What are the considerations when using non-dihydropyridine calcium-channel blockers in CKD patients?
When using non-dihydropyridine calcium-channel blockers in CKD patients, it is important to be aware of potential interactions with other drugs, such as the calcineurin inhibitors (CNIs) and mammalian target of rapamycin (mTOR) inhibitors. Fluid retention can be a problem with dihydropyridines, and the combination of non-dihydropyridines such as verapamil and diltiazem with beta-blockers can lead to severe bradycardia. Therefore, careful monitoring of CNIs and mTOR inhibitors blood levels is required if drugs or dosages are changed, and the use of other vasodilators may be sensible.