Verapamil

DEA Class; Rx

Common Brand Names; Isoptin SR, Calan SR, Covera HS, Isoptin, Isoptin IV, Calan, Verap, Verapamil SR, Verelan, Verelan PM

•  Antidysrhythmics, IV; 
• Calcium Channel Blockers; 
• Calcium Channel Blockers, Non-dihydropyridine

Indicated for the treatment of variant angina (Prinzmetal angina), unstable angina, and chronic stable angina.

Hypersensitivity to verapamil or other calcium channel blockers

Cardiogenic shock

Congestive heart failure

Symptomatic hypotension

Sick sinus syndrome (unless permanent pacemaker in place)

2°/3° AV block (unless permanent pacemaker in place)

• Headache
• Gingival hyperplasia
• Constipation (9%)
• Dizziness (4%)
• Hypotension (4%)
• Dyspepsia (3%)
• Nausea (3%)
• Edema (2%)
• Rash (2%)
• Increased liver enzymes (1%)
• Sleep disturbance (1%)
• Dyspnea
• Abnormal ECG
• Hypertension
• Elevated liver function test results
• Asthenia

Aortic stenosis

Atrial fibrillation/flutter with accessory bypass tract

1° AV block

Hypertrophic cardiomyopathy (eg, idiopathic hypertrophic subaortic stenosis)

Hypotension (initially or after dose increases)

Exacerbation of angina (during initiation of treatment, after dose increase, or after withdrawal of beta blocker)

Neuromuscular transmission defects; may exacerbate myasthenia gravis

Hepatic or renal impairment

Persistent progressive dermatologic reactions

Generic products may not be bioequivalent

Do not prescribe Covera-HS or Verelan PM for shift workers

Concurrent beta-blocker therapy

Concurrent ivabradine therapy

Slows AV conduction; use cautiously with beta blockers

Hypotension and bradyarrhythmias observed with concurrent use of other CYP3A4 substrates (eg, cyclosporine, telithromycin) because of competitive metabolism

Coadministration with CYP3A4 inhibitors (eg, erythromycin, itraconazole) may decrease metabolism and thus increase toxicity

Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with concurrent use of clonidine with verapamil; monitor heart rate if coadministered

Verapamil is no longer part of Pediatric Advanced Life Support tachyarrhythmia algorithm

Potential toxic dose in patients <6 years old: 15 mg/kg

Pregnancy category: C

Lactation: Distributed in milk; nursing infant doses range from <0.01% to 0.1% of mother’s dose; manufacturer suggests refraining from nursing (though American Academy of Pediatrics committee states that drug is compatible with nursing)