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Background: The therapeutic use of nifedipine, a dihydropyridine calcium channel blocker, is limited due to its poor solubility profile, rapid onset of its action, stability profile and short biological half-life. Many formulation techniques have been applied to improve physicochemical and pharmacological properties of the drug. Objective: The objective of the study is to summarize the nanotechnology approaches made to improve the therapeutic and pharmacokinetic properties of nifedipine till 2020. Methods: The searches for the related articles were done up to 28 March 2020 with the specific keywords in Pubmed and Google Scholar excluding review articles. Results: The discussion showed that among the nano-carriers used to improve the pharmacological property of the drug, lipid nanoparticles, polymeric nanoparticles, crystalline nanoparticles, and nano-emulsions were prevalent. Nanotechnology has been efficient to improve the solubility profile of nifedipine, achieve sustained and controlled release by achieving targeted and local delivery and transdermal drug delivery. Exploiting nano-formulations, new windows of therapeutic applications have been achieved. Finally, micelle media, polymeric nanoparticles, and microcrystalline nanoparticles have been used to develop a photostable formulation. Conclusion: The technological innovations in the field of nanomedicine have paved many ways for the delivery of nifedipine and such sparingly water-soluble compounds.

Amlodipine, a dihydropyridine calcium channel blocker (CCB), is the leading cause of cardiovascular drug-related overdose deaths in the USA. In contrast, angiotensin-II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) cause minimal toxicity in overdose. ACEIs/ARBs are often combined with dihydropyridines in hypertension treatment. Co-ingested ARBs/ACEIs may significantly contribute to the toxicity of dihydropyridine, but this has not been investigated.To investigate the clinical outcomes from dihydropyridine overdoses with ARBs/ACEIs versus dihydropyridine overdoses alone.This was a retrospective study of patients reported to the New South Wales Poisons Information Centre (NSW PIC) and 3 toxicology units (Jan 2016 to Jun 2019) in Australia. Patients14 years who took an overdose of dihydropyridines (amlodipine, felodipine, lercanidipine, nifedipine) were included. Concurrent overdoses with non-dihydropyridine CCBs, alpha-blockers and beta-blockers were excluded. Patient demographics, drugs exposure details, serial vital signs, treatments and outcome were collected.There were 100 patients. 68 took mixed overdoses of dihydropyridines with ARBs/ACEIs and 32 took single overdoses of dihydropyridines without ARBs/ACEIs. The mixed group had lower median nadir mean arterial pressures (62 vs 75 mmHg,Combined overdoses of dihydropyridines with ARBs/ACEIs caused more significant hypotension and required more haemodynamic support than overdoses of dihydropyridines alone.

Objectives: This study aimed to evaluate the effect of dihydropyridine calcium-channel blocker (CCB) on adverse aortic events (AAE) in patients undergoing thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Methods: A retrospective study was conducted on patients undergoing TEVAR of TBAD from January 2010 to December 2017 in our center. Patients were divided into CCB group and non-CCB group according to the postoperative dihydropyridine CCB use. AAE including aorta-relative mortality and reintervention, were compared between these two groups. Propensity score matching analysis was performed to avoid the potential effect of known confounders.Results: Before matching, the study cohort comprised 548 patients, including 435 (79.4%) and 113 (20.6%) patients in the CCB and non-CCB groups, respectively. After matching, 101 patients in each group were eligible for the analysis. In the unmatched cohort, AAE occurred in 52 (12.0%) and 29 (25.7%) patients in the CCB and non-CCB groups, respectively (P < 0.001). In the matched cohort, AAE occurred in 8 (7.9%) and 22 (21.8%) patients in the CCB and non-CCB groups, respectively (P = 0.013). Log-rank test analysis revealed that the levels of freedom from AAE were significantly different between the 2 groups in both the unmatched and matched cohorts (P < 0.001 and P = 0.007, respectively). Multivariable analysis showed that CCB use (hazard ratio 0.50, 95% confidence interval 0.32–0.80; P = 0.003) was associated with a lower AAE rate after adjustment for other variables, and was minimally changed after the propensity score matching (HR 0.34, 95% CI 0.15–0.75; P = 0.008).Conclusions: Postoperative dihydropyridine CCB use is protective in patients undergoing TEVAR for acute and sub-acute TBAD.

