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     CALCIUM CHANNEL BLOCKERS : PROPERTIES

           Three calcium channel blockers are presently available in
     the USA: diltiazem, nifedipine, and verapamil. Their major in-
     dication is in the treatment of angina.

     Pharmacokinetics (dosage forms )
     * Absorption: All 3 agents are well absorbed from the gut.
        Nifedipine is also rapidly absorbed from the buccal mucosa.
     * Elimination: Nifedipine and verapamil are excreted primarily
        by the kidneys into the urine; diltiazem and its metabolites
        appear in the feces.

     Other Indications of the Calcium Channel Blockers
     * Arrhythmias: Verapamil is labeled for use in supraventricular
        arrhythmias (see Chapter 3).
     * Hypertension: Verapamil has recently been approved for use in
        hypertension. Nifedipine and diltiazem are also useful (but
        at present unlabeled) in hypertension (see Chapter 5).
                                                      (PgDn key for more text)


     *  Hypertrophic cardiomyopathy (unlabeled): Verapamil is fre-
        quently useful. Nifedipine and diltiazem are also effective
        in selected patients.
     * Other indications (unlabeled): Nifedipine is effective in the
        treatment of some cases of Raynaud's phenomenon. Verapamil
        has been used to treat insulinoma-induced hypoglycemia.
     * Hypersensitivity: (uncommon)
     * CV: verapamil and diltiazem are contraindicated in sick sinus
        syndrome or AV conduction defect (in the absence of a
        pacemaker), and in severe hypotension as in cardiogenic
        shock. Warning: Congestive heart failure may be worsened by
        verapamil or diltiazem.








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