Third Generation Calcium Antagonists: Further Developments

We have read with interest and appreciation the Viewpoint Third generation calcium entry blockers, by Toyo-Oka and Nayler [11. Third generation calcium antagonists (CAs) may indeed be appreciated as an improvement, not only for pharmacological and pharmacokinetic reasons, but also as a clinical amelioration in the treatment of hypertension or angina pectoris. Amlodipine has been discussed in this Viewpoint [1] as the prototype of the third generation CAs. This drug is without any doubt a representative and favourable example of this newer type of CA. Its slow onset of action and concomitant virtual absence of reflex tachycardia are probably even more attractive features than its long duration of action [2], although the latter property is usually emphasized. Similarly, nifedipine-GITS and other slow release preparations of short-acting compounds are put forward as significant kinetic improvements of classic, rapidly and short-acting dihydropyridine CA.