Calcium Channel

Detail-Document #250414
This Detail-Document accompanies the related article published in
PHARMACISTS LETTER / PRESCRIBERS LETTER

April 2009 ~ Volume 25 ~ Number 250414
Comparison of Calcium Channel Blockers

Calcium channel blockers (CCBs) are divided into two classes: the non-dihydropyridines (diltiazem [e.g., Cardizem, etc] and verapamil [e.g.,
Calan, etc]) and the dihydropyridines (all CCBs except verapamil and diltiazem). The following chart provides information on the pharmacology and
therapeutic interchange for the CCBs in the U.S. Many states allow therapeutic interchange without prescriber approval of therapeutic equivalents as
listed in the FDAs Orange Book. Therapeutic equivalents are drugs that demonstrate BOTH pharmaceutical equivalence (same active ingredient,
dosage form, and strength) and bioequivalence (comparable rate and extent of absorption). (See our Detail-Document Generic Substitution for
Commonly Prescribed Drugs for information about generic substitution of other drugs and for a chart of state substitution regulations). The chart
below does not include authorized generics. Authorized generics are the exact same product as the brand name, but marketed as a generic (e.g.,
Pfizers nifedipine ER tablet is the same as Procardia XL).
Abbreviations: A. fib-atrial fibrillation; A. flutter-atrial flutter; ER-extended release; HS-at bedtime; HTN-hypertension; IR-immediate release; mfrmanufacturer; SVT-supraventricular tachycardia
Drug4-38
Formulation/
Therapeutic Equivalentsa Indication and Doseb
Commentsb
Strength
(Drug/Mfr)
DIHYDROPYRIDINES: Mechanism of action involves coronary and peripheral arteriolar vasodilation. This can lead to reflex tachycardia, headache,
flushing, and peripheral edema. The dihydropyridines can impair myocardial contractility to varying degrees.1 Dihydropyridines are CYP3A4 substrates.2
Once-a-day (24 hour) Dihydropyridines
May be the safest choice if
Amlodipine (Norvasc)
2.5 mg, 5 mg,
Amlodipine tablet
HTN: initial 5 mg QD (2.5 mg QD for
a CCB is needed in a
10 mg tablets
Actavis Totowa, Amneal,
small, frail, elderly, or hepatic
patient with systolic heart
Apotex, Aurobindo,
insufficiency); max
failure.1
Caraco, Cobalt, Dr.
10 mg QD
Reddys, Gedeon Richter,
CAD: 5 mg to 10 mg QD
Invagen, Kali, Lek, Lupin,
Matrix, Mylan, Ranbaxy,
Roxane, Synthon, Teva,
Torrent, Upsher Smith,
Watson, Wockhardt, Zydus
More. . .
Copyright 2009 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #250414: Page 2 of 10)
Drug4-38
Formulation/
Therapeutic Equivalentsa
Strength
(Drug/Mfr)
Once-a-day (24 hour) Dihydropyridines, continued
Felodipine ER (Plendil)
2.5 mg, 5 mg,
Felodipine ER tablet
10 mg tablet
Mutual, Mylan
Indication and Doseb
Commentsb
HTN: initial 5 mg QD (2.5 mg QD

elderly); max 10 mg QD
Isradipine ER (DynaCirc CR)
5 mg, 10 mg
tablet
Nonec
HTN: 5 mg QD; max 20 mg per day
Patients may have more

side effects with no
additional benefit at doses
>10 mg daily.
Nifedipine ER (Adalat CC)
30 mg, 60 mg
tablet
Nifedipine ER tablet
Actavis, Afeditab CR
(Watson), Biovail
(marketed by Teva as
Nifediac CC)
HTN: initial 30 mg QD; doses >90 mg

not recommended
Take on an empty stomach.
90 mg
Biovail (marketed by Teva

as Nifediac CC)
Nifedipine ER (Afeditab CR)
30 mg, 60 mg
tablet
Actavis, Adalat CC
(Bayer), Biovail (marketed
by Teva as Nifediac CC)
HTN: initial 30 mg QD; doses >90 mg

not recommended
Take on an empty stomach.
Nifedipine ER (Procardia XL)
30 mg, 60 mg
tablet
Biovail (marketed by Teva
as Nifedical XL), Osmotica
HTN: initial 30-60 mg QD; max

