Calcium Channel Blockers

Background

Calcium channel blockers (CCBs) are used by millions of Americans to treat high blood pressure, angina, and certain heart rhythm abnormalities. The monthly cost for these drugs varies from less than $20 to more than $200. This report gives you information that will help you: (a) determine when you might need a CCB; (b) choose the right CCB and dosage; and (c) save $1,000 or more per year if you are currently taking or have been prescribed an expensive brand-name CCB.

To help you and your doctor choose the right CCB if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 20-page report you can access for free on the Internet at CRBestBuyDrugs.org. This Web site also has free reports about other drugs we’ve analyzed.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need a Calcium Channel Blocker?

CCBs are typically not prescribed as initial or first-line treatment in people with high blood pressure who have no other form of heart disease. Instead, CCBs are often used as a second or third drug to help lower blood pressure when other drugs have failed to bring levels down enough.

CCBs should be considered as initial treatment (usually in combination with other drugs) for people who have high blood pressure plus angina and/or a high risk of stroke. CCBs should not be taken by people with heart failure (often called congestive heart failure).

Blood Pressure Treatment Guidance

Blood Pressure Classification

Systolic Measure (mm Hg)

Diastolic Measure (mm Hg)

General Treatment Guidance

Normal

Below 120

Below 80

  • No treatment needed
  • Healthy lifestyle encouraged to maintain normal blood pressure

Prehypertensive

120–139

80–89

  • Lifestyle changes needed: weight loss, quitting smoking, low-salt and low-fat diet, curb excessive alcohol use, and increased exercise
  • Drug treatment not indicated except if you have diabetes or kidney or heart disease

Stage 1 High Blood Pressure

140–159

90–99

  • Lifestyle changes urged, same as above
  • Drug treatment needed. Doctor may start with one medicine (usually a diuretic) to see if it works

Stage 2 High Blood Pressure

160 or above

100 or above

  • Contact your doctor immediately
  • Drug treatment needed. Two or more medicines usually required to bring blood pressure down
  • Lifestyle changes, as described above, are a critical component of your treatment

Source: Chobanian AV, Bakris GL, Black HR, et al., “The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure,” Journal of the American Medical Association, 2003; 289(19):2560-2572

Our Recommendations

CCBs are effective medicines that have been shown to lower blood pressure and help prevent and treat the symptoms of angina (chest pain). In addition, some CCBs are effective in controlling certain heart rhythm problems.

Taking effectiveness, safety, dosing convenience, and cost into account, we have chosen the following CCBs as Consumer Reports Best Buy Drugs. They can save you $1,000 to $1,700 per year if you are already taking or have been prescribed an expensive brand-name CCB.

All these medicines are available as low-cost or moderately priced generic drugs. All are as effective as other CCBs. And all are long-acting pills that need to be taken just once a day.

CCBs are generally safe drugs, but they can cause some side effects, most commonly dizziness, headache, flushing, and swollen ankles. Bleeding gums may also occur. Serious side effects include breathing problems; an irregular, fast heart beat; or a dangerously slow heart rate. Starting with as low a dose as possible can reduce your risk of side effects.

This information was released in March 2011.

Cost Comparison

Generic Name, Dosage Strength, and Form1

Brand Name2

Drug a Generic 3

Frequency per Day4

Average Monthly Cost5

Best Buy Indication

Amlodipine 5 mg tablet

Generic

Yes

One

$22

Angina and 2nd drug for high blood pressure

Amlodipine 5 mg tablet

Norvasc

No

One

$78

Amlodipine 10 mg tablet

Generic

Yes

One

$30

Angina and 2nd drug for high blood pressure

Diltiazem CD 120 mg capsule6

Generic

Yes

One

$28

Heart rhythm abnormalities

Diltiazem CD 120 mg capsule

Cardizem CD

No

One

$119

Diltiazem CD 180 mg capsule

Generic

Yes

One

$33

Heart rhythm abnormalities

Diltiazem CD 180 mg capsule

Cardizem CD

No

One

$143

Diltiazem SR 60 mg capsule7

Generic

Yes

One

$23

Heart rhythm abnormalities

Diltiazem SR 90 mg capsule

Generic

Yes

One

$28

Heart rhythm abnormalities

Felodipine SR 5 mg tablet

Generic

Yes

One

$37

Felodipine SR 10 mg tablet

Generic

Yes

One

$69

Isradipine 5 mg capsule

Generic

Yes

Two

$116

Nicardipine 30 mg capsule

Generic

Yes

Three

$60

Nicardipine SR 30 mg capsule

Cardene SR

No

Two

$102

Nifedipine 10 mg capsule

Generic

Yes

Three

$84

Nifedipine SR 30 mg tablet

Generic

Yes

One

$34

Nifedipine SR 30 mg tablet

Procardia XL6

No

One

$82

Nifedipine SR 60 mg tablet

Generic

Yes

One

$51

Nifedipine SR 60 mg tablet

Procardia XL

No

One

$138

Nisoldipine SR 25.5 mg tablet

Generic

Yes

One

$200

Nisoldipine SR 25.5 mg tablet

Sular

No

One

$352

Verapamil SR 120 mg tablet

Generic

Yes

One

$24*

Heart rhythm abnormalities

Verapamil SR 120 mg tablet

Calan SR

No

One

$80

Verapamil SR 180 mg tablet

Generic

Yes

One

$31*

Heart rhythm abnormalities

Verapamil SR 180 mg tablet

Calan SR

No

One

$100

Verapamil SR 100 mg capsule

Generic (PM)8

Yes

One

$60

Verapamil SR 100 mg capsule

Verelan PM

No

One

$126

Verapamil SR 200 mg capsule

Generic

Yes

One

$77

Heart rhythm abnormalities

Verapamil SR 200 mg capsule

Verelan PM

Yes

One

$151

*Indicates the dose of that drug may be available for a low monthly cost through programs offered by chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

1. Selected drugs and dosages only. For a complete price list of CCBs, go to CRBestBuyDrugs.org to download the free, full 20-page report.

2. “Generic” indicates that this drug is sold as a generic under the generic or chemical name.

3. “Yes” means it is a generic, sold under the chemical name. “No” means it is a brand-name drug not yet available as a generic or a branded generic.

4. Frequency per day reflects usual frequency; some medicines may be used more or less frequently.

5. Prices reflect nationwide cash prices of retail average for January 2011, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

6. “CD” stands for continuous delivery.

7. “SR” stands for sustained release.

8. "PM" is a type of extended-release formulation that is usually taken at night in order to reduce high blood pressure in the morning hours.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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