Calcium channel blockers vs. ACE inhibitors: What’s the difference?
- Calcium channel blockers (CCBs) and angiotensin-converting enzyme (ACE) inhibitors are used to treat high blood pressure.
- Calcium channel blockers (CCBs) are also used to relieve or prevent angina (chest pain), to treat certain abnormal heart rhythms, and to treat migraine headaches.
- ACE inhibitors are also used to treat left ventricular dysfunction and heart failure, to prevent strokes, and to prevent and treat kidney disease in people with hypertension or diabetes.
- Examples of calcium channel blockers include amlodipine (Norvasc), amlodipine and atorvastatin (Caduet), amlodipine and benazepril (Lotrel), amlodipine and valsartan (Exforge), amlodipine and telmisartan (Twynsta), amlodipine and olmesartan (Azor), amlodipine and olmesartan and hydroclorothiazide (Tribenzor), amlodipine and aliskiren and hydroclorothiazide, amlodipine and perindopril (Prestalia), clevidipine (Cleviprex), diltiazem (Cardizem), felodipine (Cardene, Cardene SR), isradipine, nicardipine, nimodipine, nisoldipine (Sular), and verapamil (Calan).
- Examples of ACE inhibitors include benazepril (Lotensin), captopril, enalapril (Vasotec, Epaned), fosinopril, lisinopril (Prinivil, Zestril, Qbrelis), moexipril, perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik).
- Side effects of calcium channel blockers and ACE inhibitors that are similar include rash, low blood pressure, drowsiness, and dizziness.
- Side effects of calcium channel blockers that are different from ACE inhibitors include constipation, nausea, headache, swelling of the legs and feet with fluid (edema), liver dysfunction, overgrowth of the gums, and sexual dysfunction.
- Side effects of ACE inhibitors that are different from calcium channel blockers include cough, elevated blood potassium levels, headache, weakness, abnormal taste (metallic or salty), chest pain, increased uric acid levels, sun sensitivity, and increased BUN and creatinine levels.
What are Calcium Channel Blockers? What are ACE Inhibitors?
Calcium channel blockers (CCBs) dilate the arteries, reducing pressure, making it easier for the heart to pump blood so the heart needs less oxygen. Reducing the heart's need for oxygen helps relieve or prevent angina (heart pain). CCBs also are used to treat high blood pressure (hypertension) because of their blood pressure-lowering effects. Calcium channel blockers decrease the excitability of heart muscle and are used for treating certain types of abnormally rapid heart rhythms. Calcium channel blockers also may be used after a heart attack, particularly among patients who cannot tolerate beta-blocking drugs, have atrial fibrillation, or require treatment for their angina. They also are used for treating migraine headaches.
Angiotensin converting enzyme inhibitors (ACE inhibitors) slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, blood vessels enlarge or dilate, and blood pressure is reduced. Lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. The progression of kidney disease due to high blood pressure or diabetes is slowed. ACE inhibitors are used to treat high blood pressure, left ventricular dysfunction and heart failure, to prevent strokes, and to prevent and treat kidney disease in people with hypertension or diabetes.
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What are the side effects of calcium channel blockers and ACE inhibitors?
Calcium channel blockers
The most common side effects of calcium channel blockers are:
- Constipation
- Nausea
- Headache
- Rash
- Edema (swelling of the legs and feet with fluid)
- Low blood pressure
- Drowsiness
- Dizziness
Liver dysfunction and over growth of the gums also occurs.
When diltiazem (Cardizem) or verapamil (Calan, Isoptin) are given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood.
Like other blood pressure medications, calcium channel blockers are associated with sexual dysfunction.
ACE Inhibitors
ACE inhibitors are well-tolerated by most individuals. Nevertheless, they are not free of side effects, and some patients should not use ACE inhibitors.
ACE inhibitors usually are not prescribed for pregnant women because they may cause birth defects.
Individuals with bilateral renal artery stenosis (narrowing of the arteries that supply the kidneys) may experience worsening of kidney function, and people who have had a severe reaction to ACE inhibitors probably should avoid them.
