Dihydropyridine Calcium Channel Blockers
Calcium channel blockers bind to the 1-subunit of the L-type calcium channel in muscle cell membranes, reducing calcium flux through the channels and lowering cytosolic calcium concentration, which ultimately reduces muscle contractility . The dihydropyridine calcium channel blockers are so called for their shared chemical structure, and they are more specific for vascular smooth muscle, causing arterial vasodilation with fewer effects on cardiac muscle than the nonDHP-CCBs verapamil and diltiazem. Although nonDHP-CCBs can reduce BP, they are not commonly prescribed in our practice primarily because of many drug interactions, notably with statins and calcineurin inhibitors. Furthermore, nonDHP-CCBs, when combined with BABAs, can provoke atrioventricular conduction delays and complete heart block. The DHP-CCBs are effective and well tolerated, which is why they are recommended first-line therapy in some guidelines for uncomplicated primary hypertension . Large trials specifically examining DHP-CCBs for hypertension in CKD are lacking, but these drugs have been used to lower BP as an active comparator in landmark trials of ACEi and ARB agents in CKD. They are effective antihypertensive agents in both CKD and ESKD . A major advantage of using DHP-CCBs is that they work well in a volume-expanded state. Furthermore, when used with ACEis or ARBs, they lower BP more than either drug alone.
Subgroup Analysis And Durationresponse Analysis
The efficacy of amlodipine on the prevention of incidence of CI-AKI in the subgroups was shown in Table 3. Before matching, a significant reduction in CI-AKI was observed in the elderly , diabetes groups , non-CKD group , and low-osmolar group but not CKD group and iso-osmolar group . However, after matching, this result was found in the elderly and those with diabetes , CKD , non-CKD , and low-osmolar , but not in iso-osmolar group . We also investigated the durationresponse relationship between duration of amlodipine therapy and risk of CI-AKI . It was found that as the duration of amlodipine increased from 3 to 7 days to greater than 7 days, there was a decrease risk of the CI-AKI incidence .
Table 3 The association between amlodipine and CI-AKI in the subgroups.
Figure 4 Risk of CI-AKI associated with increasing duration of amlodipine. *P< 0.05 vs. controls.
Is Amlodipine Hard On The Kidneys Vibramycin
Prices from 5) Amlodipine increases my cancer risk. The changes in your estimated glomerular filtration rate seem excessive and may represent an episode of acute kidney injury rather than slow progression of CKD. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Available for Android and iOS devices. With several blood pressure medications recently recalled due to contamination , patients have been asking about switching to other options, which makes this the perfect time to take a closer look at amlodipine , the calcium channel blocker introduced more than 35 years ago. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. Use extra care during exercise or hot weather.Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. Amlodipine is used with or without other medications to treat high blood pressure.Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.
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Protective Effects Of Amlodipine Pretreatment On Contrast
- 1Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
- 2Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Backgroud: Contrast-induced acute kidney injury is the most common adverse reaction caused by contrast media, which has been reported to prolong hospitalization and increase mortality and morbidity. The hypertensive population has proved susceptible to CI-AKI. Unfortunately, no therapeutic has been shown to prevent and cure CI-AKI effectively. A few studies have shown the protection of amlodipine on renal function, but the relationship between amlodipine and CI-AKI in hypertensive group is unknown, we aimed to study the effects of amlodipine on CI-AKI and overall survival in a large Chinese hypertensive cohort.
Methods: A retrospective, matched, cohort study was conducted among adults hospitalized at the Third Xiangya Hospital of Central South University from October 2007 to May 2017. CI-AKI was the primary end point of the trial, time-related all-cause mortality and length of hospital stay were the secondary end points. Propensity Score Matching was used to reduce the effect of selection bias and potential confounding.
In conclusion, we first found amlodipine treatment before contrast exposure played a role in protecting hypertensive patients from CI-AKI and prolonging survival.
If You Have Kidney Disease Other Medications Can Be Harmful
If your kidneys are already damaged, certain drugs can make them worse or lead to kidney failure. Talk to your doctor before taking cholesterol or diabetes medication, antacid medicine for an upset stomach, or antimicrobial meds, like antifungal and antiviral drugs. In some cases, you may be able to take a smaller dose that’s safer for you.