Purpose There is an increased use in the (prescription) sequence symmetry analysis (PSSA); however, limited studies have incorporated a negative control, and no study has formally quantified and controlled for within-patient time-varying bias using a negative control. Our aim was to develop a process to incorporate the effect of negative controls into the main analysis of a PSSA. Methods Using a previously assessed dihydropyridine calcium channel blocker (DH-CCB) and loop diuretic PSSA, we directly compared the adjusted sequence ratios (aSRs) of DH-CCBs to each of the two negative control index drugs (levothyroxine and angiotensin converting enzyme [ACE] inhibitor/ angiotensin-2 receptor blocker [ARB]) using the ratio of the aSRs to estimate a relative aSR with a Z test. Further, we utilized the relative aSR in stratum-specific analyses and varying exposure windows. Results The relative aSR of DH-CCBs decreased from 1.87 to 1.72 (95% CI 1.66-1.78) using levothyroxine as a negative control index drug. ACE inhibitor/ARB negative control index drug resulted in an aSR of 1.27 thus reducing the relative aSR for DH-CBB from 1.84 to 1.45 (95% CI 1.41-1.49). When restricting the exposure window to 180 and 90 days, the relative aSR of DH-CCBs increased to 1.68 (95% CI 1.62-1.74) and 1.86 (95% CI 1.78-1.94), respectively, relative to the ACE inhibitor/ARB negative control index drug. Conclusion We illustrated how to incorporate negative control index drugs into a PSSA and generate relative aSRs. Stratum-specific assessments and varying the exposure windows while using negative control index drugs can yield more informative results.

Oronasal fistula (ONF) is the most common complication after palatoplasty in patients with cleft lip and palate (CLP). When left untreated, it may negatively affect the quality of life, leading to development of other comorbidities. This study reports for the first time, the use of a portion of a hyperplasic tissue associated with pedicled buccal fat pad flap to repair a large anterior ONF in a 60-year-old man. The hyperplasic tissue may have developed due to the combination of a loose fitting upper denture and long-term use of dihydropyridine calcium channel blocker (amlodipine besylate). There is controversy in the literature about use of pedicled buccal fat pad flap in the anterior region. However, in this study, we report successful repair of a large anterior ONF using a portion of a fibroepithelial hyperplasic tissue associated with pedicled buccal fat pad flap.

International audience; Amlodipine is a dihydropyridine calcium channel blocker widely used in the treatment of high blood pressure and coronary heart disease. Intoxication can lead to reflex tachycardia following massive hypotension and death. The objective of this work was to study the post-mortem concentrations of amlodipine in 62 patients in order to determine whether the use of the reference concentrations from the living patients was applicable in postmortem setting, and to define more precisely the fatal and non-fatal postmortem concentrations of amlodipine. The amlodipine concentrations were measured in femoral whole blood by LC–MS/MS validated method. When sufficient information was available, the data were classified into 2 different groups, based on the conclusions of the autopsy and toxicological results: G1: non-toxic death and G2: fatal poisoning involving amlodipine alone or as part of a multidrug poisoning. The median concentration of amlodipine [1st quartile - 3rd quartile] of the whole population (n = 62) was 81 [42–134] ng/mL. Twenty-two cases were classified as G1 and thirteen as G2. The observed median [1st quartile - 3rd quartile] concentration of amlodipine was 66 [40.5–79.5] ng/mL in G1 and 240 [170–404] ng/mL in G2. The median concentrations observed in “non-toxic” deaths (66 ng/mL) were three times higher than those usually observed in living patients. Amlodipine distribution ratio between plasma and whole blood concentrations seems insufficient to explain this difference and postmortem redistribution from organs should be considered, and could suggest the same redistribution pattern for other drugs belonging to the same family.

