BNF for Children (BNFC) 2018-2019

Calcium-channel blockers f

lDRUG ACTIONCalcium-channel blockers (less correctly

called‘calcium-antagonists’) interfere with the inward

displacement of calcium ions through the slow channels of

active cell membranes. They influence the myocardial

cells, the cells within the specialised conducting system of

the heart, and the cells of vascular smooth muscle. Thus,

myocardial contractility may be reduced, the formation

and propagation of electrical impulses within the heart

may be depressed, and coronary or systemic vascular tone

may be diminished.

lSIDE-EFFECTS

▶Common or very commonDizziness.flushing.

gastrointestinal disorders.headache.nausea.palpitations

.peripheral oedema.sexual dysfunction.skin reactions.

tachycardia.vomiting

▶UncommonGingival hyperplasia

SIDE-EFFECTS, FURTHER INFORMATION

OverdoseFeatures of calcium-channel blocker poisoning

include nausea, vomiting, dizziness, agitation, confusion,

and coma in severe poisoning. Metabolic acidosis and

hyperglycaemia may occur.

In overdose, the dihydropyridine calcium-channel

blockers cause severe hypotension secondary to profound

peripheral vasodilatation.

For details on the management of poisoning, see

Calcium-channel blockers, under Emergency treatment of

poisoning p. 832.

lTREATMENT CESSATIONThere is some evidence that

sudden withdrawal of calcium-channel blockers may be

associated with an exacerbation of myocardial ischaemia.

eiiiiFabove

Amlodipine 07-Feb-2018

lDRUG ACTIONAmlodipine is a dihydropyridine calcium-

channel blocker.

lINDICATIONS AND DOSE

Hypertension

▶BY MOUTH

▶Child 1 month–11 years:Initially 100 – 200 micrograms/kg

once daily; increased if necessary up to

400 micrograms/kg once daily, adjusted at intervals of

1 – 2 weeks; maximum 10 mg per day

▶Child 12–17 years:Initially 5 mg once daily, then

increased if necessary up to 10 mg once daily, adjusted

at intervals of 1 – 2 weeks

DOSE EQUIVALENCE AND CONVERSION

▶Tablets from various suppliers may contain different

salts (e.g. amlodipine besilate, amlodipine maleate,

and amlodipine mesilate) but the strength is expressed

in terms of amlodipine (base); tablets containing

different salts are considered interchangeable.

lUNLICENSED USENot licensed for use in children under

6 years.

IMPORTANT SAFETY INFORMATION

SAFE PRACTICE

Amlodipine has been confused with nimodipine and

atenolol; care must be taken to ensure the correct drug is

prescribed and dispensed.

lCONTRA-INDICATIONSCardiogenic shock.significant

aortic stenosis

lINTERACTIONS→Appendix 1 : calcium channel blockers

lSIDE-EFFECTS

▶Common or very commonAsthenia.constipation.

diarrhoea.drowsiness.dyspnoea.gastrointestinal

discomfort.joint disorders.muscle complaints.oedema.

vision disorders

▶UncommonAlopecia.anxiety.arrhythmias.chest pain.

cough.depression.dry mouth.gynaecomastia.

hyperhidrosis.hypotension.insomnia.malaise.mood

altered.pain.rhinitis.sensation abnormal.skin reactions

.syncope.taste altered.tinnitus.tremor.urinary

disorders.weight changes

▶Rare or very rareAngioedema.confusion.hepatic

disorders.hyperglycaemia.hypersensitivity.leucopenia.

muscle tone increased.pancreatitis.peripheral

neuropathy.photosensitivity reaction.Stevens-Johnson

syndrome.thrombocytopenia.vasculitis

▶Frequency not knownExtrapyramidal symptoms.

pulmonary oedema

lPREGNANCYNo information available—manufacturer

advises avoid, but risk to fetus should be balanced against

risk of uncontrolled maternal hypertension.

lBREAST FEEDINGManufacturer advises avoid—no

information available.

lHEPATIC IMPAIRMENT

Dose adjustmentsMay need dose reduction—half-life

prolonged.

lDIRECTIONS FOR ADMINISTRATIONTablets may be

dispersed in water.

lPATIENT AND CARER ADVICE

Medicines for Children leaflet: Amlodipine for hypertension

http://www.medicinesforchildren.org.uk/amlodipine-for-hypertension

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: oral suspension, oral solution

Oral solution

▶Amlodipine (Non-proprietary)

Amlodipine 1 mg per 1 mlAmlodipine 5 mg/ 5 ml oral solution sugar

free sugar-free| 150 mlP£ 75. 76 DT = £ 75. 76

Amlodipine 2 mg per 1 mlAmlodipine 10 mg/ 5 ml oral solution sugar

free sugar-free| 150 mlP£ 115. 73 DT = £ 115. 73

Tablet

▶Amlodipine (Non-proprietary)

Amlodipine 5 mgAmlodipine 5 mg tablets| 28 tabletP£ 9. 99 DT

=£ 1. 43

Amlodipine 10 mgAmlodipine 10 mg tablets| 28 tabletP

£ 14. 07 DT = £ 1. 58

▶Istin(Pfizer Ltd)

Amlodipine 5 mgIstin 5 mg tablets| 28 tabletP£ 11. 08 DT =

£ 1. 43

Amlodipine 10 mgIstin 10 mg tablets| 28 tabletP£ 16. 55 DT =

£ 1. 58

eiiiiFabove

Nicardipine hydrochloride

lDRUG ACTIONNicardipine is a dihydropyridine calcium-

channel blocker.

lINDICATIONS AND DOSE

Life-threatening hypertension (specialist use only)|Post-

operative hypertension (specialist use only)

▶BY CONTINUOUS INTRAVENOUS INFUSION

▶Neonate:Initially 500 nanograms/kg/minute (max. per

dose 5 micrograms/kg/minute), adjusted according to

response; maintenance 1 – 4 micrograms/kg/minute.

▶Child:Initially 500 nanograms/kg/minute (max. per

dose 5 micrograms/kg/minute), adjusted according to

response; maintenance 1 – 4 micrograms/kg/minute

(max. per dose 250 micrograms/minute)

lCONTRA-INDICATIONSAcute porphyrias p. 603 .avoid

within 8 days of myocardial infarction.cardiogenic shock.

compensatory hypertension.significant or advanced

aortic stenosis

108 Blood pressure conditions BNFC 2018 – 2019

Cardiovascular system

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