Can a dihydropyridine calcium channel blocker (CCB) like amlodipine be prescribed in addition to a non-dihydropyridine CCB such as diltiazem or verapamil for treating hypertension?
Yes, with extreme caution.
Diltiazem and Verapamil are CYP450 inhibitors, which can interfere with the metabolism of many medications (commonly statins and calcineurin inhibitors), but also can increase levels of nifedipine and presumably other dihydropyridine CCBs, like amlodipine.
Diltiazem or ver...
Why would you use two antihypertensive medications of the same class?
There are so many other options available.
I think as a last resort, perhaps. Most of the time I have seen this combination used by other physicians. It was not really necessary.
Now in true resistant hypertensive patients, I supp...
Dihydropyridine CCB, such as amlodipine, block only peripheral calcium channels, whereas the non-dihydropyridines, like diltiazem, also block the central (cardiac, AV node) channels, which confers them the rate-slowing say during AF. These agents help hypertension by blocking the peripheral calcium ...
I use them together in certain patients who have intolerance to different anti-hypertensives and require rate reducing as well as anti-hypertensive meds.
Typically, Diltiazem does not have much anti-hypertensive effects below 240 mg daily.
When used, I document the rationale in the chart and let the...
Rarely, I have done it without issue primarily in patients with many drug intolerances with the other standard classes.
Amlodipine is useful to control BP in addition to Verapamil and Diltiazem in relatively bradycardic patients. M.R Chaudhry
I never use it especially in the population that I take care of. As a geriatric cardiologist, I tend not to use verapamil/diltiazem (due to their side effects and drug interactions) unless I have other reasons or they were already taking them. But not in conjunction with amlodipine/nifedipine. I tak...