You also should talk to your doctor before having some kinds of imaging tests. With a magnetic resonance imaging or computed tomography scan, doctors sometimes use a dye to help them see a specific area of your body better. In rare cases, this dye can cause serious conditions called contrast-induced nephropathy or nephrogenic systemic fibrosis . Ask your doctor about other tests you might have instead.
National Kidney Foundation: “Contrast Dye and the Kidneys,” “How Your Kidneys Work,” “Oral Sodium Phosphate Safety Alerts,” “Pain Medicines ,” “Watch out for Your Kidneys When You Use Medicines for Pain,” “Which Drugs are Harmful to Your Kidneys?”
MedShadow: “6 Medications That Can Harm the Kidneys.”
Cleveland Clinic: “Supplements, OTCs May Hurt Your Kidneys.”
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Vitamin D Receptor Activation Increases Creatinine Production
In a 2011 study appearing in Kidney International, Agarwal et al. gave 16 patients with chronic kidney disease daily doses of paricalcitol, an orally active vitamin D receptor activator.2) The vitamin D analog was stopped after four days, and measurements were continued for three. Researchers found that subjects’ serum creatinine significantly increased at a rate of 0.010 mg/dl/day and urine creatinine at a rate of 17.6 mg/day. Researchers also found a small increase in blood levels of BUN.
In conclusion, VDR activation may alter creatinine metabolism. An increase in creatinine generation may lead to an increase in serum creatinine and, if eGFR is used to measure kidney function, it may give the appearance that kidney function is declining when truly it may not be altered.
Rajiv Agarwal et al.
This in vivo study is significant as it confirms several key aspects of the Marshall Protocol:3)
- Patients with kidney disease on a treatment designed to stimulate the VDR can expect their measures of creatinine to increase.
- The strategy of waiting-out abnormal creatinine values, rather than trying to intervene, is the most sensible approach currently available.
- A more valid method for measuring kidney function is the 24hr creatinine clearance test, rather than the calculated eGFR.
Why Do Ace Inhibitors Cause Cough
The means by which ACE inhibitors affect the respiratory system is thought to be through an increase of substance P, which is released from the vagal and glossopharyngeal sensory nerves in the pharynx and upper airways, and is naturally degraded by ACE . In this case, this will increase the cough reflex.
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Proper Use Of Norvasc
This section provides information on the proper use of a number of products that contain amlodipine. It may not be specific to Norvasc. Please read with care.
Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium . Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that this medicine will not cure your high blood pressure, but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You might have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, strokes, or kidney disease.
You may take this medicine with or without food. Take it at the same time each day.
Proper Use Of Amlodipine
Take amlodipine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
In addition to the use of amlodipine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium . Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that amlodipine will not cure your high blood pressure, but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You might have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, strokes, or kidney disease.
You may take amlodipine with or without food. Take it at the same time each day.
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Drugs Found To Protect The Kidneys
- Date:
- NIH-National Institute Of Diabetes And Digestive And Kidney Diseases
- Summary:
- The National Institutes of Health called an early halt to one arm of a study on the advice of an independent data and safety monitoring board after finding that people with kidney disease and protein in their urine were more likely to postpone kidney failure using either an angiotensin-converting enzyme inhibitor or a beta blocker than a calcium channel blocker .
The National Institutes of Health called an early halt to one arm of a study on the advice of an independent data and safety monitoring board after finding that people with kidney disease and protein in their urine were more likely to postpone kidney failure using either an angiotensin-converting enzyme inhibitor or a beta blocker than a calcium channel blocker .
The ACE inhibitor ramipril or the beta blocker metoprolol significantly reduced the risk of kidney failure compared to the CCB amlodipine in a group of patients who had at least one gram of protein in a 24-hour sample of urine when they joined the African American Study of Kidney Disease and Hypertension . Blood pressures were comparable.
Dr. Lawrence Agodoa, a kidney specialist and NIH director of AASK, cautions patients to keep taking prescribed blood pressure medicine until they have worked out an alternative with their doctor. “Calcium channel blockers are good for controlling high blood pressure, and patients are not in immediate risk,” he explains.
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Precautions While Using Norvasc
It is very important that your doctor check your or your child’s progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.
This medicine may cause angina or a heart attack in certain patients with severe heart or blood vessel disease. Check with your doctor right away if you are having chest pain or discomfort, fast or irregular heartbeat, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, trouble breathing, or sweating.
Dizziness, lightheadedness, or fainting may also occur, especially when you get up suddenly from a lying or sitting position. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning. If you faint, call your doctor right away.
