Calcium influx through voltage-gated calcium channels (VGCCs) is required for neurotransmitter release. Recent research has characterised several pharmacologically and electrophysiologically distinct VGCC subtypes, some of which are involved in neurotransmitter release. Transmitter release from autonomic neurons can be coupled to calcium entry through N-, P/Q- and/or R-type VGCCs; the precise combination of VGCC subtypes appears to vary according to the neurotransmitter, tissue and species. L-type channels rarely appear to be important in autonomic neurotransmitter release. There does not appear to be a general rule regarding the nature of the VGCCs coupled to release of a particular transmitter in different tissues or species. Release of the same neurotransmitter from different populations of neurons often reveals a different pattern of involvement of VGCCs. Transmitters released from the same population of neurons are sometimes coupled to calcium influx through different VGCC subtypes. However, release of transmitters thought to be co-localised within vesicles is coupled to calcium influx through the same VGCCs. The role of VGCC subtypes in transmitter release can be altered by mode of nerve stimulation. Different VGCC subtypes may be coupled to transmitter release at low versus high electrical stimulation frequencies, or in response to potassium depolarization or chemical stimulation. In certain disease processes, voltage-gated calcium channels on autonomic neurons can be targeted; for example antibodies to P/Q-type VGCCs in Lambert-Eaton myasthenic syndrome downregulate VGCCs, thereby inhibiting autonomic neuroeffector transmission.