GENERIC NAME: bepridil

BRAND NAME: Vascor

DRUG CLASS AND MECHANISM: Bepridil is an oral calcium channel blocker (CCB). Other calcium channel blockers include nifedipine (Procardia, Adalat), amlodipine (Norvasc), felodipine (Plendil), nicardipine (Cardene), isradipine (Dynacirc), nisoldipine (Sular), verapamil (Calan; Isoptin; Covera; Verelan), and diltiazem (Cardizem; Tiazac; Dilacor). Bepridil is unrelated chemically to other calcium channel blockers. Moreover, unlike other calcium channel blockers, bepridil blocks sodium as well as calcium channels in a manner similar to quinidine (Quinaglute; Duraquin; Quinidex), procainamide (Procan-SR; Pronestyl), and disopyramide (Norpace), drugs that are used to treat abnormal heart rhythms.

Like other calcium channel blockers, bepridil partially prevents the increase in calcium within the heart's muscle cells that causes the cells to contract. As a result, the muscle contracts less vigorously. Less vigorous contraction means that the heart has to work less and needs less oxygen. This effect is useful in treating angina pectoris (heart pain), which occurs when the need of the heart for oxygen exceeds its supply of oxygen. By reducing the need for oxygen, bepridil prevents angina pectoris. Unlike other calcium channel blockers, bepridil does not lower blood pressure and is not used to treat high blood pressure

Because it can cause abnormal heart rhythms, bepridil generally is reserved for patients who have not responded to other drugs for angina pectoris. Bepridil was approved by the FDA in December of 1990.

GENERIC AVAILABLE: no

PRESCRIPTION: yes

PREPARATIONS: Tablets: 200mg.

STORAGE: Tablets should be stored at room temperature, 15- 30°C (59-86°F).

PRESCRIBED FOR: Bepridil is prescribed for patients with angina pectoris (heart pain) due to coronary artery disease.

DOSING: Bepridil usually is taken once daily. It can be taken with meals or at bedtime if nausea is a problem.

DRUG INTERACTIONS: Bepridil can reduce the strength with which the heart muscle contracts. Drugs which also have this effect could seriously reduce contractions and possibly precipitate congestive heart failure. Such drugs include quinidine (Quinaglute; Duraquin; Quinidex), procainamide (Procan-SR; Pronestyl), disopyramide (Norpace), flecainide (Tambocor), verapamil (Calan; Isoptin; Covera; Verelan), diltiazem (Cardizem; Tiazac; Dilacor), and all beta-blockers, for example, atenolol (Tenormin).

Bepridil slows the ability of the heart's muscle to recover electrically and get ready for the next contraction. Other drugs which have the same effect could interact with bepridil, possibly causing serious problems with abnormal heart rhythms and should be used cautiously if at all with bepridil. Such drugs include quinidine (Quinaglute; Duraquin; Quinidex), procainamide (Procan-SR; Pronestyl), disopyramide (Norpace), flecainide (Tambocor), and tricyclic Antidepressants, e.g., amitriptyline (Elavil)

Bepridil may increase levels of digoxin (Lanoxin) in the blood, thereby increasing the risk of digoxin toxicity.

Diuretics, e.g., furosemide (Lasix), bumetanide (Bumex), torsemide Demadex), hydrochlorothiazide (Hydrodiuril), chlorthalidone (Hygroton), metolazone (Zaroxolyn) may cause a reduction in blood potassium concentrations thereby increasing the risk of bepridil-induced abnormal heart rhythms.

PREGNANCY: Bepridil crosses the placenta, and therefore should not be used during pregnancy unless the benefit to the mother outweighs the potential but unknown risk to the fetus.

NURSING MOTHERS: Bepridil is secreted into breast milk and therefore should not be used by breast-feeding mothers unless benefit to the mother clearly outweighs the potential but unknown risk to the infant.

SIDE EFFECTS: Bepridil can cause very serious cardiac arrhythmias. The risk is increased in patients with a specific electrocardiographic abnormality called QT prolongation and in patients with low blood concentrations of potassium or magnesium . Bepridil also can cause increased or decreased heart rate and other abnormal rhythms.

Other side effects that can occur in patients taking bepridil include flu-like symptoms, muscle aches, fever, Nausea, vomiting, loss or appetite, constipation , gas, stomach ache, dry mouth, diarrhea , headache, fatigue, nervousness, drowsiness, dizziness , depression , inability to sleep , and blurred vision. Impotence and reduction in sexual drive also have been reported during bepridil therapy.

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