Supplemental Digital Content is available in the text., OBJECTIVES: The aim was to evaluate the effect of dihydropyridine calcium channel blocker on the prognosis for moderate-severe pulmonary acute respiratory distress syndrome in hypertension patients. DESIGN: A retrospective, observational, multicenter cohort study. SETTING: A total of 307 patients without propensity score matching and 186 adult inpatients with propensity score matching diagnosed with hypertension and moderate-severe pulmonary acute respiratory distress syndrome in five teaching hospitals in Jiangsu province, China, from December 2015 to December 2020 were enrolled. PATIENTS: A total of 307 patients without propensity score matching and 186 patients with propensity score matching diagnosed with hypertension and moderate-severe pulmonary acute respiratory distress syndrome were included in the final analysis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic characteristics and clinical characteristics were recorded. The propensity score matching method was used to eliminate the difference between group with dihydropyridine calcium channel blocker and group without dihydropyridine calcium channel blocker. The primary outcome was in-hospital mortality. We used univariate and multivariate regression analyses for both patients with or without propensity score matching to assess the effect of these variables on mortality. In the subset of 186 patients with propensity score matching, in-hospital mortality was 53.2%. Inpatient mortality was significantly higher in patients treated with dihydropyridine calcium channel blocker than in those not treated with dihydropyridine calcium channel blocker of patients without propensity score matching (65.4% vs 40.4%; p < 0.01). Multivariate analysis for patients without propensity score matching showed that dihydropyridine calcium channel blocker (hazard ratio, 1.954; 95% CI, 1.415–2.699), lactate dehydrogenase greater than or equal to 600 U/L (hazard ratio, 3.809; 95% CI, 2.106–4.531), and lactate greater than or equal to 2 mmol/L (hazard ratio, 1.454; 95% CI, 1.041–2.029) were independently associated with in-hospital mortality. Based on univariate analysis for patients with propensity score matching, dihydropyridine calcium channel blocker (hazard ratio, 2.021; 95% CI, 1.333–3.064), lactate dehydrogenase greater than or equal to 600 U/L (hazard ratio, 4.379; 95% CI, 2.642–7.257), and lactate greater than or equal to 2 mmol/L (hazard ratio, 2.461; 95% CI, 1.534–3.951) were independently associated with in-hospital mortality. In contrast, patients not treated with dihydropyridine calcium channel blocker had a significant survival advantage over those treated with dihydropyridine calcium channel blocker in both patients without or with propensity score matching (p < 0.001; p = 0.001 by Kaplan-Meier analysis). CONCLUSIONS: Dihydropyridine calcium channel blocker, lactate dehydrogenase greater than or equal to 600 U/L, and lactate greater than or equal to 2 mmol/L at admission were independent risk factors for patients with hypertension and moderate-severe pulmonary acute respiratory distress syndrome.

Amlodipine, a dihydropyridine calcium channel blocker, is commonly prescribed for the treatment of hypertension. Ingestion of an overdose leads to severe hypotension; if the hypotension is not treated, death may be imminent. Conventional and unconventional interventions were used to treat an adolescent who ingested a life-threatening dose of amlodipine. Severe hypotension resistant to conventional treatment with intralipids and hyperinsulinemia-euglycemia therapy led to the use of plasmapheresis and a pneumatic antishock garment as lifesaving measures. Plasmapheresis has been described in only one other case of severe amlodipine overdose, and the use of a pneumatic antishock garment has never been described in the management of a calcium channel blocker overdose. Because short-term use of a pneumatic antishock garment has associated risks, the critical care nurse’s anticipation of side effects and promotion of safe use of the garment were instrumental in the patient’s care and outcome. (Critical Care Nurse. 2016; 36[4]:64–69)

Author discusses antiatherosclerotic effects of dihydropyridine calcium channel blocker, amlodipine, in patients with coronary artery disease. Results of randomized clinical trials PREVENT (2000), CAPARES (2000), CAMELOT (2004) and ENCORE II (2009) are analyzed.

Calcium channel blockers (CCBs), particularly dihydropyridine-CCBs, (DHP-CCBs), have an established role in antihypertensive therapy, either as monotherapy or in combination with other antihypertensive drugs. Two hundred and fifty-one papers published in PubMed in English between January 1, 1990, and October 31, 2016, were identified using the keyword 'lercanidipine.' Lercanidipine is a lipophilic third-generation DHP-CCB, characterized by high vascular selectivity and persistence in the smooth muscle cell membranes. Lercanidipine is devoid of sympathetic activation, and unlike the first and second generation of DHP-CCBs, it dilates both the afferent and the efferent glomerular arteries, while preserving the intraglomerular pressure. In addition, lercanidipine prevents renal damage induced by angiotensin II and demonstrates anti-inflammatory, antioxidant, and anti-atherogenic properties through an increasing bioavailability of endothelial nitric oxide. It is associated with a regression of microvascular structural modifications in hypertensive patients. The efficacy of lercanidipine has been demonstrated in patients with different degrees of hypertension, in the young and elderly and in patients with isolated systolic hypertension. In patients with diabetes and renal impairment, lercanidipine displays a renal protection with a significant decrease of microalbuminuria and improvement of creatinine clearance. Lercanidipine is well tolerated and is associated with a very low rate of adverse events, particularly ankle edema, compared with amlodipine and nifedipine. In conclusion, lercanidipine produces a sustained blood pressure-lowering activity with a high rate of responder/normalized patients, associated with a favorable tolerability profile.