120 mg QD
90 mg tablet
Osmotica
Vasospastic or chronic stable angina:

initial
30-60 mg QD; max
120 mg QD (limited experience with
>90 mg QD)
More. . .
Drug4-38
Formulation/
Strength
(Drug/Mfr)
Once-a-day (24 hour) Dihydropyridines, continued
Nisoldipine ER (Sular)
8.5 mg, 17 mg,
Nonec
25.5 mg, 34 mg
tablet
Nisoldipine ER (generic only;
brand to which it was
equivalent has been
reformulated) (Mylan)
20 mg, 30 mg,
40 mg tablet
Commentsb
HTN: initial 17 mg QD; max 34 mg

QD
None
HTN: initial 20 mg QD; usual

20-40 mg QD; max 60 mg QD
Increased risk of adverse

effects over 40 mg.
Twice Daily Dihydropyridines

Isradipine (DynaCirc [brand
2.5 mg, 5 mg
discontinued], generics
capsule
available)
Isradipine capsule
Actavis, Cobalt
HTN: initial 2.5 mg BID; max daily

dose 20 mg (given in divided doses)
Patients may have more

side effects with no
additional benefit with
>10 mg daily.
Nicardipine ER (Cardene SR)
Nonec
HTN: usual 30-60 mg twice daily
Nicardipine capsule
Amneal, Barr, Mylan,
Teva, Watson
HTN: initial 20 mg TID; usual

20-40 mg TID
30 mg, 45 mg,
60 mg capsule
Three Times Daily Dihydropyridines

Nicardipine (Cardene [brand
20 mg, 30 mg
discontinued], generics
capsule
available)
Start with 20 mg BID in

hepatic insufficiency.
Chronic stable angina: initial 20 mg

TID; usual 20-40 mg TID
Nifedipine IR (Procardia)
10 mg, 20 mg
capsule
Nifedpine capsule
Actavis Elizabeth, Catalent,
Inverness
Vasospastic or chronic stable angina:

initial
10 mg TID; usual
10-20 mg TID;
max 60 mg TID
Not to be used to treat acute

blood pressure elevation or
hypertension.
More. . .
Formulation/
Therapeutic Equivalentsa Indication and Doseb
Commentsb
Strength
(Drug/Mfr)
NON-DIHYDROPYRIDINES: Compared to the dihydropyridines, the non-dihydropyridines provide relatively less peripheral and coronary arteriolar
vasodilation. They have significant negative inotropic and negative chronotropic effects, with verapamil having the most pronounced effect. The nondihydropyridines also slow cardiac conduction.1 Diltiazem and verapamil are CYP3A4 substrates and CYP3A4 inhibitors.2 Constipation is common with
verapamil.1
Once-a-day (24 hour) Non-dihydropyridine Products
Drug4-38
Diltiazem ER (Cardizem CD)
Diltiazem ER (Cardizem LA)
Diltiazem ER (Cartia XT)
Diltiazem ER (Dilacor XR)
120 mg, 180 mg,

240 mg, 300 mg
capsule
Diltiazem ER capsule
Actavis Elizabeth, Biovail,
Cartia XT (Watson Labs
Florida), Dilt-CD
(Torpharm)
HTN: initial 180-240 mg QD; usual

240-360 mg QD; max 480 mg QD
Capsules can be opened for

administration of the intact
granules.3
Vasospastic and chronic stable angina:

120-180 mg QD; max
480 mg QD
Some patients may respond

to lower dose.

