Verapamil

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Update Date 08/05/2020 . 1 min read
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Know the basics

What is verapamil used for?

Verapamil is used with or without other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Verapamil is called a calcium channel blocker. It works by relaxing blood vessels so blood can flow more easily.

Verapamil is also used to prevent chest pain (angina). It may help to increase your ability to exercise and decrease how often you may get angina attacks. Verapamil is also used to control your heart rate if you have a fast/irregular heartbeat (such as atrial fibrillation). It helps to lower the heart rate, helping you to feel more comfortable and increase your ability to exercise.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used to treat another type of heart disease (hypertrophic cardiomyopathy).

How should I take verapamil?

Take this medication by mouth with or without food, usually 3 or 4 times daily or as directed by your doctor.

The dosage is based on your medical condition and response to treatment.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

For the treatment of high blood pressure, it may take a week before you get the full benefit of this drug. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick.

To prevent chest pain, it is very important to take this medication regularly as prescribed. This drug should not be used to treat chest pain when it occurs. Use other medications to relieve sudden attacks as directed by your doctor (for example, nitroglycerin tablets placed under the tongue). Consult your doctor or pharmacist for details.

Do not suddenly stop taking this medication without consulting your doctor. Your condition may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.

Tell your doctor if your condition does not improve or if it worsens (for example, your routine blood pressure readings remain high or increase or your chest pain occurs more often).

How do I store verapamil?

Verapamil is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store verapamil in the bathroom or the freezer. There may be different brands of verapamil that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush verapamil down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Know the precautions & warnings

What should I know before using verapamil?

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

The use of verapamil in children is allowed to treat supraventricular arrhythmias and hypertension. Some data has recommended against the use of verapamil for the treatment of hypertension in pediatric patients and suggests using other calcium channel antagonists that have more pediatric data available.

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of verapamil in the elderly. However, elderly patients are more likely to have age-related heart, liver, or kidney problems which may require an adjustment of dose in patients receiving verapamil.

Is it safe to take verapamil during pregnancy or breast-feeding?

Verapamil is a pregnancy category C drug. There are no adequate or well-controlled studies of verapamil in pregnant women. Verapamil distributes into breast milk. Due to the potential for adverse effects in nursing infants, discontinue breast-feeding during verapamil administration.  Please always consult with your doctor to weigh the potential benefits and risks before taking this medication.

Know the side effects

What are the side effects of verapamil?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

  • fast or slow heartbeats;
  • feeling like you might pass out;
  • fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
  • restless muscle movements in your eyes, tongue, jaw, or neck;
  • feeling short of breath, even with mild exertion;
  • swelling, rapid weight gain; or
  • nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

  • constipation, nausea;
  • skin rash or itching;
  • dizziness, headache, tired feeling; or
  • warmth, itching, redness, or tingly feeling under your skin.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with verapamil?

Verapamil may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Colchicine
  • Dofetilide
  • Lomitapide

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Adenosine
  • Afatinib
  • Alprenolol
  • Amiodarone
  • Apixaban
  • Aripiprazole
  • Atazanavir
  • Atenolol
  • Atorvastatin
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bosutinib
  • Bucindolol
  • Bupivacaine
  • Bupivacaine Liposome
  • Carbamazepine
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Ceritinib
  • Clarithromycin
  • Clonidine
  • Clopidogrel
  • Clozapine
  • Cobicistat
  • Crizotinib
  • Cyclobenzaprine
  • Dabigatran Etexilate
  • Dabrafenib
  • Dantrolene
  • Digoxin
  • Dilevalol
  • Domperidone
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Dronedarone
  • Eliglustat
  • Eplerenone
  • Erlotinib
  • Erythromycin
  • Eslicarbazepine Acetate
  • Esmolol
  • Everolimus
  • Fentanyl
  • Fingolimod
  • Hydrocodone
  • Ibrutinib
  • Idelalisib
  • Ifosfamide
  • Ivabradine
  • Ketoconazole
  • Labetalol
  • Lacosamide
  • Levobunolol
  • Lovastatin
  • Lurasidone
  • Mepindolol
  • Mepivacaine
  • Metipranolol
  • Metoprolol
  • Mitotane
  • Morphine
  • Morphine Sulfate Liposome
  • Nadolol
  • Naloxegol
  • Nebivolol
  • Nilotinib
  • Nintedanib
  • Oxprenolol
  • Penbutolol
  • Pindolol
  • Piperaquine
  • Pixantrone
  • Primidone
  • Propranolol
  • Ranolazine
  • Siltuximab
  • Simeprevir
  • Simvastatin
  • Sotalol
  • Talinolol
  • Tertatolol
  • Timolol
  • Tizanidine
  • Tolvaptan
  • Topotecan
  • Trabectedin
  • Vilazodone
  • Vincristine
  • Vincristine Sulfate Liposome

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Aceclofenac
  • Acemetacin
  • Amtolmetin Guacil
  • Aspirin
  • Bromfenac
  • Bufexamac
  • Buspirone
  • Celecoxib
  • Choline Salicylate
  • Clonixin
  • Cyclosporine
  • Dalfopristin
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Digitoxin
  • Dipyrone
  • Dutasteride
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Flecainide
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Fosphenytoin
  • Ibuprofen
  • Ibuprofen Lysine
  • Indinavir
  • Indomethacin
  • Itraconazole
  • Ketoprofen
  • Ketorolac
  • Lithium
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Midazolam
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Nevirapine
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxcarbazepine
  • Oxyphenbutazone
  • Pancuronium
  • Parecoxib
  • Phenobarbital
  • Phenylbutazone
  • Phenytoin
  • Piketoprofen
  • Piroxicam
  • Pranoprofen
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Quinidine
  • Quinupristin
  • Rifapentine
  • Ritonavir
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sirolimus
  • Sodium Salicylate
  • St John’s Wort
  • Sulindac
  • Tedisamil
  • Telithromycin
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolfenamic Acid
  • Tolmetin
  • Tubocurarine
  • Valdecoxib
  • Vecuronium

Does food or alcohol interact with verapamil?

