Opie L H
Department of Medicine, University of Cape Town, Medical School, Observatory, Republic of South Africa.
Cardiovasc Drugs Ther. 1988 Jul;2(2):177-89. doi: 10.1007/BF00051233.
With the correct selection of drug and patient, the calcium antagonists as a group can be remarkably effective at relatively low cost of serious side effects. Almost all side effects are dose related. Minor side effects include those caused by vasodilation (flushing and headaches), constipation (verapamil), and ankle edema. Serious side effects are rare and result from improper use of these agents, as when intravenous verapamil (or diltiazem) is given to patients with sinus or atrioventricular nodal depression from drugs or disease, or nifedipine to patients with aortic stenosis. The potential of a marked negative inotropic effect is usually offset by afterload reduction, especially in the case of nifedipine which actually has the most marked negative inotropic effect. Yet caution is required when even calcium antagonists, especially verapamil, are given to patients with myocardial failure unless caused by hypertensive heart disease. Drug interactions of calcium antagonists occur with other cardiovascular agents such as alpha-adrenergic blockers, beta-adrenergic blockers, digoxin, quinidine, and disopyramide. The most marked interaction with digoxin is that with verapamil, which may raise digoxin levels by over 50%. Combination therapy of calcium antagonists with beta-blockers is increasingly common, and is probably safest in the case of dihydropyridines. Other combinations being explored are those with angiotensin-converting enzyme inhibitors and diuretics.
在正确选择药物和患者的情况下，钙拮抗剂作为一类药物，能以相对较低的成本显著有效，且严重副作用较少。几乎所有副作用都与剂量相关。轻微副作用包括血管扩张引起的症状（潮红和头痛）、便秘（维拉帕米）以及踝部水肿。严重副作用较为罕见，是由于这些药物使用不当所致，比如给因药物或疾病导致窦性或房室结抑制的患者静脉注射维拉帕米（或地尔硫䓬），或者给主动脉瓣狭窄患者使用硝苯地平。显著的负性肌力作用潜力通常会被后负荷降低所抵消，尤其是硝苯地平这种实际上具有最显著负性肌力作用的药物。然而，除非是由高血压性心脏病引起的心力衰竭，否则给心力衰竭患者使用钙拮抗剂（尤其是维拉帕米）时需谨慎。钙拮抗剂会与其他心血管药物发生相互作用，如α - 肾上腺素能阻滞剂、β - 肾上腺素能阻滞剂、地高辛、奎尼丁和丙吡胺。与地高辛最显著的相互作用是与维拉帕米的相互作用，它可能使地高辛水平升高超过50%。钙拮抗剂与β受体阻滞剂的联合治疗日益常见，对于二氢吡啶类药物来说可能是最安全的。正在探索的其他联合用药是与血管紧张素转换酶抑制剂和利尿剂的联合。