540 mg QD

to lower dose.
360 mg capsule
Nonec
120 mg, 180 mg,

240 mg, 300 mg,
360 mg, 420 mg
tablet
Nonec
120 mg, 180 mg,

240 mg, 300 mg
capsule
Cardizem CD (Biovail),
Dilt-CD (Torpharm)
HTN:initial 180-240 mg QD; usual

240-360 mg QD; max 480 mg QD
Watson Labs Florida,
Mylan, Torpharm
HTN: initial 180-240 mg (elderly

120 mg QD); usual 180-480 mg QD;
max 540 mg QD
120 mg, 180 mg,

240 mg capsule
Chronic stable angina: initial

180 mg QD; max 360 mg QD
to lower dose.

initial 120-180 mg QD; max 480 mg
QD
Chronic stable angina: initial 120 mg

QD; max 480 mg QD
More. . .
Drug4-38
Formulation/
Strength
(Drug/Mfr)
Once-a-day (24 hour) Non-dihydropyridine Products, continued
Diltiazem ER (Dilt-CD)
120 mg, 180 mg, Diltiazem ER capsule
240 mg, 300 mg
capsule
Cardizem CD (Biovail),
Cartia XT (Watson Labs
Florida)
Diltiazem ER (Diltzac)
Diltiazem ER (Taztia XT)
Diltiazem ER (Tiazac)
120 mg, 180 mg,

240 mg, 300 mg,
360 mg capsule
120 mg, 180 mg,

240 mg, 300 mg,
360 mg capsule
120 mg, 180 mg,

240 mg, 300 mg
capsule
420 mg capsule
Verapamil ER (Verelan)
Commentsb
HTN: initial 180-240 mg QD; usual

240-360 mg QD; max 480 mg QD

to lower dose.

QD
KV Pharm, Taztia XT
(Watson Labs Florida),
Tiazac (Biovail)

540 mg QD
KV Pharm, Diltzac
(Apotex),
Tiazac (Biovail)

540 mg QD
KV Pharm, Diltzac
(Apotex),
Taztia XT (Watson Labs
Florida)
KV Pharm
HTN: initial 120-240 mg QD;

max 540 mg QD
120 mg, 180 mg,

240 mg capsule
Verapamil ER capsule
Mylan
360 mg capsule
None
May administer capsule

contents sprinkled on a
spoonful of applesauce,
followed by a glass of cool
water; do not chew.

120-180 mg QD; max 540 mg QD

water; do not chew.

120-180 mg QD; max 540 mg QD

water; do not chew.
Chronic stable angina:

QD
HTN: 240 mg QD (120 mg QD for

small or elderly patients, or those with
liver impairment); max 480 mg QD

water; do not chew.
More. . .
Drug4-38
Formulation/
Strength
Therapeutic
Equivalentsa (Drug/Mfr)
Once-a-day (24 hour) Non-dihydropyridine Products, continued

Verapamil ER (Verelan PM)
100 mg,
Verapamil ER capsule
200 mg, 300 mg
Mylan
capsule
Commentsb
HTN: 200 mg HS (100 mg HS for

small or elderly patients, or renal or
hepatic insufficiency); max 400 mg HS

water; do not chew.
Taken HS, peak effect
occurs in morning & early
afternoon.
Verapamil ER (Covera-HS)
180 mg, 240 mg

tablet
Nonec
HTN: initial 180 mg QD; max 480 mg

QD
Angina: initial 180 mg QD; max
540 mg QD
Taken HS, peak verapamil

plasma concentrations
occur in the early morning
hours.
Twice-a-day (12 hour) Non-dihydropyridine Products

Diltiazem ER (formerly
Cardizem SR [discontinued];
generic available)
60 mg, 90 mg,
120 mg capsule
Mylan
HTN: initial 60-120 mg BID; usual

daily dose 240-360 mg (given in
divided doses)
Verapamil ER (Isoptin SR)
120 mg, 240 mg

tablet
Ivax, Kali, Mylan
180 mg tablet
Ivax, Mylan
HTN: initial 180 mg QD (consider

