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Verapamil vs Amlodipine
Introduction
For patients with high blood pressure or heart conditions, certain drugs that alter the levels of calcium in your heart and blood vessels can help manage these ailments. Verapamil and Amlodipine are two such medications specifically prescribed for cardiovascular issues. They each impact different aspects of calcium management but both have significant effects on reducing hypertension (high blood pressure) and angina (chest pain). Verapamil is known as a non-dihydropyridine calcium channel blocker, affecting the influx of calcium into cardiac muscle cells. On the other hand, Amlodipine falls under dihydropyridines class primarily relaxing arterial smooth muscle leading to wider arteries allowing better flow of blood.
What is Verapamil?
Verapamil, the generic name for Isoptin, is a phenylalkylamine calcium channel blocker (CCB) that was first approved by the FDA in 1981. It works by reducing the influx of calcium ions into vascular smooth muscle and cardiac cells during depolarization, effectively relaxing blood vessels and decreasing heart rate. Verapamil is typically prescribed for angina (chest pain), high blood pressure and certain types of irregular heartbeat.
Amlodipine, also known as Norvasc among other brands, belongs to a class called dihydropyridine CCBs. Unlike Verapamil's effects on both arteries and heart rate control nodes within the heart itself (the SA node), Amlodipine mainly targets peripheral vasculature causing dilation of resistance arteries which reduces overall peripheral resistance and lowers systemic blood pressure with minimal effect on heart rate or contractility.
Both medications carry their own side effect profiles; however, Amlodipine tends to have fewer gastrointestinal side effects compared to Verapamil but it may cause more edema or swelling in some patients.
What conditions is Verapamil approved to treat?
Verapamil is approved for the management of various cardiovascular conditions including:
- Hypertension, also known as high blood pressure
- Angina pectoris, chest pain caused by reduced blood flow to the heart
- Certain types of irregular heartbeats or arrhythmias such as supraventricular tachycardia.
How does Verapamil help with these illnesses?
Verapamil helps to manage hypertension and angina by blocking calcium from entering the smooth muscle cells of the heart and arteries. This causes these blood vessels to relax, reducing the amount of work that the heart has to do and lowering high blood pressure. Calcium is a chemical element in our bodies that plays an important role in muscle contraction, nerve signaling, cell division, bone health amongst other things. High levels of calcium can cause muscles such as those found in your arteries to contract more forcefully which can increase blood pressure. Therefore, by blocking calcium entry into these cells, Verapamil can limit the negative effects of hypertension and help patients manage their condition.
On the other hand, Amlodipine also works by inhibiting calcium influx across cellular membranes but it mainly affects arterial smooth muscle causing vasodilation leading to a decrease in peripheral vascular resistance reducing BP (Blood Pressure). Amlodipine has a longer duration of action than Verapamil which allows for once-daily dosing.
What is Amlodipine?
Amlodipine, also known under the brand name Norvasc and others, is a calcium channel blocker that helps to relax and widen blood vessels. It was first approved by the FDA in 1992. Unlike Verapamil which affects both the heart and blood vessels, Amlodipine primarily works on smooth muscle cells within arterial walls to reduce peripheral vascular resistance and lower high blood pressure. Its selective action means that its side-effect profile is slightly different from other calcium channel blockers like Verapamil; it does not decrease heart rate or cardiac output significantly at therapeutic doses nor increase conduction time or refractoriness. Some common side effects include swelling, dizziness, fatigue but they are usually mild and manageable. Due to its specific mechanism of action, Amlodipine can be beneficial for managing hypertension especially in patients who do not respond well to other antihypertensive drugs like beta-blockers or ACE-inhibitors.
What conditions is Amlodipine approved to treat?
Amlodipine, a medication that falls under the category of calcium channel blockers, is approved for treating:
- Hypertension (high blood pressure), to lower the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions
- Stable angina (chest pain due to heart disease)
- Vasospastic angina (Prinzmetal's or variant angina)
How does Amlodipine help with these illnesses?
Amlodipine is a calcium channel blocker that primarily affects smooth muscle cells lining the blood vessels, causing them to relax and thus lowering blood pressure. Similar to norepinephrine's impact on wakefulness, focus, and stress responses in the body, Amlodipine works by inhibiting the influx of calcium ions into vascular smooth muscle and cardiac muscle cells. This action dilates the arterial system and reduces blood pressure. It's often preferred over Verapamil for its once-daily dosing convenience and lesser side effects such as constipation or slowing of heart rate. Its action on peripheral vasodilation may also play roles in the preference of Amlodipine as an antihypertensive medication. Since it does not significantly affect heart rate unlike Verapamil, it might be prescribed when a patient needs better control over hypertension without altering their heart function too much.
