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Felodipine: a new dihydropyridine calcium-channel antagonist
1Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville 32610.
Insights
Felodipine effectively lowers blood pressure in hypertensive patients and shows comparable efficacy to other antihypertensives. Further research is needed to confirm its role in angina and heart failure management.
Area of Science:
- Cardiovascular Pharmacology
- Clinical Hypertension Management
Background:
- Felodipine is a dihydropyridine calcium-channel antagonist.
- It demonstrates beneficial hemodynamic effects in hypertension, angina pectoris, and congestive heart failure (CHF).
Purpose of the Study:
- To evaluate the efficacy and safety of felodipine in managing hypertension.
- To assess the potential role of felodipine in chronic stable angina pectoris and CHF.
Main Methods:
- Comparative studies in mild to moderate hypertension.
- Adjunct therapy evaluations with beta-blockers or diuretics.
- Limited evaluations in angina pectoris and CHF patients.
Main Results:
- Felodipine significantly reduces systolic and diastolic blood pressure (BP) in hypertensive patients.
- It is at least as efficacious as hydrochlorothiazide (HCTZ) and other antihypertensives in monotherapy and combination therapy.
- No significant impact on glomerular filtration rate, creatinine clearance, glucose tolerance, or plasma lipoprotein concentrations in hypertensive patients.
- Adverse effects are typical for dihydropyridines; a drug interaction with theophylline was noted.
Conclusions:
- Felodipine is safe and effective for hypertension management, alone or with other agents.
- Further investigation is required to establish felodipine's role in chronic stable angina pectoris and CHF.
Abstract:
Felodipine, a dihydropyridine calcium-channel antagonist, significantly reduces systolic and diastolic blood pressure (BP) in patients with hypertension and has been associated with beneficial hemodynamic effects in patients with chronic stable angina pectoris or congestive heart failure (CHF). In hypertensive patients, felodipine does not appear to significantly affect glomerular filtration rate, creatinine clearance, glucose tolerance, or plasma lipoprotein concentrations. Studies comparing felodipine with other agents as monotherapy in mild to moderate hypertension have demonstrated felodipine to be at least as efficacious as hydrochlorothiazide (HCTZ) and HCTZ plus amiloride hydrochloride in combination. Comparisons of felodipine with other agents as adjuncts to beta-blocker or diuretic therapy have shown felodipine to be at least as effective as HCTZ, propranolol hydrochloride, prazosin hydrochloride, and nifedipine. Evaluations of patients with chronic stable angina are limited, and additional studies are needed before felodipine can be recommended for the routine management of angina pectoris. Similarly, additional studies are essential to delineate the role of felodipine, if any, in the management of CHF. In the management of hypertension, felodipine 5-40 mg/d significantly reduces systolic and diastolic BP. Although some patients may be controlled throughout the entire dosing interval when felodipine is administered bid, many patients will require more frequent dosing to obtain adequate BP control. Adverse effects associated with felodipine are similar to those of other dihydropyridine calcium-channel antagonists and include peripheral edema, headache, dizziness, flushing, and fatigue. A potentially clinically important drug interaction was observed when felodipine was administered concomitantly with theophylline aminopropanol; significant decreases in theophylline concentrations were noted. In summary, felodipine appears to be safe and effective for the management of hypertension when used alone or in combination with other antihypertensive agents. The efficacy of felodipine in the management of chronic stable angina pectoris and CHF requires further investigation.