120 mg in small or elderly patients, or
hepatic insufficiency); max 240 mg Q12
hrs
More. . .
Drug4-38
Formulation/
Strength
(Drug/Mfr)
Three and Four times daily Non-dihydropyridine Products
Diltiazem IR (Cardizem)
30 mg, 60 mg,
Diltiazem IR tablet
120 mg, 90 mg
Clonmel, Mylan, Teva
tablet
Commentsb

initial 30 mg QID; average daily dose
180-360 mg (given in divided doses)
Take before meals and at

bedtime.
Verapamil IR (Calan)
HTN: initial 80 mg TID (consider

40 mg TID in small or elderly patients,
or hepatic impairment); max daily dose
480 mg (given in divided doses)(no
evidence of additional benefit beyond
360 mg)
40 mg tablet
Verapamil IR tablet
Sandoz, Watson
80 mg, 120 mg
tablet
Verapamil IR tablet
Actavis Elizabeth, Mylan,
Sandoz, Watson

usual 80-120 mg TID; consider initial
dose of 40 mg TID in small or elderly,
or hepatic impairment.
A.fib, A.flutter: 80 mg TID to 80 mg
QID (with digoxin)
SVT: 80 mg TID to 120 mg QID (nondigitalized)
Acute Care Calcium Channel Blockers

Clevidipine (Cleviprex)
0.5 mg/mL
emulsion
None
Blood pressure reduction: initial 1-2

mg/hour; usual 4-6 mg/hr
Also see our DetailDocument: New Drug:

Cleviprex (Clevidipine)
More. . .
Drug4-38
Formulation/
Strength
(Drug/Mfr)
Acute Care Calcium Channel Blockers, continued
Commentsb
Diltiazem (Cardizem) injection

(brand discontinued, generic
available)
A. fib and A. flutter: 0.25 mg/kg

(20 mg for average size patient) over 2
min; after 15 min., if needed, give
0.35 mg/kg (25 mg for average size
patient); if needed give additional
boluses or start continuous infusion of
10 mg/hour (range 5-15 mg/hour) for up
to 24 hours
Diltiazem exhibits dosedependent, non-linear

kinetics, and may
accumulate with infusion
for more than 24 hours.
5 mg/mL
100 mg/15 mL
Add-Vantage vial
Diltiazem injection
Apotex, Baxter, Bedford,
Hospira, Intl Medication,
Taylor, Teva
Diltiazem injection
Hospira
SVT: 0.25 mg/kg (20 mg for average

size patient) over 2 min; after 15 min.,
if needed, give 0.35 mg/kg (25 mg for
average size patient); subsequent doses
per patient need
Nicardipine injection (Cardene)
Nimodipine (Nimotop [brand

discontinued, generic
available])
2.5 mg/mL
Nicardipine injection
Teva
20 mg (0.1
mg/mL), 40 mg
(0.2 mg/mL)
premix
Nicardipine injection
EKR Therapeutics
30 mg capsules
Nimodipine capsules
Banner, Barr, Sun
HTN: initial 5 mg/hour, max

15 mg/hour; decrease to 3 mg/hour
when goal reached
As a substitute for oral nicardipine:
20 mg Q8hrs=0.5 mg/hour;
30 mg Q8hrs=1.2 mg/hour;
40 mg Q8hrs=2.2 mg/hour
Subarachnoid hemorrhage: 60 mg
Q4 hours for 21 days
Can puncture capsule on

both ends and withdraw
contents with 18-guage
needle & administer
through nasogastric tube
followed by 30 mL of
water. Label syringe Not
for IV use.
More. . .

Drug4-38
Formulation/
Strength
(Drug/Mfr)
Acute Care Calcium Channel Blockers, continued
Verapamil injection (Calan
[brand discontinued, generic
available])
2.5 mg/mL
Commentsb
Verapamil injection
Bedford, Hospira, Intl
Medication, Luitpold
SVT, A.fib., A.flutter: initial

