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Non Dhp vs Dhp
Introduction
For patients with hypertension or certain types of heart disease, specific medications that modulate the amount and movement of calcium within cells in the body can help to manage blood pressure and regulate heart function. Non-DHPs (Non-dihydropyridines) and DHPs (Dihydropyridines) are two such classes of drugs, falling under the broader umbrella of calcium channel blockers. They each have different effects on various tissues in the body, but both aid in managing cardiovascular conditions.
Non-DHPs like Verapamil or Diltiazem primarily affect cardiac muscle cells and slow down heart rate by impeding calcium influx into these cells. This leads to less forceful contractions as well as slower conduction speed through the atrioventricular node.
On the other hand, DHPs like Amlodipine predominantly act on smooth muscle cells lining arterial walls which when relaxed cause dilation leading to a decrease in peripheral vascular resistance lowering blood pressure without much effect on heart rate.
What is Non Dhp?
Non-DHP CCBs (non-dihydropyridine calcium channel blockers) and DHP CCBs (dihydropyridine calcium channel blockers) are two distinct classes of medications used primarily for treating high blood pressure, angina, and certain types of arrhythmias. They act by reducing the amount of calcium entering cells in the heart and blood vessel walls. Non-DHP CCBs include drugs such as verapamil and diltiazem; these have a greater effect on the heart than on the blood vessels themselves due to their action on cardiac muscle cells. On other hand, DHP CCBs like nifedipine or amlodipine predominantly affect arterial smooth muscles leading to more vasodilation with lesser direct effects on the heart rate or contraction strength. While both groups are generally well tolerated, non-DHP CCBs can sometimes slow down your heartbeat too much while DHP CCBS may cause edema or flushing due to their strong vasodilatory effects.
What conditions is Non Dhp approved to treat?
Non-dihydropyridine (non-DHP) calcium channel blockers like verapamil and diltiazem are approved to treat various conditions such as:
- High blood pressure or hypertension
- Angina pectoris, a type of chest pain that occurs when the heart doesn't get enough oxygen
- Certain types of arrhythmias, irregular heartbeats
Dihydropyridine (DHP) calcium channel blockers like nifedipine and amlodipine have been approved for treatment of:
- Hypertension
- Coronary artery disease, which can cause angina
How does Non Dhp help with these illnesses?
Non-DHP calcium channel blockers, such as Verapamil and Diltiazem, help to manage hypertension by decreasing the amount of calcium available in the heart muscle cells. They do this by blocking it from being absorbed by these cells, so levels can be maintained lower for longer periods of time. Calcium plays a pivotal role in contraction and relaxation of muscles including those present in blood vessels and heart.
On the other hand, Dihydropyridines (DHPs) like Amlodipine also block calcium but act predominantly on peripheral vasculature causing dilation with little effect on heart rate or contractility. It is believed that individuals with high blood pressure have relatively higher levels of intracellular calcium leading to vasoconstriction and increased cardiac workload. Therefore, by reducing intracellular calcium concentration, both Non-DHPs and DHPs can limit the negative effects of hypertension helping patients manage their condition effectively.
What is Dhp?
Dihydropyridine (DHP) calcium channel blockers are a class of medications that inhibit the influx of calcium ions into vascular smooth muscle and cardiac cells. This category includes drugs such as Amlodipine, Nifedipine, and Nicardipine among others. Their main action is to dilate blood vessels, which reduces systemic vascular resistance and arterial pressure. As a result, DHPs are commonly used in the treatment of hypertension.
Unlike Non-DHP Calcium Channel Blockers (such as Verapamil or Diltiazem), DHPs do not significantly decrease heart rate nor have prominent negative inotropic effects on the heart - meaning they don't reduce forcefulness of heart contractions. Side effects can include edema (swelling due to fluid accumulation), flushing and palpitations – typically resulting from their vasodilatory properties.
The use of DHPs can be highly beneficial for managing high blood pressure, especially in patients who might not respond well to other antihypertensive classes.
What conditions is Dhp approved to treat?
Dihydropyridines (DHP) calcium channel blockers are widely used for the treatment of certain cardiovascular conditions. These include:
- Hypertension, a condition characterized by persistently high blood pressure
- Angina pectoris, a type of chest pain caused by reduced blood flow to the heart
How does Dhp help with these illnesses?
Dihydropyridine (DHP) calcium channel blockers play a major role in many physiological processes, affecting muscle contraction, hormone secretion, and neurotransmitter release. These drugs block the L-type calcium channels predominantly located in vascular smooth muscles and cardiac tissues. DHPs like Amlodipine work by blocking these channels thus leading to vasodilation or widening of blood vessels which can help reduce high blood pressure and alleviate symptoms of angina. Their action is more pronounced on the peripheral circulation than non-DHPs. Non-Dihydropyridines, on the other hand, have a greater effect on the heart rate and are less likely to cause peripheral edema as a side effect compared to DHPs. However, due to their potent vasodilatory effects with fewer negative impacts on cardiac function, DHPs may be preferred when managing conditions such as hypertension or chest pain associated with coronary artery disease.
