Verapamil

Details About Generic Salt ::  Verapamil 

Main Medicine Class:: Cardiovascular System   Sub Medicine Class ::  Anti Anginals

4C. ANTI-ANGINALS in 4. CARDIOVASCULAR SYSTEM
VERAPAMIL
CCB | ANTI-ANGINAL, ANTI-ARRHYTHMIC, ANTI-HYPERTENSIVE
also comes under 4B. Anti-Arrhythmics in 4. Cardiovascular System,   4D. Anti-Hypertensives in 4. Cardiovascular System
PK: A: Well absorbed D: 3.89 L/kg (Vd) M: Hepatic E: Urine, feces

Indications & Dose: ANGINA PO Adult IR: Initially 80-120mg TID range 80-160mg TID, ER: Initially 180mg OD HS, if needed increase dose q1wk by 240mg/day then 360mg/day, then 480mg/day max dose 480mg/day Elderly 40mg TID | ATRIAL FIBRILLATION Chronic PO Adult IR: 240-480mg/day in 3-4 divided doses, range 120-360mg/day, ER: Initially 180 mg OD at HS, if needed increase dose q wk, 240mg OD, then 360mg OD, then 480mg OD, max dose: 480mg/day | HYPERTENSION PO Adult IR: 80mg TID, usual range 80-320mg/day in 2 divided dose, ER: 120-360mg/day HS, SR: 120-480mg/day in 1-2 divided doses Elderly ER: Initially 200mg/day HS | PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA Prophylactic therapy PO Adult 240-480mg/day in 3-4 divided doses | SUPRAVENTRICULAR TACHYCARDIA IV Adult Initially 2.5-5mg over 2 min if tolerated repeat second dose 5-10mg (~0.15mg/kg) after 15-30 min max total dose 20-30mg Child 1-15 yr: 0.1-0.3mg/kg over 2 min max 5mg/dose may repeated in 30 min if needed max 10mg

Contra: Hypersensitivity, severe LVD, hypotension, cardiogenic shock, sick sinus syndrome, second/third-degree AV block, atrial flutter/fibrillation, accessory bypass tract

Precautions: Attenuated neuromuscular transmission, hepatic/renal impairment, hypertrophic cardiomyopathy with outflow tract obstruction, children, DM, CHF

ADR: Serious: ECG abnormal, myalgia, paresthesia, CHF, pulmonary edema, bradycardia, increased liver enzymes, AV block, flushing, asystole, exfoliative dermatitis, parkinsonian syndrome, ventricular fibrillation, eosinophilia, SJS, blurred vision, MI, syncope, tinnitus, hypotension, Others: diaphoresis, urticaria, constipation, dizziness, fatigue, dyspepsia, nausea, diarrhea, gingival hyperplasia, dyspnea

DDI: Serious Galantamine/Donepezil/Rivastigmine bradycardia, Carbamazepine carbamazepine toxicity, Rifampicin decreases verapamil level, Alcohol increases alcohol concentration, β-blockers/Amiodarone increases cardiac depressant effects, Flecainide increases flecainide toxicity, Paclitaxel increases incidence of haematological toxicity, Lithium increases risk of neurotoxicity, Benzodiazepines increases sedation effects, Phenobarbital increases verapamil clearance, Disopyramide profound hypotension and collapse, Digoxin risk of digoxin toxicity

Diet: With/without food

Monitor: BP, LFT, renal function, electrolyte levels, ECG, CHF symptoms

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