OBJECTIVES: The Hypertension Registry at the Bangkok Hospital Medical Center has been working since June 2012. We reported on the first 7 months of 647 registry cases in February 2013. The purpose of this study was to compare and highlight the Registry profile after 2 years in operation. The findings gained from this study are aimed at optimizing service efficiency resulting in better quality of care for patients with hypertension. MATERIALS AND METHODS: Descriptive analysis using absolute number and percentage was used to draw comparisons between the characteristics of the updated registrants and the registrants from the first 7 months. RESULTS: By the end of a 2-year period, the number of active registered cases went up to 3,698 cases compared to 647 cases after the first 7 months of the Registry (December 2012). A total of 1,159 cases were discharged because of lack of follow-up for more than 12 months. Younger registrants, under 21 years of age, took part in the program. The most common associated cardiovascular risk factors included dyslipidemia and diabetes mellitus, and the smoking risk factor has increased significantly. In comparison the history of risk factors and associated diseases at 7 and 24 months from the number of patients have increased. The statistic data of dyslipidemia, diabetes mellitus, heart, kidney diseases, stroke and peripheral vascular disease are not significant changes but in contrast the smoking causes have increased significantly. Angiotensin receptor blocker was still the most commonly used medication in hypertensive care, followed by dihydropyridine calcium channel blocker and beta blocker respectively. Almost half of registrants were successful in achieving blood pressure control. CONCLUSION: The Hypertensive Registry at the 2-year point now provides more information beyond individual case treatments. The risk factors of dyslipidemia, diabetes mellitus, cardiovascular, kidney and stroke have not significantly changed in the first 7 months experience study but in contrast, smoking is increasing significantly. These highlights should be emphasized as a strategy of improving care to hypertensive patients.

Despite progress in reducing the risk of hypertension (HT) complications, control of blood pressure (BP) levels remains inadequate. Dihydropyridine calcium channel blockers show antihypertensive effect due to significant vasoselective action with a minimal impact on a conductive system of the heart. Lercanidipine is a dihydropyridine calcium channel blocker of the third generation with high lipophilicity and long-lasting action. Lercanidipine had shown both in monotherapy and in combination with ACE inhibitors or angiotensin II blockers the good antihypertensive effect with stable BP profile throughout the day, organoprotection that slowed down the progression of HT complications, metabolic neutrality and safety in mild to moderate HT.

Barnidipine hydrochloride is a long term dihydropyridine calcium channel blocker used for the treatment of hypertension. During the process development of barnidipine hydrochloride, four barnidipine impurities were detected by high-performance liquid chromatography (HPLC) with an ordinary column (Agilent ZORBAX Eclipse XDB-C18, 150 mm × 4.6 mm, 5 µm). All these impurities were identified, synthesized, and subsequently characterized by their respective spectral data (MS, 1H-NMR, and 13C-NMR). The identification of these impurities should be useful for quality control in the manufacture of barnidipine.

Data about the current approach to the choice of dual antihypertensive combinations in various clinical situations for treatment of hypertension are presented. Advantages and indications for the combination of an ACE inhibitor with a dihydropyridine calcium channel blocker are reviewed. Data from prospective studies on the efficacy and safety of combination of third generation calcium channel blocker lercanidipine with ACE inhibitor enalapril are presented.

