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Anyone ever understood why CCBs are not used in heart failure. Beta blockers are used in heart failure and they work similarly to calcium channel blockers. What if a patient was on amlodipine for BP and had heart failure, would that have to be stopped and the ACEi covers the bp aspect when being used in HF.
Keep it surreal
No they don't - refer back to a pharmacology text. Beta blockers have beneficial effects in HF. As heart struggles to increase output, sympathetic nervous system gets activated to try and increase rate and force of contraction. Although this may work in the short term, in the long run it adversely affects cardiac function as the heart is being made to work harder and harder. B-blockers target this sympathetic overdrive, however pts may be reliant on this overdrive to keep their output up. Therefore starting these in the acute phase should be avoided and done slowly when more stable to allow the pt to adjust to a slower HR. CCB's such as verapamil and diltiazem have a negative inotropic effect and should be totally avoided in HF. Dihydropyridines such as amlodipine don't tend to worsen HF because any negative inotropic effect is offset by reduced ventricular workload. Amlod can be used in stable patients but at the end of the day cardiologists make the call...Originally Posted by Pharmguru
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would the ACEi cover the bp effect not needing amlodipine etc, I am assuming apart from Diltiazem and Verapamil, ALL the other CCBS can be used in someone with HF?
Amlodipine, nifedipine etc are not negative inotropes though.
It's mental how verapamil and diltiazem are negative inotropes as are b-blockers but these can be used in HF...
Last edited by Pharmguru; 17th, January 2012 at 08:41 PM.
Keep it surreal
Dude totally, it's like, whoa I still can't believe it...
As a side point verapamil is the worst culprit because it is the most negatively inotropic. Dihydropyridines are safer because they are not specific for the heart and have a peripheral vasodilatory effect, offsetting any negative inotropic action.
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BNF says avoid all ccbs in left ventricular failure...
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Where?BNF says avoid all ccbs in left ventricular failure...
The BNF-62 says 'Verapamil and diltiazem should usually be avoided in heart failure because they may further depress cardiac function and cause clinically significant deterioration................Amlodipine and felodipine also resemble nifedipine and nicardipine in their effects and do not reduce myocardial contractility and they do not produce clinical deterioration in heart failure'.
In addition, doctors use a large range of textbooks and alternative sources to make prescribing decisions. They do not simply use the BNF, it does not provide enough information in many areas. Other textbooks may not agree with the BNF on certain issues.
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In fact, b-blockers are very beneficial and essential in HF.As they improve ejection fraction , exercise tolerance, functional status, and survival in patients with NYHA class II-IV symptoms.
There is a consensus about this.
Dihydropyridines ( e.g: amlodipine ) can be used in HF, but we should be alert about their adverse effects, mainly reflex tachycardia, that may be relieved by co-current use of B-blockers with amlodipine.
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all the dihydropyridines seem to be licensed for angina and htn amazes me the other uses they can have
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