Cal channel blockers including nifedipine Antihypertensives , including centrally acting agents eg clonidine Antiarrhythmics , antipsychotics TCADs , MAOIs . fluvoxamine, barbiturates , cardiac glycosides, sympathomimetics,

Cimetidine, hydralyzine, rifampicin, Insulin, oral hypoglycemics, NSAIDs, ergot derivatives, erthythromycin, Anesthetics, antimalarials, diuretics, Moxisylate, resperine, guanethedine, Thyroid hormones, Potassiun overdose

Arrhythmias

Bradycardia, postural hypotension, heart failure Increased AV block, cardiac arrhythmias Raynauds phenomenon, cold extremites Sexual dysfunction,

GI, Sleep CNS disturbances, headache, vivid dreams Dizziness, depression, dyspnoea Rarely bronchospasm. Skin reactions Withdraw if unexplained dry eyes or rash

Fatigue, paraesthesia, peripheral neuropathy, Arthalgia, myopathy, Altered blood sugar Haemotology and lipid levels

2nd and 3rd degree AV block ( without pacemaker ) Severe bradycardia, sick sinus sybdrome, Uncontrolled heart failure Cardiogenic shock, Severe peripheral heart disease, Hypotension, Metabolic acidosis, Untreated phaeochromocytoma Severe asthma or COPD or History of bronchospasm Right ventricular failure secondary to pulmonary hypetension Significant right ventricular hypertrophy Concurrent calcium antasgonists ( verapramil, diltiazem ) Allergic disorder with bronchospasm pre-disposition

Special precautions

1st degree AV block Heart failure ( avoid if uncontrolled )

Peripheral vascular disease . Prinzmetal angina, myasthena gravis

Chronic myocardial insufficiency Unseupected cardiomypoathy Ischemic heart disease , with draw gradually History of bronchospasm, Diabetes, hyperthyrodism

Renal or hepatic impairment, Psoriasis

Elderly

Consider withdrawal before elective surgery Anaphylaxis risk due to increaeed sensitivity to allergens Always withdraw gradually over period of 1 to 2 weeks Pregnancy Lactation

Arrhythmias

Dosage-

40 to 240mg daily in 2- 3 divided doses Children - not recommended

Contraindicated Observe caution if required to be used during pregnancy or lactation