Verapamil Tablet: Essential hypertension Angina pectoris and prevention of re-infarction Supraventricular arrhythmias Verapamil Injection: Tachycardias such as: Paroxysmal supraventricular tachycardias Atrial fibrillation with rapid ventricular response (except WPWS) Atrial flutter with rapid conduction Extrasystoles Acute hypertension Acute coronary insufficiency For the prophylaxis and / or therapy of ectopic arrhythmias (predominantly ventricular extrasystoles) in halothane anaesthesia and in the application of adrenaline in halothane anaesthesia respectively.
Verapamil is an L-type calcium channel blocker with antiarrhythmic, antianginal, and antihypertensive activity. Immediate-release verapamil has a relatively short duration of action, requiring dosing 3 to 4 times daily, but extended-release formulations are available that allow for once-daily dosing. As verapamil is a negative inotropic medication (i.e. it decreases the strength of myocardial contraction), it should not be used in patients with severe left ventricular dysfunction or hypertrophic cardiomyopathy as the decrease in contractility caused by verapamil may increase the risk of exacerbating these pre-existing conditions.
Intravenous- Supraventricular arrhythmias: Adult: Initially, 5-10 mg via slow inj over 2-3 min then 5 mg via inj over 5-10 min if needed. Child: ≤1 yr 100-200 mcg; 1-15 yr 100-300 mcg/kg. All doses to be given over at least 2 min, repeat after 30 min if needed. Oral- Angina pectoris: Adult: 120 mg tid or 80 mg tid in patients w/ angina of effort. As modified-release: Up to 480 mg daily. Supraventricular arrhythmias: Adult: 120-480 mg daily in 3-4 divided doses depending on patient's response and severity of the condition. Child: ≤2 yr 20 mg 2-3 times daily; >2 yr 40-120 mg 2-3 times daily, depending on age and response. Hypertension: Adult: Initially, 240 mg daily in 2-3 divided doses. Max: 480 mg daily. Child: ≤2 yr 20 mg 2-3 times daily; >2 yr 40-120 mg 2-3 times daily, depending on age and response. Secondary prophylaxis of myocardial infarction: Adult: Modified release: Initially, 360 mg daily in divided doses 1 wk after acute infarction.
May increase plasma level with CYP3A4 inhibitors (e.g. erythromycin, ritonavir), cimetidine. May decrease plasma level with CYP3A4 inducers (e.g. rifampicin), phenobarbital, sulfinpyrazone. Increased risk of bleeding with aspirin. May increase bradycardic and hypotensive effect with telithromycin. Increased AV blocking effect with clonidine. May increase plasma level of cardiac glycosides (e.g. digoxin, digitoxin), β-blockers (e.g. propranolol, metoprolol), α-blockers (e.g. terazosin, prazosin), immunosuppressants (e.g. sirolimus, ciclosporin, tacrolimus, everolimus), lipid lowering agents (e.g. lovastatin, simvastatin, atorvastatin), colchicines, quinidine, carbamazepine, imipramine, glibenclamide, doxorubicin, midazolam, buspirone, almotriptan, theophylline. May potentiate hypotensive effect with diuretics, antihypertensives, vasodilators. May increase neurotoxic effect of lithium.
Severe left ventricular dysfunction Hypotension or cardiogenic shock Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker) Second or third-degree atrioventricular (AV) block (except in patients with a functioning artificial pacemaker) Patients with atrial flutter or atrial fibrillation and an accessory by pass tract (eg. Wolff-Parkinson-White, Lown-Ganong-Levine syndrome) Patients with known hypersensitivity to verapamil hydrochloride Verapamil injection should not be administered intravenously to patients on beta-blockers (except in an intensive care setting) and known hypersensitivity to Verapamil hydrochloride. Patient with bradycardia or 1st-degree AV block, attenuated neuromuscular transmission, hypertrophic cardiomyopathy. Avoid abrupt withdrawal. Renal and hepatic impairment. Childn. Pregnancy and lactation.
AV block, bradycardia, worsening heart failure, transient asystole, hypotension, dizziness, flushing, fatigue, headache, dyspnoea, peripheral oedema, constipation, nausea, abnormal liver function, skin reactions, gingival hyperplasia, extrapyramidal symptoms. Rarely, gynaecomastia.
Verapamil carries the potential to produce fetal hypoxia associated with maternal hypotension. Verapamil should not be administered intravenously during the first six months of pregnancy. There are no data on use in the first and second trimester. Verapamil should not be used in the final trimester unless the benefits clearly outweigh the risks. Verapamil should not be administered intravenously during lactation. If a nursing mother requires intravenous Verapamil, breast feeding should be discontinued for the duration of treatment.
Treatment of overdose should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solution may increase calcium ion flux across the slow channel and have been used in the treatment of overdose with Verapamil. Verapamil cannot be removed by hemodialysis.
Do not store above 30°C. Keep away from light and out of the reach of children.
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