Verapamil
Therapeutic Class: Cardiovascular
Therapeutic Class: Cardiovascular
Indications:
Verapamil Tablet:
Verapamil Tablet:
- Essential hypertension
- Angina pectoris and prevention of re-infarction
- Supraventricular arrhythmias
- Tachycardias such as:
Paroxysmal supraventricular tachycardias
- Atrial fibrillation with the rapid ventricular response (except WPWS)
- Atrial flutter with rapid conduction
- Extrasystoles
- Acute hypertension
- Acute coronary insufficiency
Presentation:
Verapamil 40: Each tablet contains Verapamil Hydrochloride USP 40 mg.
Verapamil 80: Each tablet contains Verapamil Hydrochloride USP 80 mg.
Verapamil SR: Each sustained release tablet contains Verapamil Hydrochloride USP 240 mg.
Verapamil SR 180: Each sustained release tablet contains Verapamil Hydrochloride USP 180 mg.
Verapamil Injection: Each 2 ml of injection solution contains 5 mg of Verapamil hydrochloride USP.
Description:
Verapamil has a pronounced antiarrhythmic action, particularly in supraventricular cardiac arrhythmias. It prolongs impulse conduction in the AV node and thereby depending on the type of arrhythmia restores the sinus rhythm and/or normalizes the ventricular rate. The calcium antagonist Verapamil reduces myocardial oxygen consumption directly by intervening in the energy-consuming metabolic processes of the myocardial cell and indirectly by diminishing the peripheral resistance ( afterload ). The decrease of the vascular smooth muscle tone moreover prevents coronary spasms and lowers raised blood pressure.
Verapamil 40: Each tablet contains Verapamil Hydrochloride USP 40 mg.
Verapamil 80: Each tablet contains Verapamil Hydrochloride USP 80 mg.
Verapamil SR: Each sustained release tablet contains Verapamil Hydrochloride USP 240 mg.
Verapamil SR 180: Each sustained release tablet contains Verapamil Hydrochloride USP 180 mg.
Verapamil Injection: Each 2 ml of injection solution contains 5 mg of Verapamil hydrochloride USP.
Description:
Verapamil has a pronounced antiarrhythmic action, particularly in supraventricular cardiac arrhythmias. It prolongs impulse conduction in the AV node and thereby depending on the type of arrhythmia restores the sinus rhythm and/or normalizes the ventricular rate. The calcium antagonist Verapamil reduces myocardial oxygen consumption directly by intervening in the energy-consuming metabolic processes of the myocardial cell and indirectly by diminishing the peripheral resistance ( afterload ). The decrease of the vascular smooth muscle tone moreover prevents coronary spasms and lowers raised blood pressure.
Dosage & Administration:
Verapamil Tablet
The dose of Verapamil should be individualized by titration and the drug should be administered with food.
For essential hypertension, the initial dose should be given 180 mg in the morning. If
adequate response is not obtained with 180 mg of Verapamil then the dose may be titrated in the following manner:
240 mg each morning.
180 mg each morning plus 180 mg each evening.
240 mg every 12 hourly.
For angina, the usual dose is 80 mg to 120 mg three times a day.
For arrhythmias in digitalized patients, Verapamil should be given 240 mg to 360 mg in divided doses, depending on the severity of the condition. Divided doses up to 180 mg/day may occasionally be needed.
Verapamil Injection:
Adults: 5mg slowly intravenously, in tachycardias and hypertensive crises, if necessary repeat after 5 to 10 minutes. Drip infusion to maintain the therapeutic effect: 5-10 mg/hour in physiological saline, glucose, laevulose or similar solutions, on average up to a total dose of 100mg/day.
Children:
Newborn 0.75-1mg (= 0.3-0.4ml)
Infants 0.75-2mg (= 0.3-0.8ml)
Children age 1-5 years: 2-3mg (= 0.8-1.2ml)
age 6-14 years: 2.5-5mg (= 1-2ml)
of Verapamil, given intravenously, depending on age and action. The injection should be made slowly under electrocardiographic control and only until the onset of the effect. Intravenous infusion in hypertensive crises: initially 0.05-0.1mg/kg/hour; if the effect proves to be insufficient, the dose is increased at 30-60 minute intervals until twice the dose or more is reached. Average total dose up to 1.5mg/kg/day.
Side Effects:
Verapamil is generally well tolerated. The following reaction to orally administered Verapamil appeared clearly drug-related or occurred at rates greater than 1% in clinical trials with approximately 5000 patients.