How effective are both Verapamil and Amlodipine?
Both verapamil and amlodipine are calcium channel blockers with established histories of success in managing hypertension and angina, though they were initially approved by the FDA several years apart. While both medications block the flow of calcium into heart cells and blood vessel walls which helps to relax and widen vessels, their place within different sub-categories of this class means they may be used under varying circumstances.
A 2003 clinical trial compared verapamil against amlodipine in patients with isolated systolic hypertension where both drugs showed similar efficacy in lowering blood pressure levels while maintaining promising safety profiles. The study found no significant difference between patients receiving either medication regarding overall cardiovascular risk reduction.
A 2010 review indicated that verapamil is effective in controlling blood pressure from the initial stages of treatment, has an acceptable side effect profile when compared to other antihypertensives, and remains well-tolerated across diverse patient groups including elderly individuals. Verapamil's unique property as a non-dihydropyridine type allows it to slow down the heart rate which can be beneficial for conditions like atrial fibrillation besides treating high blood pressure or chest pain.
On another note, a 2015 meta-analysis indicates that amlodipine appears more effective than placebo at reducing systolic blood pressure and proves similarly efficacious when compared with other common antihypertensive classes. Amlodipine is often considered as first-line treatment due to its long half-life allowing once daily dosing along with low incidence of serious side effects. However, research data confirming its superiority over verapamil as stand-alone treatment remains sparse. Despite some differences such as minimal impact on heart rate unlike verapamill; due to their separate pharmacologic properties each could provide optimal control for hypertensive patients depending upon individual requirements such as those prone to rapid heartbeat or certain types of chest pain.
At what dose is Verapamil typically prescribed?
Oral dosages of Verapamil range from 120–480 mg/day, but studies have shown that 180-240 mg/day is usually sufficient for treating hypertension and angina. Children can be started at 2.5–5 mg/kg/day in divided doses. In either population, dosage can be adjusted after a few weeks if there is no response or if side effects occur. The maximum dosage that should not be exceeded in any case is 480 mg/day.
On the other hand, Amlodipine's typical starting dose for adults ranges from 2.5–10mg once daily depending on the condition being treated; children aged six and older may start with a lower dose of between 2.5 -5mg per day based upon their doctor's recommendation. Dosage adjustments are typically made every two to three weeks as necessary until optimal results are seen with the standard maximum dose being set at 10mg daily.
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At what dose is Amlodipine typically prescribed?
Amlodipine therapy usually begins at a dosage of 2.5–5 mg/day for adults with hypertension or coronary artery disease. The dose can then be increased to a maximum of 10 mg per day, taken as one single dose, based on the patient's response and tolerance. For pediatric patients aged 6-17 years old with high blood pressure, the starting dosage is typically 2.5-5 mg once daily and may be adjusted according to their response to treatment. As always, changes in medication should only occur under careful supervision by your healthcare provider, especially when increasing dosages if there seems to be no response after several weeks at lower doses.
What are the most common side effects for Verapamil?
Some of the most common side effects of Verapamil include:
- Constipation
- Dizziness, lightheadedness, or feeling faint
- Headache
- Nausea and vomiting
- Unusual tiredness or weakness
On the other hand, Amlodipine may cause different side effects such as:
- Swelling in your hands or feet (oedema)
- Flushing (feeling warm and looking red)
- Palpitations (irregular heartbeat)
- Abdominal pain -Drowsiness/sleepiness.
Remember that each individual's body responds differently to medication. Therefore, it is imperative to report any unusual symptoms to a healthcare provider promptly.
Are there any potential serious side effects for Verapamil?
In some rare instances, Verapamil can cause potentially serious side effects which include:
- Difficulty breathing or swallowing
- Signs of an allergic reaction such as hives, swelling in your face or throat
- Unusually slow heartbeat or a rapid, pounding heartbeat
- Severe dizziness and fainting spells
- Abnormal bruising or bleeding
- Yellowing of the skin and eyes (jaundice), indicating potential liver problems
On the other hand, Amlodipine may also cause severe side effects like:
- Swelling in your hands, ankles, or feet due to fluid retention
- Rapid weight gain caused by fluid accumulation
- Chest pain and discomfort
- Fast or irregular heartbeats
- Lightheadedness leading to fainting
If you experience any of these symptoms while taking either Verapamil or Amlodipine it's crucial that you seek medical attention immediately.
What are the most common side effects for Amlodipine?