Introduction: Although improved during the past few years, blood pressure control remains sub optimal. Aim: The impact of follow-up assessment on blood pressure control was evaluated in a group of patients of the HYT (HYperTension survey), treated with a combination of different dihydropyridine calcium-channel blockers (CCBs regimen) and inhibitors of renin-angiotensin-aldosterone system (RAAS) and with uncontrolled blood pressure. This was obtained assessing (a) the rate of blood pressure control at 3 and 6 months of follow-up in the whole group of patients, (b) the rate of blood pressure control and the average blood pressure values in subjects treated with different DHP-CCBs regimen. Methods: From the 4993 patients with uncontrolled blood pressure, (BP ? 140/90 or ?140/85 in patients with diabetes), 3729 (mean age 61.2 ± 11.5 years), maintained CCBs regimen combined wih RAAS blockers and were evaluated at 3 and 6 months follow-up. At each visit BP (semiautomatic device, Omron-M6, 3 measurements), heart rate, adverse events and treatment persistence were collected. Results: At 1st and 2nd follow-up the rate of controlled BP was 63.5 and 72.8% respectively (p < 0.05 vs 35.3% at baseline), whereas in diabetes was 32.5 and 37.9% respectively (p < 0.05 vs 20% at baseline). No differences in heart rate were observed. No differences in control rate were observed between the different CCBs regimen. The incidence of drugs related adverse events was 3.6%. Conclusions: These findings provide evidence that: (a) the follow-up of hypertensive patients under therapy increase the rate of blood pressure control; (b) there is no significant difference in the antihypertensive effect between different CCBs regimen; (c) lipophilic CCBs induce less ankle edema. © 2017, Springer International Publishing Switzerland.

Alma Rivera1, Elsa Montoya2, Joseph Varon31Universidad Autónoma de Chihuahua, Chihuahua, México; 2Universidad de Monterrey, Nuevo León, México; 3University of Texas Health Science Center at Houston, Texas, USAAbstract: Hypertension remains one of the most prevalent diseases affecting our society, and its complications lead the list of causes of mortality all over the world. Most efforts to control the disease are unsuccessful, failing in at least two-thirds of affected patients, despite the availability of multiple drugs for its treatment. The limited number of medications available for aggressive management of hypertensive crises has intensified the search for novel drugs that can achieve a rapid decrease in blood pressure without increasing the possible complications. Clevidipine is a novel, vasculoselective, dihydropyridine calcium channel blocker characterized by a very fast onset and offset of action. Metabolism of clevidipine does not occur in the liver or kidneys, and thus there are no restrictions to using clevidipine in patients with hepatic or renal dysfunction. This agent has been widely used to reduce blood pressure when oral therapy is not appropriate, and its use in the perioperative setting has been shown to be beneficial. This manuscript reviews the key characteristics of clevidipine and its role in the management of acute hypertension.Keywords: clevidipine, hypertension management, acute, hypertensive crises, intravenous

Influence of the combined antihypertensive therapy, including combination of ACE inhibitors and dihydropyridine calcium channel blocker (DCCB), on frequency of cardiovascular events is studied in many trails. Advantages of the combination of ACE inhibitor and DCCB which is one of the most rational are discussed. Both components are vasodilators and have synergistic mode of action in arterial hypertension. Combination of ACE inhibitor and DCCB allows neutralizing of antiregulatory mechanisms reducing drug efficacy. Results of clinical trails which promoted of the fixed combination of lisinopril (10 mg) and amlodipine (5 mg) are presented. Safety and organoprotective properties of this combination are also shown according to the trail results.

Morgan E Snider1, Donald S Nuzum2, Angie Veverka21Virginia Commonwealth University Health Systems Richmond, VA USA; 2Wingate University School of Pharmacy Wingate, NC USAAbstract: Hypertension is a global condition affecting billions worldwide. It is a significant contributor to cardiovascular events, cardiac death and kidney disease. A number of medication classes exist to aid healthcare providers and their patients in controlling hypertension. Nifedipine, a dihydropyridine calcium channel blocker, was once one of the most widely used medications for hypertension, but safety and tolerability concerns along with the introduction of new classes of antihypertensive medications and an increasing pool of data showing mortality benefit of other classes caused nifedipine to fall out of favor. More recently, long-acting formulations were developed and made available to clinicians. These newer formulations were designed to address many of the concerns raised by earlier formulations of nifedipine. Numerous clinical trials have been conducted comparing long-acting nifedipine to many of the more commonly prescribed antihypertensive medications. This review will address the pharmacology, pharmacokinetics and the available clinical trial data on long-acting nifedipine and summarize its role in the management of hypertension.Keywords: nifedipine, calcium channel blockers, hypertension