Infuse over at least 3 min.
5-10 mg (0.075-0.15 mg/kg) over 2
in elderly patients.
min; if needed, after 30 min., give
10 mg (0.15 mg/kg); optimal interval
for subsequent doses not determined
a. From Electronic Orange Book. March 13, 2009. http://www.fda.gov/cder/ob/default.htm. (Accessed March 14, 2009). The manufacturers
listed may differ from the company who markets or distributes the drug. Both the manufacturer and distributor are listed on the drugs
product labeling.
b. From U.S. prescribing information unless otherwise specified.
c. Cost of 30-day supply (drugstore.com): Cardene SR 60 mg BID $125.99; Cardizem CD 360 mg QD $215.23; Cardizem LA 360 mg QD
$133.78; Covera HS 240 mg HS $79.37; DynaCirc CR 10 mg QD $159.73; Sular 34 mg QD $92.38; Verelan 360 mg QD $191.20.
Users of this document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical
judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and Internet links in this article were current as of the date of publication.
More. . .
Project Leader in preparation of this DetailDocument: Melanie Cupp, Pharm.D., BCPS
References
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Saseen JJ, Carter BL. Essential hypertension. In:

Koda-Kimble MA, Young LY, Kradjan WA, Gugliemo
BJ, editors. Applied therapeutics: the clinical use of
drugs. Philadelphia, PA: Lippincott Williams &
Wilkins; 2005.
Cytochrome P450 drug interactions. Pharmacist's
Letter/Prescriber's Letter 2006;22(2):220233.
Medications that should not be crushed.
Pharmacist's
Letter/Prescriber's
Letter
2008;24(12):241204.
Product information for Norvasc. Pfizer Inc. NY, NY
10017. August 2006.
Product information for Plendil. AstraZeneca LP.
Wilmington, DE 19850. November 2003.
Product information for DynaCirc CR.
Reliant
Pharmaceuticals, Inc. Liberty Corner, NJ 07938.
August 2005.
Product information for Adalat CC.
Schering
Corporation. Kenilworth, NJ 07033. October 2004.
Product information for Afeditab CR.
Watson
Laboratories. Corona, CA 92880. September 2007.
Product information for Nifediac CC.
Teva
Pharmaceuticals USA. Sellersville, PA 18960. July
2003.
Product information for Nifedical XL.
Teva
Pharmaceuticals USA.
Sellersville, PA 18960.
September 2003.
Product information for Procardia XL. Pfizer Inc.
NY, NY 10017. August 2003.
Product information for Sular. Sciele Pharma, Inc.
Atlanta, GA 30328. January 2008.
Product information for nisoldipine.
Mylan
Pharmaceuticals Inc. Morgantown, WV 26505. June
2008.
Product information for isradipine.
Cobalt
Laboratories. Bonita Springs, FL 34134. May 2008.
Product information for Cardene SR.
PDL
BioPharma, Inc. Redwood City, CA 94063. January
2007.
Product information for nicardipine.
Mylan
Pharmaceuticals Inc.
Morgantown, WV 26505.
December 2004.
Product information for Procardia. Pfizer Inc. NY,
NY 10017. March 2006.
Product information for Cardizem CD.
Biovail
Pharmaceuticals, Inc.
Morrisville, NC 27560.
August 2001.
19. Product information for Cardizem LA.