How effective are both Non Dhp and Dhp?
Both non-dihydropyridine (Non-DHP) calcium channel blockers, such as verapamil and diltiazem, and dihydropyridine (DHP) calcium channel blockers, such as amlodipine and nifedipine, are widely used in the management of hypertension. They were introduced into clinical practice within a few years of each other during the late 1970s to early 1980s.
The mechanism of action differs between these two classes - Non-DHP calcium channel blockers primarily affect the heart's muscle cells reducing heart rate and contractility while DHP calcium channel blockers mainly act on blood vessels causing them to dilate which decreases peripheral vascular resistance.
A head-to-head comparison study conducted in 1991 found that both Non-DHPs and DHPs effectively lower blood pressure but with different side effect profiles: for instance, Dihydropyridines can cause more peripheral edema or flushing due to their vasodilatory effects whereas Non-Dihydopyridines may lead to bradycardia or constipation due to their primary influence on heart muscle cells.
Evidence from various meta-analysis studies have demonstrated both classes provide effective control over high blood pressure starting from first week of treatment; however they may be prescribed under different circumstances depending upon patient-specific factors like presence of angina pectoris or atrial fibrillation where Non-Dhp class might be preferred because they decrease heart rate whereas in elderly patients with isolated systolic hypertension Dhp class might be more beneficial due extensive arterial dilation leading decreased afterload.
Despite having comparable efficacy at lowering high blood pressure, it's important for clinicians to consider individual patient needs when choosing between these two types of medication. For example if there is need for avoiding certain side effects like edema then one might prefer prescribing Non-dhp instead.
At what dose is Non Dhp typically prescribed?
Oral dosages of Non-DHP CCBs (Non-dihydropyridine calcium channel blockers) such as Verapamil and Diltiazem generally range from 120-480 mg/day, but studies have indicated that the lower end of this dosage spectrum is often adequate for managing hypertension or angina in most adults. On the other hand, DHP CCBs (Dihydropyridines), like Amlodipine and Nifedipine, are typically initiated at lower doses ranging from 2.5–10 mg/day due to their potent vasodilatory effects. For both types of medications, depending on individual response and tolerability, doctors may adjust the dose upward after a few weeks if necessary. However, exceeding the maximum recommended daily dose can lead to unwanted side effects or even toxicity.
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At what dose is Dhp typically prescribed?
Dihydropyridines (DHPs), a type of calcium channel blocker, are typically initiated at a dose ranging from 30-60 mg/day depending on the specific medication and patient's condition. The dosage can then be increased to anywhere between 90-360 mg/day, divided into one or two doses as per the physician's advice. For some DHPs like Amlodipine, it is usually taken once daily while others may require twice-daily dosing. The maximum dosage for each DHP varies and should only be determined by your healthcare provider based on individual response after several weeks of treatment. If there is no response or if symptoms persist even after increasing the dose, consult with your doctor immediately.
What are the most common side effects for Non Dhp?
Non-dihydropyridine (DHP) and Dihydropyridine (DHP) are two types of calcium channel blockers that have different effects on the body.
Common side effects for Non-DHPs, like diltiazem or verapamil, can include:
- Constipation
- Nausea
- Fatigue
- Headache
- Rash
- Swelling of legs or ankles due to fluid build-up (edema)
- Reduced heart rate (bradycardia)
On the other hand, common side effects associated with DHPs such as amlodipine or nifedipine typically include:
- Flushing
- Rapid heart rate (tachycardia)
- Lower leg swelling due to fluid retention(edema)
- Headaches
- Dizziness
Remember that while these symptoms may occur they do not always mean you're having an adverse reaction; however if any become severe or persistent it's best to consult your healthcare provider.
Are there any potential serious side effects for Non Dhp?
Non-DHP calcium channel blockers and DHP calcium channel blockers are two different types of medications used to treat conditions like high blood pressure, angina, and certain heart arrhythmias. Both have their own unique side effect profiles:
- Potential signs of an allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
- Changes in vision or hearing
- Irregular or fast heartbeat
- Shortness of breath
- Severe lightheadedness or fainting
- Symptoms related to electrolyte imbalance such as muscle cramps or weakness, irregular heartbeats
- Nervous system-related effects such as headache, fatigue and confusion. In more serious cases one might experience tremors and unsteady feeling.
It's important to note that these side effects are generally rare but if you notice any unusual symptoms while taking either Non-DHPs or DHPs it is advisable to seek medical attention promptly.
What are the most common side effects for Dhp?
Dihydropyridines (Dhp) calcium channel blockers can lead to the following side effects:
- Flushing, or a feeling of warmth in your face
- Rapid heartbeat (tachycardia)
- Headaches and dizziness
- Swelling in the lower extremities due to fluid build-up (edema)
- Gingival hyperplasia - an overgrowth of gum tissue
- Constipation and other gastrointestinal discomforts. It's important to remember that while these symptoms may be uncomfortable, they are usually manageable with appropriate medical guidance. Always consult your healthcare provider if you experience any adverse effects from medication.
Are there any potential serious side effects for Dhp?