Verapamil may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Grapefruit juice and alcohol increase the effects of verapamil while St. John’s wort decreases its levels in the body, which reduces its effect. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with verapamil?

Verapamil may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

  • Congestive heart failure or
  • Muscle disease (e.g., Duchenne’s muscular dystrophy, myasthenia gravis) or
  • Pulmonary edema (fluid in the lungs)—Use with caution. May make these conditions worse.
  • Heart block (type of abnormal heart rhythm) or
  • Heart problems (e.g., Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome) or
  • Low blood pressure (hypotension) or
  • Sick sinus syndrome (heart rhythm problem, can use if have a pacemaker that works properly)—Should not be used in patients with these conditions.
  • Kidney problems or
  • Liver problems—Use with caution. The effects may be increased because of slower removal of the medicine from the body

Understand the dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this medication.

What is the dose of verapamil for an adult?

Oral: The antihypertensive effects of verapamil are evident within the first week of therapy.

Immediate release tablets (Calan (R)):

Initial dose: 80 mg orally 3 times a day; alternatively, 40 mg orally 3 times a day may be considered in patients who might respond to lower doses (e.g., small stature)

Maintenance dose: Upward titration should be based on therapeutic efficacy, assessed at the end of the dosing interval. Daily dosages of 360 and 480 mg have been used but there is no evidence that dosages beyond 360 mg provided added effect.

Sustained release tablets (Calan SR (R), Isoptin SR (R)):

Initial dose: 180 mg orally once a day in the morning with food: alternatively, 120 mg orally once a day in the morning with food may be warranted in patients who may have an increased response to verapamil (e.g., small stature)

Maintenance dose: Upward titration should be based on therapeutic efficacy and safety evaluated weekly, about 24 hours after the previous dose. If adequate response is not obtained with the initial dose, it may be titrated upward.

Sustained release capsules (Verelan (R)):

Initial dose: 240 mg orally once a day in the morning (usual dose in clinical trials); alternatively, 120 mg orally once a day in the morning may be warranted in patients who may have an increased response to verapamil (e.g., small stature)

Maintenance dose: Upward titration should be based on therapeutic efficacy and safety evaluated about 24 hours after dosing. If adequate response is not obtained with the initial dose, it may be titrated upward.

Extended release tablets (Covera HS (R)):

Initial dose: 180 mg orally once a day at bedtime

Maintenance dose: If adequate response is not obtained with the initial dose, it may be titrated upward.

Extended release capsules (Verelan PM (R)):

Initial dose: 200 mg orally once a day at bedtime (usual dose in clinical trials); in rare cases, initial doses of 100 mg orally once a day at bedtime may be warranted in patients who have an increased response to verapamil (e.g., low-weight patients)

Maintenance dose: Upward titration should be based on therapeutic efficacy and safety evaluated about 24 hours after dosing. If adequate response is not obtained with the initial dose, it may be titrated upward.

What is the dose of verapamil for a child?

Less than 1 year: Generally not recommended due to potential risk of severe apnea, bradycardia, hypotensive reactions, and cardiac arrest; IV calcium should be available at bedside

Initial dose: 0.1 to 0.2 mg/kg/dose (usual single dose range: 0.75 to 2 mg/dose) should be administered as an IV bolus over at least 2 minutes under continuous ECG monitoring

Repeat dose: 0.1 to 0.2 mg/kg/dose (usual single dose range: 0.75 to 2 mg/dose) 30 minutes after the first dose if the initial response is not adequate (under continuous ECG monitoring)

An optimal interval for subsequent doses has not been determined and must be individualized for each patient.

1 to 15 years:

Initial dose: 0.1 to 0.3 mg/kg/dose (usual single dose range: 2 to 5 mg/dose) should be administered as an IV bolus over at least 2 minutes; doses of 5 mg should not be exceeded

Repeat dose: 0.1 to 0.3 mg/kg/dose (usual single dose range: 2 to 5 mg/dose) 30 minutes after the first dose if the initial response is not adequate; doses of 10 mg should not be exceeded

An optimal interval for subsequent doses has not been determined and must be individualized for each patient.

How is verapamil available?

Verapamil is available in the following dosage forms and strengths:

Tablet 180 mg; 240 mg

Injection 2.5mg/mL

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

Symptoms of overdose may include:

  • dizziness
  • blurred vision
  • slow, fast, or irregular heartbeat
  • seizures
  • confusion
  • difficulty breathing or swallowing

What should I do if I miss a dose?

If you miss a dose of verapamil, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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