They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Wolff-Parkinson-White-syndrome ; bradycardia; cardiogenic shock; heart failure with reduced ejection fraction ; history of significantly impaired left ventricular function even if controlled by therapy ; hypotension; second- and third-degree AV block; sick sinus syndrome; sino-atrial block. See also Prescribing in the elderly. Acute phase of myocardial infarction avoid if bradycardia, hypotension, left ventricular failure ; first-degree AV block; neuromuscular disorders. Abdominal pain; dizziness; drowsiness; flushing; headache; nausea; palpitations; peripheral oedema; skin reactions; tachycardia; vomiting. Angioedema; depression; erectile dysfunction; gingival hyperplasia; myalgia; paraesthesia; syncope. Features of calcium-channel blocker poisoning include nausea, vomiting, dizziness, agitation, confusion, and coma in severe poisoning.

Treatment of chronic atrial fibrillation rate control ; prevention of paroxysmal supraventricular tachycardia. In general, lower initial doses are warranted; doses should be adjusted on basis of clinical response. Exacerbation of angina during initiation of treatment, after dose increase, or after withdrawal of beta blocker. Hypotension and bradyarrhythmias observed with concurrent use of other CYP3A4 substrates eg, cyclosporine, telithromycin because of competitive metabolism. Coadministration with CYP3A4 inhibitors eg, erythromycin, itraconazole may decrease metabolism and thus increase toxicity.

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