Key to symbols
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
2.6. Nitrates, calcium-channel blockers and other antianginal drugs
2.6.2. Calcium-channel blockers
The choice of therapeutic class for the management of hypertension is dependent on individual patient parameters. See the NHSGGC Guidelines for the Management of Hypertension, available on the Clinical Guidelines store on StaffNet. Calcium-channel blockers differ in their possible sites of action; therefore their therapeutic effects are disparate, with much greater variation than those of beta-blockers. There are important differences between verapamil/diltiazem and the dihydropyridine group of nifedipine/amlodipine. Within the dihydropyridine group, the efficacy and side effect profiles are similar, except that amlodipine has a much longer half-life.
Preferred List
DILTIAZEM
Prescribing Notes:
Prescribe by brand name. Diltiazem should not be prescribed in conjunction with beta-blockers because of the risk of severe bradycardia.
NIFEDIPINE
Restrictions:
Short-acting formulations are not recommended for angina and hypertension.
Prescribing Notes:
Prescribe modified-release preparations by brand name.
Total Formulary
NIMODIPINE
Restrictions:
Restricted to specialist initiation only.
Prescribing Notes:
Only licensed for the prevention and treatment of ischaemic neurological deficits following aneurysmal subarachnoid haemorrhage.
VERAPAMIL