Abstract
The Ca2+ channel blockers, diltiazem, nifedipine, and vcrapamil, are now well-established members of the therapeutic armamentarium employed in cardiovascular disease including, but not limited to, angina in its several forms, hypertension, some cardiac arrhythmias including supraventricular tachycardia, congestive heart failure, and hypertrophic cardiomyopathy. Several reviews detail these and related clinical uses (1-8). The introduction of these agents into cardiovascular medicine has had several major and related consequences. Investigators are examining the efficacy of Ca2+ blockers in a number of additional disorders both within and without the cardiovascular system, in cluding achalasia, asthma, atherosclerosis, dysmenorrhea, intestinal spasm, labyrinthine disorders, migraine, peripheral vascular disorders, premature labor, and urinary incontinence. In addition to diltiazem, nifedipine, and verapamil, a large number of related agents are coming into use or are under clinical investigation. In the 1,4-dihydropyridine (nifedipine) category these related agents include felodi pine, nicardipine, nitrendipine, nisoldipine, nimodipine, and PN 200-110. Among the phenyl alkylamine (verapamil) class they include gallopamil and tiapamil (Figure 1). As a consequence of this high level of clinical activity, discrete sections or chapters on Ca2+ channel antagonists are appearing in standard texts of pharmacology (9, 10).
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