Select therapeutic use:

Angina:

Indications for: Verapamil

Vasospastic, unstable and chronic stable angina.

Adult Dosage:

Initially 80–120mg 3 times daily, increase daily or weekly if needed; max 480mg daily. Elderly or small patients: initially 40mg 3 times daily.

Children Dosage:

<18yrs: not established.

Verapamil Contraindications:

Severe left ventricular (LV) dysfunction or LV dysfunction treated with β-blockers. Moderate to severe heart failure. Hypotension. Cardiogenic shock. Sick sinus syndrome, 2nd- or 3rd-degree AV block, unless paced. Atrial flutter or fibrillation and an accessory bypass tract.

Verapamil Warnings/Precautions:

Control mild ventricular dysfunction (eg, with digitalis, diuretics) before initiation. AV conduction or neuromuscular transmission disorders. Hepatic or renal impairment. Monitor liver function periodically. Hypertrophic cardiomyopathy. Pregnancy. Nursing mothers: not recommended.

Verapamil Classification:

Calcium channel blocker (CCB) (diphenylalkylamine).

Verapamil Interactions:

Potentiates alcohol, β-blockers, other antihypertensives, digitalis, theophylline, neuromuscular blockers, flecainide, carbamazepine, cyclosporine, lovastatin (limit to max 40mg/day), simvastatin (limit to max 10mg/day), atorvastatin (use lower doses). Avoid ivabradine; quinidine in hypertrophic cardiomyopathy; disopyramide within 48hrs before or 24hrs after verapamil. Potentiated by CYP3A4 inhibitors (eg, erythromycin, ritonavir), grapefruit juice; antagonized by CYP3A4 inducers (eg, phenobarbital, rifampin). Inhalation anesthetics may potentiate cardiac depression. May increase bleeding with aspirin. Monitor theophylline, lithium. Concomitant mTOR inhibitors (eg, sirolimus, temsirolimus, everolimus); consider dose reductions of both drugs. Monitor heart rate with concomitant clonidine.

Adverse Reactions:

Constipation, dizziness, nausea, hypotension, headache, edema, CHF, fatigue, dyspnea, bradycardia, AV block, rash, flushing, elevated liver enzymes; rare: paralytic ileus.

How Supplied:

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CHF and arrhythmias:

Indications for: Verapamil

Control (with digitalis) of ventricular rate in patients with chronic atrial flutter and/or fibrillation. Prophylaxis of repetitive paroxysmal supraventricular tachycardia (PSVT).

Adult Dosage:

Digitalized patients with chronic atrial fibrillation: 240mg–320mg/day in 3–4 divided doses. Prophylaxis of PSVT (non-digitalized patients): 240mg–480mg/day in 3–4 divided doses.

Children Dosage:

<18yrs: not established.

Verapamil Contraindications:

Severe left ventricular (LV) dysfunction or LV dysfunction treated with β-blockers. Moderate to severe heart failure. Hypotension. Cardiogenic shock. Sick sinus syndrome, 2nd- or 3rd-degree AV block, unless paced. Atrial flutter or fibrillation and an accessory bypass tract.

Verapamil Warnings/Precautions:

Control mild ventricular dysfunction (eg, with digitalis, diuretics) before initiation. AV conduction or neuromuscular transmission disorders. Hepatic or renal impairment. Monitor liver function periodically. Hypertrophic cardiomyopathy. Pregnancy. Nursing mothers: not recommended.

Verapamil Classification:

Calcium channel blocker (CCB) (diphenylalkylamine).

Verapamil Interactions:

Potentiates alcohol, β-blockers, other antihypertensives, digitalis, theophylline, neuromuscular blockers, flecainide, carbamazepine, cyclosporine, lovastatin (limit to max 40mg/day), simvastatin (limit to max 10mg/day), atorvastatin (use lower doses). Avoid ivabradine; quinidine in hypertrophic cardiomyopathy; disopyramide within 48hrs before or 24hrs after verapamil. Potentiated by CYP3A4 inhibitors (eg, erythromycin, ritonavir), grapefruit juice; antagonized by CYP3A4 inducers (eg, phenobarbital, rifampin). Inhalation anesthetics may potentiate cardiac depression. May increase bleeding with aspirin. Monitor theophylline, lithium. Concomitant mTOR inhibitors (eg, sirolimus, temsirolimus, everolimus); consider dose reductions of both drugs. Monitor heart rate with concomitant clonidine.

Adverse Reactions:

Constipation, dizziness, nausea, hypotension, headache, edema, CHF, fatigue, dyspnea, bradycardia, AV block, rash, flushing, elevated liver enzymes; rare: paralytic ileus.

How Supplied:

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Hypertension:

Indications for: Verapamil

Hypertension.

Adult Dosage:

Initially 80mg 3 times daily; usual max 360mg/day in divided doses. Elderly or small patients: initially 40mg 3 times daily.

Children Dosage:

<18yrs: not established.

Verapamil Contraindications:

Severe left ventricular (LV) dysfunction or LV dysfunction treated with β-blockers. Moderate to severe heart failure. Hypotension. Cardiogenic shock. Sick sinus syndrome, 2nd- or 3rd-degree AV block, unless paced. Atrial flutter or fibrillation and an accessory bypass tract.

Verapamil Warnings/Precautions:

Control mild ventricular dysfunction (eg, with digitalis, diuretics) before initiation. AV conduction or neuromuscular transmission disorders. Hepatic or renal impairment. Monitor liver function periodically. Hypertrophic cardiomyopathy. Pregnancy. Nursing mothers: not recommended.

Verapamil Classification:

Calcium channel blocker (CCB) (diphenylalkylamine).

Verapamil Interactions:

Potentiates alcohol, β-blockers, other antihypertensives, digitalis, theophylline, neuromuscular blockers, flecainide, carbamazepine, cyclosporine, lovastatin (limit to max 40mg/day), simvastatin (limit to max 10mg/day), atorvastatin (use lower doses). Avoid ivabradine; quinidine in hypertrophic cardiomyopathy; disopyramide within 48hrs before or 24hrs after verapamil. Potentiated by CYP3A4 inhibitors (eg, erythromycin, ritonavir), grapefruit juice; antagonized by CYP3A4 inducers (eg, phenobarbital, rifampin). Inhalation anesthetics may potentiate cardiac depression. May increase bleeding with aspirin. Monitor theophylline, lithium. Concomitant mTOR inhibitors (eg, sirolimus, temsirolimus, everolimus); consider dose reductions of both drugs. Monitor heart rate with concomitant clonidine.

Adverse Reactions:

Constipation, dizziness, nausea, hypotension, headache, edema, CHF, fatigue, dyspnea, bradycardia, AV block, rash, flushing, elevated liver enzymes; rare: paralytic ileus.

How Supplied:

Contact supplier