Insufficient control of blood pressure levels of the essential hypertension in Russia (less than 30% for women, less than 20% for men) was proven by epidemiology trials. This article is a review of the present opportunities to increase efficacy of treating hypertension by application of combined anti-hypertensive therapy and the advantages of fixed dose combinations (FDC). The authors scientifically prove the importance of using the combination, including angiotensin I-converting enzyme perindopril arginine and the long-half time dihydropyridine calcium channel blocker amlodipine in various clinical cases. Also the article summarizes the research of real clinical practice proving the high efficiency and safety of perindopril arginine /amlodipine FDC.

Nifedipine is a dihydropyridine calcium channel blocker used for the treatment of hypertension in pregnant women. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for analysis of nifedipine in human plasma and amniotic fluid. Separation of nifedipine and nitrendipine (IS) was performed using a LiChroCART(®) RP-Select B column and a mixture of water:acetonitrile:glacial acetic acid (30:70:0.5 v/v) as the mobile phase. Aliquots of 500μL of biological samples were extracted at pH 13 using dichloromethane:n-pentane (3:7 v/v). The validated method was applied to a study of the pharmacokinetics of nifedipine in human plasma and amniotic fluid samples collected up to 12h after administration of the last slow-release nifedipine (20mg/12h) dose to 12 hypertensive pregnant women. The estimated pharmacokinetic parameters of nifedipine showed a mean AUC(0-12) of 250.2ngh/mL, ClT/F of 89.2L/h, Vd/F of 600.0L and t1/2 5.1h. The mean amniotic fluid/plasma concentration ratio was 0.05. The methods proved to be highly sensitive by showing a lower quantification limit of 0.1ng/mL for both matrices. And this study reports for the first time the complete development and validation of the method to quantify nifedipine in amniotic fluid using LC-MS-MS.