The most common side effects are:
- Cough
- Elevated blood potassium levels
- Low blood pressure,
- dizziness
- Headache
- Drowsiness
- Weakness
- Abnormal taste (metallic or salty taste)
- Rash
- Chest pain
- Increased uric acid levels
- Sun sensitivity
- Increased BUN and creatinine levels
It may take up to a month for coughing to subside, and if one ACE inhibitor causes cough it is likely that the others will too.
The most serious, but rare, side effects of ACE inhibitors are:
- Kidney failure
- Allergic reactions
- Pancreatitis
- Liver dysfunction
- A decrease in white blood cells
- Swelling of tissues (angioedema).
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What is the dosage for calcium channel blockers vs. ACE inhibitors?
Calcium channel blockers
Calcium channel blockers often come in oral tablet form. For example, the recommended starting dose of amlodipine, a common CCB, for children and adults is 2.5 to 5 mg once daily. The maximum dose for adults is 10 mg once daily and the maximum dose for children is 5 mg once daily. Amlodipine can be taken with or without food. Amlodipine is inactivated mainly by the liver, and dosages may need to be lowered in patients with liver dysfunction.
ACE Inhibitors
ACE inhibitors are often supplied as oral tablet. For example, the usual starting dose of benazepril, a common ACE inhibitor, is 10 mg daily. If patients are taking a diuretic (water pill) the starting dose is 5 mg daily. Doses may be increased to 20-40 mg once daily or divided and administered twice daily.
What drugs interact with calcium channel blockers and ACE inhibitors?
Calcium channel blockers
The interactions of calcium channel blockers occur with verapamil (Calan, Isoptin) or diltiazem (Cardizem). The interaction occurs because verapamil and diltiazem decrease the elimination of a number of drugs by the liver. Through this mechanism, verapamil and diltiazem may reduce the elimination and increase the blood levels of carbamazepine (Tegretol), simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor). This can lead to toxicity from these drugs.
Grapefruit juice (approximately 200 ml) may elevate blood concentrations of felodipine (Plendil), verapamil (Calan, Isoptin), nisoldipine (Sular), nifedipine (Adalat, Procardia), nicardipine (Cardene), and possibly amlodipine (Norvasc). Grapefruit juice should not be consumed within 2 hours before or 4 hours after administration of affected calcium channel blockers.
ACE Inhibitors
ACE inhibitors have few interactions with other drugs.
- Since ACE inhibitors may increase blood levels of potassium, the use of potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase the body's potassium may result in excessive blood potassium levels.
- ACE inhibitors also may increase the blood concentration of lithium (Eskalith, Lithobid) and lead to an increase in side effects from lithium.
- There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the blood pressure lowering effects of ACE inhibitors.
- Patients receiving diuretics may experience excessive reduction in blood pressure when ACE inhibitors are started. Stopping the diuretic or increasing salt intake prior to taking the ACE inhibitor may prevent excessive blood pressure reduction. Close supervision for at least two hours after the start of ACE inhibitors and until blood pressure is stable is recommended if the diuretic cannot be stopped.
- ACE inhibitors should not be combined with ARBs because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment.
- Ace inhibitors should not be combined with aliskiren (Tekturna), another class of drugs that is used to treat high blood pressure because such combinations increase the risk of kidney failure, excessive low blood pressure, and hyperkalemia.
- Nitritoid reactions (symptoms include facial flushing, nausea, vomiting and low blood pressure) may occur when injectable (gold sodium aurothiomalate [Myochrysine]), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors.
Are calcium channel blockers and ACE inhibitors safe to use while pregnant or breastfeeding?
Calcium channel blockers
Women who are pregnant or nursing should talk to their doctors before using this class of drugs.
ACE Inhibitors
ACE inhibitors usually are not prescribed for pregnant women because they may cause birth defects. Women who are nursing should talk to their doctors before using this class of drugs