Calcium channel blockers are a class of drugs with effects on the muscle of the heart and the muscles of the rest of the body. The main action of calcium channel blockers is to lower the blood pressure. It is for this action that it is used in individuals with hypertension.

Most calcium channel blockers decrease the force of contraction of the myocardium (muscle of the heart). This is known as the negative inotropic effect of calcium channel blockers. It is because of the negative inotropic effects of most calcium channel blockers that they are avoided (or used with caution) in individuals with cardiomyopathy (weak muscle of the heart).

Many calcium channel blockers also slow down the conduction of electrical activity within the heart, by blocking the calcium channel during the plateau phase of the action potential of the heart (see: cardiac action potential). This causes a lowering of the heart rate and may cause heart blocks. This is known as the negative chronotropic effect of calcium channel blockers. The negative chronotropic effects of calcium channel blockers make them a commonly used class of agents in individuals with atrial fibrillation or flutter in whom control of the heart rate is an issue.

Mechanism of action

Calcium channel blockers work by blocking voltage-sensitive calcium channels in the heart and in the blood vessels. This prevents calcium levels from increasing as much in the cells when stimulated, leading to less contraction.

This decreases total peripheral resistance by dilating the blood vessels, and decreases cardiac output by lowering the force of contraction. Because resistance and output drop, so does blood pressure.

With low blood pressure, the heart does not have to work as hard, this can ease problems with cardiomyopathy and coronary disease.

Unlike with beta-blockers, the heart is still responsive to sympathetic nervous system stimulation, so blood pressure can be maintained more effectively.

List of calcium channel blockers

• Lercanidipine (Zanidip)
• Nisoldipine (Sular)
• Dihydropyridine calcium channel blockers
  • Amlodipine besylate (Norvasc)
  • Nicardipine (Cardene, Carden SR)
  • Nifedipine (Procardia, Adalat)
  • Nitrendipine (Cardif, Nitrepin)
  • Nimodipine (Nimotop)
• Phenylalkylamine calcium channel blockers
  • Gallopamil (D600)
  • Verapamil hydrochloride (Calan)
• Benzothiazepine calcium channel blockers
  • Diltiazem hydrochloride (Cardizem)
• menthol (mint oil)

Other drugs with similar uses

Other classes of pharmaceutical agents that have overlapping effects as calcium channel blockers include ACE inhibitors, beta-blockers, and nitrates.

Related topics

• Action potential
  • Cardiac action potential
• Antiarrhythmic agents
• Hypertension
• Tachycardia