E-drug: Nifedipine deletion WHO Essential medicines List
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Dear e-druggers,
I totally agree that nifedipine should not be deleted [Norman Olson,
17/9/2003] not only because of its safety, efficacy and affordability but
also because a great proportion of hypertensive patients end up
having to use multiple therapy to keep blood pressure under control.
A modified release calcium channel blocker is hardly ever a first
choice in the UK but is a very useful adjunct. I personally have lots of
patients on triple or quadruple therapy and nifedipine or amlodipine
are generally the third or fourth line drug to be added. The sequence
in UK is generally: diuretic (especially in the elderly), long acting
Angiotensin Converting Enzyme inhibibitor (Angiotensin Receptor
Inhibitor when ACE-I not tolerated), beta blocker (this, with an ACE-I
also used in secondary cardiovascular prevention in post-infarction
patients), Ca-channel antagonist (nifedipine or amlodipine),
alpha-blocker when all the above is still not enough. Please note that
virtually all patients with co-morbid conditions, such as ischaemic
heart disease, cerebrovascular or peripheral vascular disease,
advanced renal disease, long-standing diabetes require multiple
therapy.
Valeria
Dr. Valeria Frighi
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Oxford
UK
e-mail: valeria.frighi@dtu.ox.ac.uk
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