From the Guidelines
Calcium channel blockers should not be used as routine treatment for patients with heart failure with reduced ejection fraction (HFrEF), as they have been shown to have no clinical benefit or even worse outcomes in patients with HF 1.
Treatment of Calcium in Heart Conditions
When considering the treatment of calcium-related issues in heart conditions, it's essential to prioritize the management of hypercalcemia, which can occur in patients with lung cancer and other conditions.
- Hypercalcemia can be managed with oral hydration, intravenous fluids, and bisphosphonates, as well as loop diuretics and glucocorticoids in some cases 1.
- In patients with heart failure, the focus should be on managing the underlying condition, rather than relying on calcium channel blockers, which have been shown to be ineffective or even harmful in patients with HFrEF 1.
- The most recent guidelines recommend against the routine use of calcium channel blockers in patients with HFrEF, except in cases where they are necessary for the management of hypertension or ischemic heart disease 1.
Key Considerations
- The management of hypercalcemia and heart failure requires a comprehensive approach, taking into account the underlying cause of the condition and the patient's overall health status.
- Calcium channel blockers may be effective in certain situations, such as coronary artery disease or arrhythmias, but their use should be carefully considered and monitored due to potential side effects and interactions with other medications.
- The latest guidelines and research should be consulted to ensure that treatment decisions are based on the most up-to-date and effective approaches 1.
From the FDA Drug Label
Zoledronic acid injection is indicated for the treatment of hypercalcemia of malignancy defined as an albumin-corrected calcium (cCa) of greater than or equal to 12 mg/dL [3.0 mmol/L] The maximum recommended dose of zoledronic acid injection in hypercalcemia of malignancy (albumin-corrected serum calcium greater than or equal to 12 mg/dL [3. 0 mmol/L]) is 4 mg.
The treatment of calcium in the heart is related to hypercalcemia of malignancy. Zoledronic acid injection is indicated for this condition, with a maximum recommended dose of 4 mg.
- Key points:
- The dose must be given as a single-dose intravenous infusion over no less than 15 minutes.
- Patients should be adequately rehydrated prior to administration of zoledronic acid injection.
- Consideration should be given to the severity of, as well as the symptoms of, tumor-induced hypercalcemia when considering use of zoledronic acid injection 2.
From the Research
Treatment of Calcium in the Heart
- The treatment of calcium in the heart depends on the underlying condition, such as hypercalcemia or heart failure 3, 4.
- Hypercalcemia can be treated with hydration, intravenous bisphosphonates, and glucocorticoids, while heart failure can be managed with calcium channel blockers, such as amlodipine 3, 4.
- Calcium channel blockers can be effective in reducing blood pressure and preventing cardiovascular disease, but their use in heart failure is limited 5.
Calcium Channel Blockers
- Calcium channel blockers can be classified into two main types: dihydropyridine and nondihydropyridine 5.
- Dihydropyridine calcium channel blockers, such as nifedipine, can cause edema, headache, and flushing, while nondihydropyridine calcium channel blockers, such as verapamil, can cause constipation 5.
- Calcium channel blockers can be used to treat various conditions, including hypertension, angina, and cardiac dysrhythmias 5, 6.
Hypercalcemia Treatment
- Severe hypercalcemia can be treated with zoledronic acid, which has been shown to be effective in reducing serum calcium levels in pediatric patients 7.
- Hypercalcemia due to primary hyperparathyroidism can be managed with parathyroidectomy or observation, while severe hypercalcemia is typically treated with hydration and intravenous bisphosphonates 3.
- The treatment of hypercalcemia should be individualized based on the underlying cause and severity of the condition 3, 7.
Heart Failure Treatment
- Calcium channel blockers, such as amlodipine, can be used to treat heart failure, particularly in patients with nonischemic dilated cardiomyopathy 4.
- The use of calcium channel blockers in heart failure is limited, and other treatments, such as beta blockers and diuretics, may be more effective 4, 6.
- The treatment of heart failure should be individualized based on the underlying cause and severity of the condition 4, 6.