Digestive system: Constipation, nausea;
Cardiovascular system: Hypotension, edema, CHF, pulmonary edema, bradycardia, AV block;
Respiratory system: Upper respiratory tract infections;
Nervous system: Dizziness, headache, fatigue;
Skin: Rash, flashing;
Hepatic: Elevated liver enzyme.
Precautions:
Care should be taken in 1st degree AV block, bradycardia <50 beats/minutes, hypotension <90 mm Hg systolic pressure, atrial fibrillation/flutter, and simultaneous pre-excitation syndrome e.g. WPW syndrome, heart failure (previous compensation with cardiac glycosides/diuretics required).
Verapamil may impair the ability to drive or operate machinery, particularly in the initial stages of treatment and with concomitant consumption of alcohol. Verapamil markedly slows down the elimination of alcohol and prolongs the duration of the effects of alcohol.
Verapamil should be given as a slow intravenous injection over at least 2 minutes under continuous ECG and blood pressure monitoring. Intravenous injection should only be given by the physician.
In atrial fibrillation and simultaneous WPW syndrome, there is a risk of inducing ventricular fibrillation
Use in Pregnancy & Lactation:
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, breastfeeding should be discontinued for the duration of treatment.
Over Dose:
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 haemodialysis.
Verapamil Tablet
The dose of Verapamil should be individualized by titration and the drug should be administered with food.
For essential hypertension, the initial dose should be given 180 mg in the morning. If
adequate response is not obtained with 180 mg of Verapamil then the dose may be titrated in the following manner:
240 mg each morning.
180 mg each morning plus 180 mg each evening.
240 mg every 12 hourly.
For angina, the usual dose is 80 mg to 120 mg three times a day.
For arrhythmias in digitalized patients, Verapamil should be given 240 mg to 360 mg in divided doses, depending on the severity of the condition. Divided doses up to 180 mg/day may occasionally be needed.
Verapamil Injection:
Adults: 5mg slowly intravenously, in tachycardias and hypertensive crises, if necessary repeat after 5 to 10 minutes. Drip infusion to maintain the therapeutic effect: 5-10 mg/hour in physiological saline, glucose, laevulose or similar solutions, on average up to a total dose of 100mg/day.
Children:
Newborn 0.75-1mg (= 0.3-0.4ml)
Infants 0.75-2mg (= 0.3-0.8ml)
Children age 1-5 years: 2-3mg (= 0.8-1.2ml)
age 6-14 years: 2.5-5mg (= 1-2ml)
of Verapamil, given intravenously, depending on age and action. The injection should be made slowly under electrocardiographic control and only until the onset of the effect. Intravenous infusion in hypertensive crises: initially 0.05-0.1mg/kg/hour; if the effect proves to be insufficient, the dose is increased at 30-60 minute intervals until twice the dose or more is reached. Average total dose up to 1.5mg/kg/day.
Side Effects:
Verapamil is generally well tolerated. The following reaction to orally administered Verapamil appeared clearly drug-related or occurred at rates greater than 1% in clinical trials with approximately 5000 patients.
Digestive system: Constipation, nausea;
Cardiovascular system: Hypotension, edema, CHF, pulmonary edema, bradycardia, AV block;
Respiratory system: Upper respiratory tract infections;
Nervous system: Dizziness, headache, fatigue;
Skin: Rash, flashing;
Hepatic: Elevated liver enzyme.
Precautions:
Care should be taken in 1st degree AV block, bradycardia <50 beats/minutes, hypotension <90 mm Hg systolic pressure, atrial fibrillation/flutter, and simultaneous pre-excitation syndrome e.g. WPW syndrome, heart failure (previous compensation with cardiac glycosides/diuretics required).
Verapamil may impair the ability to drive or operate machinery, particularly in the initial stages of treatment and with concomitant consumption of alcohol. Verapamil markedly slows down the elimination of alcohol and prolongs the duration of the effects of alcohol.
Verapamil should be given as a slow intravenous injection over at least 2 minutes under continuous ECG and blood pressure monitoring. Intravenous injection should only be given by the physician.
In atrial fibrillation and simultaneous WPW syndrome, there is a risk of inducing ventricular fibrillation
Use in Pregnancy & Lactation:
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, breastfeeding should be discontinued for the duration of treatment.
Over Dose:
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 haemodialysis.
Storage:
Keep in a dry place far away from light and warmth. exclude the reach of Children's.
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