Dizziness, lightheadedness, or fainting may also occur if you exercise or if the weather is hot. Heavy sweating can cause loss of too much water and result in low blood pressure. Use extra care during exercise or hot weather.
Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
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Why Is Amlodipine Given At Night
New research suggests that taking your blood pressure medication at bedtime may more effectively reduce your risk of illness or death due to heart and blood vessel disease. Timing of medication is important because blood pressure follows a daily rhythm. It rises higher during the day and falls at night when we sleep.
Goals Of Bp Reduction And Bp Targets
Guidelines offer the treating clinician a rapid, evidence-based, expert opinion regarding the management of certain conditions. Often criticised for a lack of flexibility, however, they are seen by some as unhelpful due to the complexities involved in clinical decision-making. Guidelines governing the management of patients with CKD are relatively few in relation to other conditions of similar prevalence. This may, in part, reflect the relative dearth of high-quality clinical trials in CKD. Despite this, guidelines outlining optimal treatment for CKD patients with hypertension are important, particularly as many of these patients are jointly managed in primary care.
In their 2017 guidelines, the ACC recommended that all adults with hypertension and CKD should be treated to a target BP of< 130/80 mmHg regardless of proteinuria . The National Institute for Health and Care Excellence and UK Renal Association suggest a more conservative target of< 140/90 mmHg, provided proteinuria is< 1 g/day . In the presence of greater degrees of urinary protein leak this target is revised to< 130/80 mmHg. KDIGO guidance also suggests a lower BP target for those with significant proteinuria, although it deploys a cut-off of> 300 mg/day . The 2018 ESC/ESH guidelines suggest a target systolic BP of< 140 mmHg regardless of proteinuria . To understand the differences between these guidelines one must consider the evidence used to create them .
Fig. 2
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Why Is This Medication Prescribed
Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina and coronary artery disease . Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain.
High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
New Cases Of Aav With Kidney Damage Reported In Hypertension Patients Using Hydralazine
A new case study supports previous findings that hydralazine a medication used to treat high blood pressure may cause ANCA-associated vasculitis with severe kidney injury, leading its researchers to recommend its use generally be avoided.
A , published in March, linked this medication to end-stage kidney disease in AAV patients, especially African-American patients.
The study, Hydralazine-associated adverse events: a report of two cases of hydralazine-induced ANCA vasculitis, was published in the Brazilian Journal of Nephrology.
Hydralazine is a vasodilator used to treat high blood pressure since the 1950s. But the medication is not without side effects, and studies have reported that 5 to 8% of patients who use hydralazine develop lupus, and 5 to 10% develop renal injury.
Researchers at the Jersey Shore University Medical Center presented two new cases giving further evidence of the detrimental adverse effects of hydralazine. The patients developed AAV after taking the medicine.
While drug-induced lupus has been frequently reported with the use of hydralazine, this medication can also cause drug-induced ANCA vasculitis, the researchers wrote.
One patient was a 57-year-old man with a history of hypertension and mild joint disease . The patient came to an outpatient clinic with symptoms of kidney impairment.
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Managing Hypertension Following Kidney Transplantation
As in haemodialysis, there are currently no randomised clinical trials exploring how best to manage hypertension following kidney transplantation. Hypertension is common post-transplant, with multiple factors contributing to its development . More than 90% of recipients of a kidney transplant receiving a calcineurin inhibitor -based immunosuppression regimen will be hypertensive post-transplant . BP is also more likely to be uncontrolled, with~50% failing to achieve a systolic BP< 140 mmHg at 1 year . Higher BP is associated with poorer graft outcomes and greater CVD risk, which is the leading cause of death following kidney transplant . A retrospective study of 1666 kidney transplant recipients demonstrated a~5% increased risk of graft failure and death with every 10 mmHg rise in systolic BP . Broader cardioprotection including lipid-lowering and antiplatelet therapy is likely to be beneficial in most patients .
Fig. 3
CNIs such as tacrolimus, which form the mainstay of post-transplant immunosuppression, cause afferent arteriolar vasoconstriction. There is some evidence to suggest that dihydropyridine CCBs confer particular benefit in those treated with CNIs due to their ability to cause afferent arteriolar vasodilatation in this context . Non-dihydropyridine CCBs interfere with CNI metabolism, necessitating closer monitoring of drug levels .