Common side effects of Amlodipine include:
- Flushing, feeling warm
- Headache or dizziness
- Heart palpitations
- Swelling in the ankles and feet (edema)
- Abdominal pain, nausea
- Drowsiness or fatigue
- Excessive sweating Although these effects are relatively common, they can cause discomfort. However, most patients find that these symptoms decrease over time as their bodies adjust to the medication. It's crucial to monitor your body's reactions and consult with a healthcare professional if any side effect persists or worsens.
Are there any potential serious side effects for Amlodipine?
While Amlodipine is generally well-tolerated, it can occasionally cause serious side effects. Please be aware of the following potential risks:
- Signs of an allergic reaction such as hives, itching, difficulty breathing or swallowing, puffiness in your face or throat
- Severe skin reactions including red or purple rashes that blister and peel
- Feelings of a pounding or fast heartbeat (palpitations)
- Swelling in your hands, ankles, feet (edema) resulting from fluid build-up
- Lightheadedness due to low blood pressure
- Unusual mood changes or confusion
- Painful and prolonged erection which lasts for 4 hours or more
If you experience any of these symptoms while taking Amlodipine, please seek immediate medical attention.
Contraindications for Verapamil and Amlodipine?
Both verapamil and amlodipine, like most other medications for hypertension or angina, may cause side effects such as lightheadedness, dizziness, or fatigue. If you notice these symptoms worsening significantly or persistently while taking either medication, please get in touch with your healthcare provider promptly.
Neither verapamil nor amlodipine should be taken if you are already on certain heart rhythm medications such as disopyramide or flecainide without consulting your doctor. Always inform your physician about all the medications and supplements you're currently taking; some of these drugs may require time to clear from your system to prevent hazardous interactions with verapamil and amlodipine. Moreover, both drugs should be used cautiously in patients with severe liver disease due to altered drug metabolism.
How much do Verapamil and Amlodipine cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Verapamil SR (180 mg) averages around $90, which works out to approximately $1.50/day.
- The price of 30 capsules of Norvasc (10mg Amlodipine) averages is about $112, working out to approximately $3.73/day.
This means that if you are in the higher dosage range for Verapamil SR (i.e., 360 mg/day), then brand-name Amlodipine is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which drug is right for you.
For the generic versions of Verapamil and Amlodipine, costs are significantly lower:
- Generic verapamil comes in packs ranging from 15 to hundreds of tablets with an average daily cost between $0.20 - $0.80 depending on dosage and size purchased.
- Generic amlodipine can come at similar pack sizes as verapamil but generally runs cheaper with prices averaging between $.04/day - $.40/day again depending on dose and pack size purchased.
It's important to remember though that while costs can help guide your choice they should not be the deciding factor when choosing medication as efficacy often varies person-to-person regardless whether it's brand or generic medication being used.
Popularity of Verapamil and Amlodipine
Verapamil, in generic form as well as brand names such as Calan and Verelan, was estimated to have been prescribed to about 2.1 million people in the US in 2020. Verapamil accounted for approximately 3% of calcium channel blocker prescriptions in the US. However, it appears to be a commonly used medication for conditions including high blood pressure, angina (chest pain) and certain heart rhythm disorders. The prevalence of verapamil has remained steady over the past decade.
Amlodipine, under brand versions such as Norvasc among others, was prescribed to about 75 million people in the USA in 2020. In the US market, amlodipine accounts for just over 48% of calcium channel blocker prescriptions making it one of the most commonly used medications from this class. Over time its popularity has increased due to its effectiveness and tolerability profile with once-daily dosing which enhances patient compliance.
Conclusion
Both Verapamil and Amlodipine have been used extensively in the management of hypertension and angina, with an abundance of clinical studies supporting their efficacy over placebo treatments. At times, these drugs might be given together to achieve better blood pressure control or angina relief but this must follow strict medical supervision as they can also counteract each other's effects due to their different mechanisms of action. Verapamil is a non-dihydropyridine calcium channel blocker that affects both the heart muscle cells and smooth muscle cells of the vascular system while Amlodipine, a dihydropyridine calcium channel blocker, primarily acts on vascular smooth muscle cells causing more peripheral vasodilation.
Verapamil is often considered when there is co-existing atrial fibrillation or hypertrophic cardiomyopathy while Amlodipine would typically be chosen for patients who require significant lowering of blood pressure without affecting cardiac rate.
Both medications are available in generic form which provides substantial cost savings especially for those paying out-of-pocket. Neither Verapamil nor Amlodipine usually requires an adjustment period; however, one may not see full therapeutic effects until after several weeks.
Side effect profiles are generally similar between the two drugs although edema (swelling) tends to occur more frequently with Amlodipine use than with Verapamil. Both medications should be taken under regular monitoring by a healthcare provider as misuse could lead to severe hypotension or bradycardia.