Dihydropyridine (DHP) calcium channel blockers, unlike their non-DHP counterparts, can occasionally induce certain adverse reactions. It is crucial to stay vigilant for the following indications of a potential serious side effect:
- Signs of an allergic reaction such as hives, skin rash or itching, feverishness, swollen glands or facial features
- Difficulty in breathing which may denote a severe allergic reaction
- Swelling in the throat causing difficulty swallowing
- Experiencing sudden and severe chest pain – could be indicative of angina
- Dizziness and fainting spells due to low blood pressure
- Rapid heartbeat and palpitations
- Noticeable swelling in your hands, ankles or feet due to fluid retention
If you notice any of these symptoms while on DHP medication like Amlodipine or Nifedipine it is advisable that you consult your healthcare provider immediately.
Contraindications for Non Dhp and Dhp?
Dihydropyridines (DHPs) and non-dihydropyridines (non-DHPs), both types of calcium channel blockers, may exacerbate symptoms in some people. If you notice your cardiac symptoms worsening, such as increased chest pain or irregular heartbeats, please seek immediate medical attention.
Neither DHP nor non-DHP should be taken if you are taking, or have been taking certain medications like beta-blockers without consulting with your physician first. Always inform your healthcare provider about the medications that you currently take; this includes over-the-counter drugs and herbal supplements as well. Some drugs require a period to clear from the system to prevent dangerous interactions with DHP and non-DHP calcium channel blockers.
Both DHPs and non-DHPS can affect liver function so they should be used cautiously in patients with liver impairment. Also, these medication classes may lower blood pressure significantly leading to dizziness or fainting especially when standing up too quickly from sitting or lying down position.
How much do Non Dhp and Dhp cost?
When comparing Non-Dihydropyridine (Non-DHP) calcium channel blockers to Dihydropyridine (DHP) calcium channel blockers:
For the brand name versions of these drugs:
- The price for 60 tablets of Cardizem CD, a non-DHP drug (180 mg), averages around $400, which works out to approximately $13–26/day depending on your dose.
- For Norvasc, a DHP drug, the price is about $40 for 30 tablets (5mg), or roughly $1.33/day.
Thus, if you are in the higher dosage range for Cardizem CD (i.e., 360 mg/day), then brand-name Norvasc could be less expensive per day. However, cost should not be the primary factor when deciding which medication is best suited for your health needs.
As with most medications, generic versions are significantly cheaper:
- Generic diltiazem is available in packs starting from 30 capsules and up, with approximate costs ranging from as low as $0.15 to about $0.50 per day dependent on dosages between 120 to 240 mg daily.
- Generic amlodipine besylate comes in packs ranging from 10 up to several hundreds of pills at strengths from 2.5mg up to10mg and can start costing as little as just over one cent ($0.01) per pill if bought upfront in bulk but may go high as nearly half dollar ($0.45).
Popularity of Non Dhp and Dhp
Dihydropyridines (DHPs) and non-dihydropyridines (non-DHPs) are two different classes of calcium channel blockers. These medications are commonly used to treat high blood pressure, angina pectoris, and certain types of arrhythmias.
In 2020 in the United States, DHPs such as amlodipine were prescribed to an estimated 55 million people. Amlodipine alone accounted for just under 50% of all prescriptions for calcium channel blockers. The use of DHPs has been generally increasing over the past decade due to their effectiveness and relatively good safety profile.
On the other hand, non-DHPs like verapamil were prescribed to about 10 million people in the US during that same year. Non-DHP prescriptions account for roughly 20% of all calcium channel blocker prescriptions in America. The prevalence of non-Dhp's has remained steady over recent years due mainly to specific therapeutic indications such as certain types of arrhythmias where they have shown superior efficacy compared with Dhp's.
Conclusion
Non-DHP (non-dihydropyridine) and DHP (dihydropyridine) calcium channel blockers both have a long-standing record of usage in patients with cardiovascular conditions, backed by numerous clinical studies and meta-analyses indicating that they are more effective than placebo treatments. Both classes of drugs may be used together under certain circumstances, but this requires careful consideration as their effects on the heart rate and blood pressure can add up.
Due to their different mechanisms of action, non-DHPs primarily affecting the heart's contractility and conduction while DHPs primarily acting on vascular smooth muscle cells causing vasodilation, they tend to be prescribed under different circumstances. Non-DHPs like verapamil or diltiazem are often considered for arrhythmias or angina where slowing down the heart rate could be beneficial, whereas DHPs such as nifedipine or amlodipine would usually be considered first-line treatment options for hypertension due to their potent vasodilatory effect.
Both non-DHPs and DHPs are available in generic form which could mean significant cost savings especially for patients who must pay out-of-pocket. Both these groups of medications may require an adjustment period meaning that full benefits may not become noticeable immediately after starting them.
The side effect profile differs between these two drug types; both being generally well-tolerated but with some differences - edema is more common with DHP calcium channel blockers whereas constipation is more likely with non-DHP ones. For both drug types patients must closely monitor their symptoms particularly if there’s worsening chest pain or palpitations – medical help should then be sought promptly.