Dangerous Drug: Verapamil Hydrochloride(ver ap’ a mill)
Apo-Verap (CAN), Apo-Verap SR (CAN)DNC, Calan, Calan SRDNC, Covera-HS, Gen-Verapamil (CAN), Gen-Verapamil SR (CAN)DNC, Isoptin SRDNC, Nu-Verap (CAN), VerelanDNC, Verelan PMDNC
PREGNANCY CATEGORY C
Drug Classes
Antianginal
Antiarrhythmic
Antihypertensive
Calcium channel blocker
Therapeutic Actions
Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; calcium is involved in the generation of the action potential in specialized automatic and conducting cells in the heart, in arterial smooth muscle, and in excitation-contraction coupling in cardiac muscle cells; inhibition of transmembrane calcium flow results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, the depression of myocardial contractility, and the dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac energy consumption, and in patients with vasospastic (Printzmetal) angina, increased delivery of oxygen to myocardial cells.
Indications
Angina pectoris due to coronary artery spasm (Printzmetal variant angina)
Effort-associated angina
Chronic stable angina
Unstable, crescendo, preinfarction angina
Essential hypertension
Treatment of chronic atrial fibrillation or flutter with digoxin
Parenteral: Treatment of supraventricular tachyarrhythmias
Parenteral: Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation
Unlabeled uses: Prevention of migraine, tardive dyskinesia, cluster headache, hypertrophic cardiomyopathy
Contraindications and Cautions
Contraindicated with allergy to verapamil; sick sinus syndrome, except with ventricular pacemaker; heart block (second- or third-degree); hypotension; pregnancy, lactation.
Use cautiously with idiopathic hypertrophic subaortic stenosis, cardiogenic shock, severe HF, impaired renal or hepatic function, and in patients with atrial flutter or atrial fibrillation and an accessory to bypass tract.
Available Forms
Tablets—40, 80, 120 mg; SR tabletsDNC—120, 180, 240 mg; ER tabletsDNC—120, 180, 240 mg; injection—2.5 mg/mL; ER capsulesDNC—100, 120, 180, 200, 240, 300, 360 mg
Dosages
Adults
Oral
Immediate-release
Angina: 80–120 mg PO tid. Doses of 40 mg PO tid may be used. Maintenance 240–480 mg daily.
Arrhythmias: 240–480 mg/day PO in divided doses.
In digitalized adults: 240–320 mg/day PO.
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