There can be variation in the licensing of
different medicines containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS 8
▶Nebivolol (Non-proprietary)
Nebivolol (as Nebivolol hydrochloride) 2.5 mg Nebivolol 2.5mg
tablets | 28 tablet P £69.84 DT = £11.80
Nebivolol (as Nebivolol hydrochloride) 5 mg Nebivolol 5mg tablets
| 28 tablet P £9.23 DT = £3.04
Nebivolol (as Nebivolol hydrochloride) 10 mg Nebivolol 10mg
tablets | 28 tablet P £27.92 DT = £27.36
▶Nebilet (A. Menarini Farmaceutica Internazionale SRL)
Nebivolol (as Nebivolol hydrochloride) 5 mg Nebilet 5mg tablets |
28 tablet P £9.23 DT = £3.04
CALCIUM-CHANNEL BLOCKERS
Calcium-channel blockers
Cardiovascular system
Overview
Calcium-channel blockers differ in their predilection for the
various possible sites of action and, therefore, their
therapeutic effects are disparate, with much greater
variation than those of beta-blockers. There are important
differences between verapamil hydrochloride p. 175,
diltiazem hydrochloride p. 169, and the dihydropyridine
calcium-channel blockers (amlodipine p. 168, felodipine
p. 171, lacidipine p. 172, lercanidipine hydrochloride p. 172,
nicardipine hydrochloride p. 173, nifedipine p. 174, and
nimodipine p. 122). g Calcium channel blockers, with the
exception of amlodipine, should be avoided in heart failure
as they can further depress cardiac function and exacerbate
symptoms. h For further guidance on the management of
heart failure, see Chronic heart failure p. 204. With the
exception of amlodipine, they can also increase mortality
after myocardial infarction in patients with left ventricular
dysfunction and pulmonary congestion.
Verapamil hydrochloride is used for the treatment of
angina, hypertension, and arrhythmias. It is a highly
negatively inotropic calcium channel-blocker and it reduces
cardiac output, slows the heart rate, and may impair
atrioventricular conduction. It may precipitate heart failure,
exacerbate conduction disorders, and cause hypotension at
high doses and should not be used with beta-blockers.
Constipation is the most common side-effect.
Nifedipine relaxes vascular smooth muscle and dilates
coronary and peripheral arteries. It has more influence on
vessels and less on the myocardium than does verapamil
hydrochloride, and unlike verapamil hydrochloride has no
anti-arrhythmic activity. It rarely precipitates heart failure
because any negative inotropic effect is offset by a reduction
in left ventricular work.
Nicardipine hydrochloride has similar effects to those of
nifedipine and may produce less reduction of myocardial
contractility. Amlodipine and felodipine also resemble
nifedipine and nicardipine hydrochloride in their effects and
do not reduce myocardial contractility and they do not
produce clinical deterioration in heart failure. They have a
longer duration of action and can be given once daily.
Nifedipine, nicardipine hydrochloride, amlodipine, and
felodipine are used for the treatment of angina or
hypertension. All are valuable in forms of angina associated
with coronary vasospasm. Side-effects associated with
vasodilatation such as flushing and headache (which become
less obtrusive after a few days), and ankle swelling (which
may respond only partially to diuretics) are common.
Intravenous nicardipine hydrochloride is licensed for the
treatment of acute life-threatening hypertension, for
example in the event of malignant arterial hypertension or
hypertensive encephalopathy; aortic dissection, when a
short-acting beta-blocker is not suitable, or in combination
with a beta-blocker when beta-blockade alone is not
effective; severe pre-eclampsia, when other intravenous
anti-hypertensives are not recommended or are contra-
indicated; and for treatment of postoperative hypertension.
Lacidipine and lercanidipine hydrochloride have similar
effects to those of nifedipine and nicardipine hydrochloride;
they are indicated for hypertension only.
Nimodipine is related to nifedipine but the smooth muscle
relaxant effect preferentially acts on cerebral arteries. Its use
is confined to prevention and treatment of vascular spasm
following aneurysmal subarachnoid haemorrhage.
Diltiazem hydrochloride is effective in most forms of
angina; the longer-acting formulation is also used for
hypertension. It may be used in patients for whom beta-
blockers are contra-indicated or ineffective. It has a less
negative inotropic effect than verapamil hydrochloride and
significant myocardial depression occurs rarely. Nevertheless
because of the risk of bradycardia it should be used with
caution in association with beta-blockers.
Cardiovascular system
Unstable angina
Calcium-channel blockers do not reduce the risk of
myocardial infarction in unstable angina. The use of
diltiazem hydrochloride or verapamil hydrochloride should
be reserved for patients resistant to treatment with beta-
blockers.
Calcium-channel blockers
f
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