Abbott
Laboratories. North Chicago, IL 60064. September
2007.
20. Product information for Cartia XT.
Watson
Laboratories, Inc. Corona, CA 92880. December
2006.
21. Product information for Dilt-CD.
Apotex Corp.
Weston, FL 33326. May 2004.
22. Product information for Dilt-XT.
Apotex Corp.
Weston, FL 33326. September 2005.
23. Product information for Diltzac.
Apotex Corp.
Weston, FL 33326. July 2008.
24. Product information for Diltia XT.
Watson
Laboratories, Inc. Corona, CA 92889. July 2007.
25. Product information for Taztia XT.
Watson
Laboratories. Corona, CA 92880. December 2006.
26. Product
information
for
Tiazac.
Forest
Pharmaceuticals, Inc. St. Louis, MO 63045. April
2006.
27. Product information for Verelan. Schwarz Pharma.
Milwaukee, WI 53201. March 2005.
28. Product information for Verelan PM.
Schwarz
Pharma. Milwaukee, WI 53201. May 2004.
29. Product information for Covera-HS. Pfizer In. NY,
NY 10017. March 2006.
30. Product information for diltiazem extended-release
capsule
(twice-a-day
dosage).
Mylan
Pharmaceuticals Inc. Morgantown, WV 26505. June
2006.
31. Product information for Isoptin SR.
Ranbaxy
Laboratories Inc. Jacksonville, FL 32257. July 2007.
32. Product information for Cardizem.
Biovail
Pharmaceuticals, Inc.
Morrisville, NC 27560.
August 2001.
33. Product information for Calan. Pfizer Inc. NY, NY
10017. May 2006.
34. Product information for Cleviprex. The Medicines
Company. Parsippany, NJ 07054. August 2008.
35. Product information for diltiazem injection. Bedford
Laboratories. Bedford, OH 44146. May 2005.
36. Product information for nicardipine injection. EKR
Therapeutics, Inc. Bedminster, NJ 07921. May
2008.
37. Product information for nimodipine.
Barr
Laboratories, Inc. Pomona, NY 10970. February
2007.
38. Product information for verapamil injection. Hospira,
Inc. Lake Forest, IL 60045. June 2005.
Cite this Detail-Document as follows: Comparison of calcium channel blockers. Pharmacists Letter/Prescribers
Letter 2009;25(4):250414.
Evidence and Advice You Can Trust

3120 West March Lane, P.O. Box 8190, Stockton, CA 95208 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249
Subscribers to Pharmacists Letter and Prescribers Letter can get Detail-Documents, like this one, on any
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Detail-Document #250414

This Detail-Document accompanies the related article published in

PHARMACISTS LETTER / PRESCRIBERS LETTER

Comparison of Calcium Channel Blockers

(Detail-Document #250414: Page 2 of 10)

Indication and Doseb

HTN: initial 5 mg QD (2.5 mg QD

Isradipine ER (DynaCirc CR)

HTN: 5 mg QD; max 20 mg per day

Patients may have more

Nifedipine ER (Adalat CC)

HTN: initial 30 mg QD; doses >90 mg

Take on an empty stomach.

Biovail (marketed by Teva

Nifedipine ER (Afeditab CR)

HTN: initial 30 mg QD; doses >90 mg

Take on an empty stomach.

Nifedipine ER (Procardia XL)

HTN: initial 30-60 mg QD; max

Vasospastic or chronic stable angina:

(Detail-Document #250414: Page 3 of 10)

Indication and Doseb

HTN: initial 17 mg QD; max 34 mg

HTN: initial 20 mg QD; usual

Increased risk of adverse

Twice Daily Dihydropyridines

HTN: initial 2.5 mg BID; max daily

Patients may have more

Nicardipine ER (Cardene SR)

HTN: usual 30-60 mg twice daily

HTN: initial 20 mg TID; usual

Three Times Daily Dihydropyridines

Start with 20 mg BID in

Chronic stable angina: initial 20 mg

Vasospastic or chronic stable angina:

Not to be used to treat acute

(Detail-Document #250414: Page 4 of 10)

Diltiazem ER (Cardizem CD)

Diltiazem ER (Cardizem LA)

Diltiazem ER (Cartia XT)

Diltiazem ER (Dilacor XR)

120 mg, 180 mg,

HTN: initial 180-240 mg QD; usual

Capsules can be opened for

Vasospastic and chronic stable angina:

Some patients may respond

HTN: initial 180-240 mg QD; max

Some patients may respond

120 mg, 180 mg,

120 mg, 180 mg,

HTN:initial 180-240 mg QD; usual

HTN: initial 180-240 mg (elderly

120 mg, 180 mg,

Chronic stable angina: initial

Vasospastic and chronic stable angina:

Chronic stable angina: initial 120 mg

(Detail-Document #250414: Page 5 of 10)

Diltiazem ER (Taztia XT)

120 mg, 180 mg,

120 mg, 180 mg,

120 mg, 180 mg,

Indication and Doseb

HTN: initial 180-240 mg QD; usual

Some patients may respond