or heart failure has been reported with the combination of verapamil and a P-blocker (90,115). Diltiazem also has significant negative inotropic and dromotropic effects and combination with a P-blocker may cause adverse cardiac effects (51,105). Even with nifedipine, which has a moderate degree of vascular selectivity and is generally well tolerated in combination with a @-blocker, there have been occasional reports of precipitation of heart failure (3, 94).…”

Section: Pharmacokinetic and Pharmacodynamic Interactionsmentioning

confidence: 98%

Tolerability and Safety of Felodipine

Elvelin

Kennerfalk

Elmfeldt

1993

Cardiovascular Drug Reviews

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Felodipine (Plendil@/Flodil@/Modip@, Astra) is a highly vascular selective calcium antagonist of the dihydropyridine type. At present, some 300 clinical studies involving more than 8,000 patients have been carried out with felodipine, the majority with hypertension but a substantial number also with other indications, such as angina pectoris and heart failure.In the early clinical studies, felodipine was given as conventional tablets twice daily. However, since 1986, most studies with felodipine have been performed using the extended-release formulation of the drug, which provides smoother plasma concentrations and 24-h blood pressure control with a once-daily dosage (11,37,38). This is the only formulation currently on the market.In controlled clinical trials, felodipine extended release once daily was found to be an effective antihypertensive treatment and reduced the blood pressure to S 9 0 mm Hg, 24 h after the dose, in 50430% of patients (13,22,41,65,82,106). Treatment with felodipine was reported to be more effective than with nifedipine, enalapril, chlorthalidone, or hydrochlorothiazide, but similarly effective to amlodipine, diltiazem, metoprolol, or aten-0101, at the doses studied (22,41,45,65,67,72,82,106,111). The aim of this article is to provide an overview of the experience with felodipine with regard to tolerability profile, effect on quality of life, safety in patients with diseases commonly occurring together with hypertension, effect on hormonal, metabolic, and laboratory variables, and interactions with food and drugs. PHARMACODYNAMIC AND PHARMACOKINETIC PROPERTIESFelodipine is a highly vascular selective dihydropyridine calcium antagonist. It has been shown to be over 100 times more potent in vascular than in cardiac muscle with a selectivity ratio nearly 10 times higher than that for the dihydropyridines nifedipine and amlodipine (73,87). In clinical studies, felodipine has been found to produce significant

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“…However, one patient who had tolerated each individual drug did develop congestive heart failure with the combination. This phenomenon has also been well documented by Strauss and coworkers [63].…”

Section: Chronic Stable Anginamentioning

confidence: 71%

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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Calcium-channel antagonists and beta-adrenergic blocking agents have become important modalities in the cardiovascular therapeutic armamentarium. These drugs are often administered as monotherapy to a wide range of cardiological patients with angina pectoris, hypertension, arrhythmias, congestive heart failure, and other diseases. Since within each class these drugs exhibit pharmacologic differences, it follows that their effectiveness varies in different disease states and that they exhibit a wide variety of side effects. In an attempt to optimize therapy, the individual drugs from these two classes can be combined; and the efficaciousness and side-effect profile of various combinations between calcium-channel antagonists and beta blockers are discussed in this review. Recommendations as to which patients may benefit from a combination and as to which patients may be harmed by the combination therapy will be made. Very few studies have compared the safety and efficacy of a single agent with the combination and with placebo in a controlled randomized fashion. To determine which therapy is superior and to determine which combination one should recommend under what circumstances, such placebo-controlled, randomized trials are a necessity, and will hopefully be performed although the complexity is enormous.

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Combination therapy with diltiazem and propranolol: Precipitation of congestive heart failure

Cited by 17 publications

References 13 publications

Patterns and Characteristics of Polypharmacy Among Elderly Residents in Danish Nursing Homes

Patterns and Characteristics of Polypharmacy Among Elderly Residents in Danish Nursing Homes

Tolerability and Safety of Felodipine

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

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