Aim. Dihydropyridine calcium channel blockers (CCB) are widely preferred for the treatment of hypertension for their efficacy, metabolic neutrality and low side effect profile. However pedal edema formation limits their usage. The aim of the present study is to evaluate the incidence of pedal edema formation with a different dihydropyridine CCB in hypertensive patients who developed pedal edema during a dihydropyridine CCB therapy. Method. Fifty-eight hypertensive patients (34 female, 24 male, mean age: 65.3±10.5) in whom pedal edema developed during treatment with a dihydropyridine CCB (amlodipine 10mg/day in 40 patients, amlodipine 5mg/day in 14 patients, nifedipine GITS 30mg/day in 4 patients) were enrolled. CCB which caused pedal edema was withdrawn and a different CCB (felodipine or lacidipine) were initiated after the resolution of the pedal edema. CCB therapy was continued as long as the patient tolerated pedal edema. Results. At the end of one year, 44 out of 58 patients (36 [81.8%] free of pedal edema, 8 [19.2%] with pedal edema) continued CCB therapy. Eleven (37.9%) patients in the felodipine group and 9 (31.0%) patients in the lacidipine group developed pedal edema. In 7 patients in felodipine group and in 5 patients in the lacidipine group the study drug was withdrawn due to pedal edema. In two patients, study drug was withdrawn due to intractable headache (felodipine group) or due to flushing (lacidipine group). Conclusion. A different group of dihydropyridine CCB be used as an alternative therapy for hypertension whenever pedal edema develops during treatment with a dihydropyridine CCB.Keywords: Hypertension, dihydropyridine calcium channel blockers, edema ÖzetAmaç. Dihidropiridin kalsiyum kanal blokerleri (KKB) etkinlikleri, metabolik nötraliteleri ve düşük yan etki profilleri nedeniyle hipertansiyon tedavisinde yaygın olarak tercih edilirler. Ancak tedavi sırasında ayak bileği ödemi gelişimi kullanımlarını kısıtlar. Bu çalışmanın amacı dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen hipertansif hastalarda farklı bir dihidropiridin KKB’ ne geçilmesiyle ayak bileği ödemi gelişim oranının araştırılmasıdır. Yöntem. Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen 58 hipertansif hasta (34 kadın, 24 erkek, ortalama yaş 65,3±10,5) çalışmaya alındı. Bunlardan 40’ında ayak bileği ödemine yol açan KKB amlodipin 10mg/gün, 14’ünde amlodipin 5mg/gün ve 4’ünde nifedipine GITS 30mg/gün idi. Ayak bileği ödemi yapan KKB kesilerek ödem kaybolduktan sonra farklı bir dihidropiridin KKB (felodipin ya da lasidipin) başlandı. Yeni başlanan KKB tedavisine hasta ayak bileği ödemini tolere ettikçe devam edildi. Bulgular. Bir yıllık takip dönemi sonunda 58 hastadan 44 (%75,9) tanesi (36 [%81.8] ödemsiz, 8 [%18.2] ödemli olarak) KKB tedavisine devam ediyordu. Felodipin grubunda 11 (%37,9) ve lasidipin grubunda 9 (%31,0) hastada ayak bileği ödemi gelişti. Felodipin grubunda 7, lasidipin grubunda 5 hastada ayak bileği ödemi geliştiği için tedavi kesildi. Felodipin grubunda bir hastada şiddetli başağrısı, lasidipin grubunda bir hastada ise flushing nedeniyle tedavi sonlandırıldı. Sonuç. Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen hipertansif hastalarda KKB tedavisini kesmek yerine başka gruptan bir dihidropiridin KKB alternatif olarak kullanılabilir.Anahtar sözcükler: Hipertansiyon, dihidropiridin kalsiyum kanal blokerleri, ödem, Amaç. Dihidropiridin kalsiyum kanal blokerleri (KKB) etkinlikleri, metabolik nötraliteleri ve düşük yan etki profilleri nedeniyle hipertansiyon tedavisinde yaygın olarak tercih edilirler. Ancak tedavi sırasında ayak bileği ödemi gelişimi kullanımlarını kısıtlar. Bu çalışmanın amacı dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen hipertansif hastalarda farklı bir dihidropiridin KKB’ ne geçilmesiyle ayak bileği ödemi gelişim oranının araştırılmasıdır. Yöntem. Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen 58 hipertansif hasta (34 kadın, 24 erkek, ortalama yaş 65,3±10,5) çalışmaya alındı. Bunlardan 40’ında ayak bileği ödemine yol açan KKB amlodipin 10mg/gün, 14’ünde amlodipin 5mg/gün ve 4’ünde nifedipine GITS 30mg/gün idi. Ayak bileği ödemi yapan KKB kesilerek ödem kaybolduktan sonra farklı bir dihidropiridin KKB (felodipin ya da lasidipin) başlandı. Yeni başlanan KKB tedavisine hasta ayak bileği ödemini tolere ettikçe devam edildi. Bulgular. Bir yıllık takip dönemi sonunda 58 hastadan 44 (%75,9) tanesi (36 [%81.8] ödemsiz, 8 [%18.2] ödemli olarak) KKB tedavisine devam ediyordu. Felodipin grubunda 11 (%37,9) ve lasidipin grubunda 9 (%31,0) hastada ayak bileği ödemi gelişti. Felodipin grubunda 7, lasidipin grubunda 5 hastada ayak bileği ödemi geliştiği için tedavi kesildi. Felodipin grubunda bir hastada şiddetli başağrısı, lasidipin grubunda bir hastada ise flushing nedeniyle tedavi sonlandırıldı. Sonuç. Dihidropiridin KKB tedavisi sırasında ayak bileği ödemi gelişen hipertansif hastalarda KKB tedavisini kesmek yerine başka gruptan bir dihidropiridin KKB alternatif olarak kullanılabilir.

The Novel Development of an Experimental Model of Dihydropyridine Calcium Channel Blocker Poisoning using Intravenous Amlodipine Cardiovascular drug poisoning remains a leading cause of fatality. Within this class, calcium channel blockers(CCBs) account for the majority of deaths. CCBs are typically categorized as dihydropyridines (i.e. amlodipine or nifedipine) versus the non-dihydropyridine (i.e. verapamil and diltiazem) which are the most potent and once considered the CCB type responsible for all CCB-related deaths. Most recently, dihydropyridine deaths have increased. While there are established models of nondihydropyridine poisoning there currently are no established experimental models of dihydropyridine poisoning.