Indicated for:

Angina:

• Angina at rest including: Vasospastic (Prinzmetal’s variant) angina; Unstable (crescendo, pre-infarction) angina; and

• Chronic stable angina (classic effort-associated angina).

Arrhythmias:

• In association with digitalis for the control of ventricular rate at rest and during stress in patients with chronic atrial flutter and/or atrial fibrillation; and

• The prophylaxis of repetitive paroxysmal supraventricular tachycardia.

Essential Hypertension:

• For the treatment of hypertension, to lower blood pressure.

Since verapamil is highly metabolized by the liver, it should be administered cautiously to patients with impaired hepatic function.

Verapamil should be administered cautiously to patients with impaired renal function.

Reports that verapamil decreases neuromuscular transmission in patients with Duchenne’s muscular dystrophy, prolongs recovery from the neuromuscular blocking agent vecuronium, and causes a worsening of myasthenia gravis.

Calan is contraindicated in patients with:

• Severe left ventricular dysfunction
• Hypotension (systolic pressure less than 90 mm Hg) or cardiogenic shock
• Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)
• .Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker)
• Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (eg, Wolff-Parkinson-White, Lown-Ganong-Levine syndromes)

Combined therapy with beta-blockers should usually be avoided in patients with atrioventricular conduction abnormalities and those with depressed left ventricular function.

Concurrent use of verapamil increases exposure to ivabradine and may exacerbate bradycardia and conduction disturbances. Avoid co-administration of verapamil and ivabradine.

Disopyramide should not be administered within 48 hours before or 24 hours after verapamil administration.

Limit the dose of simvastatin in patients on verapamil to 10 mg daily. Limit the daily dose of lovastatin to 40 mg.

Concomitant therapy with flecainide and verapamil may result in additive negative inotropic effect and prolongation of atrioventricular conduction.

Combined therapy of verapamil and quinidine in patients with hypertrophic cardiomyopathy should probably be avoided.

Hypotension and bradyarrhythmias have been observed in patients receiving concurrent telithromycin, an antibiotic in the ketolide class.

Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with the use of clonidine concurrently with verapamil.

Clinically significant interactions have been reported with inhibitors of CYP3A4 (e.g., erythromycin, ritonavir) causing elevation of plasma levels of verapamil while inducers of CYP3A4 (e.g., rifampin) have caused a lowering of plasma levels of verapamil.

Co-administration of verapamil with aspirin has led to increased bleeding times greater than observed with aspirin alone.

Grapefruit juice may increase plasma levels of verapamil.

Verapamil may increase blood alcohol concentrations and prolong its effects.

This drug should be used during pregnancy only if clearly needed. Verapamil crosses the placental barrier and can be detected in umbilical vein blood at delivery.

Verapamil is excreted in human milk. Because of the potential for adverse reactions in nursing infants from verapamil, nursing should be discontinued while verapamil is administered.

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• Use in patients under the age of 18. GoToSource

• Mania. GoToSource

• Cluster headaches. GoToSource

• Bipolar disorder. GoToSource

• Cerebral vasospasm after aneurysmal subarachnoid hemorrhage. GoToSource

• Peyronie’s disease. GoToSource

• Reduce the incidence of no-reflow/slow-flow phenomenon. GoToSource

• Preventative therapy in patients with calcium oxalate stone disease. GoToSource

• Use with chemotherapy drugs for malignant ascites. GoToSource

• Use with umeclidinium for chronic obstructive pulmonary disease. GoToSource

• Erectile dysfunction. GoToSource

Gynecomastia (enlargement of male breast tissue). GoToSource

Subacute cutaneous lupus erythematosus. GoToSource

Hyperprolactinemia (high levels of prolactin in the blood). GoToSource

Gingival overgrowth (increase in size of gums). GoToSource

Hypotension (low blood pressure). GoToSource

Atrioventricular block. GoToSource

Bradycardia (slow heart rate). GoToSource

Liver damage. GoToSource 

Use of calcium-channel blockers for 10 or more years is associated with higher risks of ductal breast cancer. GoToSource

No major injury lawsuits reported.