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Chronic Stable Angina (Classical Effort-Associated Angina): PROCARDIA is indicated lor the management ot chronic stable angina (effort-associated angina) without evidence of vasospasm or who cannot tolerate those agents In chronic stable angina (effort-associated angina) PROCARDIA has been effective in controlled trials ot up to eight weeks duration in reducing angina frequency and increasing exercise tolerance, but confirmation ot sustained effectiveness and evaluation ot long-term safety in those patients are Controlled studies in small numbers ot patients suggest concomitant use of PROCARDIA and beta blocking agents may be beneficial in patients with chronic stable angina, but available information is not sufficient to predict with confidence the effects ot concurrent treatment, especially In patients with compromised left ventricular function or cardiac conduction abnormalities When introducing such concomitant therapy, care must be taken to monitor blood pressure closely since severe hypotension can occur from the combined effects of the drugs (See Warnings.) CONTRAINDICATIONS: Known hypersensitivity reaction to PROCARDIA WARNINGS: Excessive Hypotension: Although in most patients, the hypotensive effect of PROCARDIA is modest and well tolerated, occasional patients have had excessive and poorly tolerated hypotension These responses have usually occurred during initial titration or at the time ot subsequent upward dosage adjustment, and may be more likely in patients on concomitant beta receiving PROCARDIA together with a beta blocking agent who underwent coronary artery bypass surgery using high dose fentanyl anesthesia The interaction with high dose fentanyl appears to be due to the combination ol PROCARDIA and a beta blocker, but the possibility that it may occur with PROCARDIA alone, with low doses ot fentanyl, in other surgical procedures, or with other narcotic analgesics cannot be ruled out In PROCARDIA treated patients where surgery using high dose fentanyl anesthesia is contemplated, the physician should be aware of these potential problems and, PROCARDIA to be washed out ot the body prior to surgery Increased Angina: Occasional patients have developed well documented increased frequency, duration or severity ot angina on starting PROCARDIA or at the time of dosage increases The mechanism of this response is not established but could result from decreased coronary perfusion associated with decreased diastolic pressure with increased heart rate, or from increased demand resulting from increased heart rate alone Beta Blocker Withdrawal: Patients recently withdrawn from beta blockers may develop a withdrawal syndrome with increased angina, probably related to increased sensitivity to catecholamines Initiation of PROCARDIA treatment will not prevent this occurrence and might be expected to exacerbate it by provoking retlex catecholamine release There have been occasional reports of increased angina in a setting of beta blocker withdrawal and PROCARDIA initiation It is important to taper beta blockers if possible, rather than stopping them abruptly before beginning Congestive Heart Failure: Rarely, patients, usually receiving a beta blocker, have developed heart failure after beginning PROCARDIA Patients with tight aortic stenosis may be at greater risk for PRECAUTIONS: General: Hypotension: Because PROCARDIA decreases peripheral vascular resistance, careful monitoring of blood pressure during the initial administration and titration of PROCARDIA is suggested. 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