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Verelan
Generic Name: Verapamil Hydrochloride
Drug Category: Calcium Channel Blocker
Litigation Alert Level: Low
This drug has been approved for use by males and females over the age of 18 years old for a maximum duration of 6 years.
| Approved Uses |
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Indicated for the treatment of hypertension, to lower blood pressure. Verapamil HCl is contraindicated in:
Verapamil should be avoided in patients with severe left ventricular dysfunction (e.g., ejection fraction less than 30% or moderate to severe symptoms of cardiac failure) and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Elevations of transaminases with and without concomitant elevations in alkaline phosphatase and bilirubin have been reported. Periodic monitoring of liver function in patients receiving verapamil is therefore prudent. Since verapamil is highly metabolized by the liver, it should be administered cautiously to patients with impaired hepatic function. About 70% of an administered dose of verapamil is excreted as metabolites in the urine. Until further data are available, verapamil should be administered cautiously to patients with impaired renal function. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Aging may affect the pharmacokinetics of verapamil. Elimination half-life may be prolonged in the elderly. It has been reported that verapamil decreases neuromuscular transmission in patients with Duchenne’s muscular dystrophy, and that verapamil prolongs recovery from the neuromuscular blocking agent vecuronium and causes a worsening of myasthenia gravis. It may be necessary to decrease the dosage of verapamil when it is administered to patients with attenuated neuromuscular transmission. Clinically significant interactions have been reported with inhibitors of CYP3A4 (eg, erythromycin, ritonavir) causing elevation of plasma levels of verapamil while inducers of CYP3A4 (eg, rifampin) have caused a lowering of plasma levels of verapamil. Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients receiving concurrent telithromycin. Concurrent use of verapamil increases exposure to ivabradine and may exacerbate bradycardia and conductions disturbances. Avoid concomitant use of ivabradine and verapamil. The use of HMG-CoA reductase inhibitors that are CYP3A4 substrates in combination with verapamil has been associated with reports of myopathy/rhabdomyolysis. Limit the dose of simvastatin in patients on verapamil to 10 mg daily. Concomitant therapy with beta-adrenergic blockers and verapamil may result in additive negative effects on heart rate, atrioventricular conduction, and/or cardiac contractility. Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with the use of clonidine concurrently with verapamil. Asymptomatic bradycardia (36 beats/min) with a wandering atrial pacemaker has been observed in a patient receiving concomitant timolol (a beta-adrenergic blocker) eye drops and oral verapamil. Verapamil administered concomitantly with oral antihypertensive agents (e.g., vasodilators, angiotensin-converting enzyme inhibitors, diuretics, beta blockers) will usually have an additive effect on lowering blood pressure. Concomitant use of agents that attenuate alpha-adrenergic function with verapamil may result in reduction in blood pressure that is excessive in some patients. Such an effect was observed in one study following the concomitant administration of verapamil and prazosin. Consider reducing digoxin dose when verapamil and digoxin are to be given together. Monitor digoxin level periodically during therapy. Chronic verapamil treatment can increase serum digoxin levels by 50% to 75% during the first week of therapy, and this can result in digitalis toxicity. Until data on possible interactions between verapamil and disopyramide phosphate are obtained, disopyramide should not be administered within 48 hours before or 24 hours after verapamil administration. Until further data are obtained, combined therapy of verapamil and quinidine in patients with hypertrophic cardiomyopathy should probably be avoided. Concomitant therapy with flecainide and verapamil may result in additive negative inotropic effect and prolongation of atrioventricular conduction. In a few reported cases, co-administration of verapamil with aspirin has led to increased bleeding times greater than observed with aspirin alone. Grapefruit juice may significantly increase concentrations of verapamil. Verapamil has been found to significantly inhibit ethanol elimination resulting in elevated blood ethanol concentrations that may prolong the intoxicating effects of alcohol. Concomitant therapy with lithium may result in a lowering of serum lithium levels in patients receiving chronic stable oral lithium therapy. Verapamil therapy may increase carbamazepine concentrations during combined therapy. Phenobarbital therapy may increase verapamil clearance. Verapamil therapy may increase serum levels of cyclosporine. Verapamil may inhibit the clearance and increase the plasma levels of theophylline. Hypotension and bradyarrhythmias have been observed in patients receiving concurrent telithromycin, an antibiotic in the ketolide class of antibiotics. A decrease in metoprolol clearance has been reported when verapamil and metoprolol were administered together. A similar effect has not been observed when verapamil and atenolol are given together. When used concomitantly, inhalation anesthetics and calcium antagonists, such as verapamil, should be titrated carefully to avoid excessive cardiovascular depression. Verapamil may potentiate the activity of neuromuscular blocking agents (curare-like and depolarizing). It may be necessary to decrease the dose of verapamil and/or the dose of the neuromuscular blocking agent when the drugs are used concomitantly. With concomitant use of mTOR inhibitors (e.g., sirolimus, temsirolimus, and everolimus) and verapamil, consider appropriate dose reductions of both medications. Verapamil can increase doxorubicin levels. The absorption of verapamil can be reduced by the cyclophosphamide, oncovin, procarbazine, prednisone (COPP) and the vindesine, adriamycin, cisplatin (VAC) cytotoxic drug regimens. Concomitant administration of verapamil can decrease the clearance of paclitaxel. There are no adequate and well-controlled studies in pregnant women. Animal studies: embryocidal and retarded fetal growth and development.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. |
| Off-label Uses |
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• Use in patients under the age of 18. GoToSource • Mania, alzheimer’s disease and tardive dyskinesia. GoToSource • Migraine prophylaxis. GoToSource • Cardiac arrhythmias. GoToSource • Angina. GoToSource • Raynaud’s phenomenon. GoToSource • Joint pain. GoToSource • Beta cell survival therapy in type 1 diabetes. GoToSource • Refractory temporal lobe epilepsy. GoToSource • Chronic rhinosinusitis. GoToSource • Keloid scarring. GoToSource • Marfan syndrome. GoToSource • Adjunctive treatment for refractory meningiomas. GoToSource • Myoclonic tardive dystonia. GoToSource • Peyronie’s disease. GoToSource • Intermittent claudication. GoToSource |
| Adverse Events |
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Liver injury, diarrhea, palpitations and peripheral edema (soft-tissue swelling). GoToSource Pulmonary edema (excess fluid in the lungs) and hypotension (low blood pressure). GoToSource Cardiogenic shock (heart does not pump enough blood to meet body’s needs) and worsening of right heart failure during long-term treatment. GoToSource Junctional bradycardia (abnormal heart rhythm). GoToSource Conduction system abnormalities including sinus node suppression, atrioventricular nodal block or bundle branch block). GoToSource Constipation. GoToSource Ventricular tachycardia (rapid heart rate originating in the heart’s lower chambers), GoToSource Acute asthma. GoToSource Stevens-johnson syndrome (severe skin disorder). GoToSource Erythema multiforme and exfoliative dermatitis (severe skin reaction). GoToSource Erythermalgia (disorder characterized by burning pain, warmth and redness of the extremities). GoToSource Primary polydipsia (excessive fluid intake). GoToSource Gingival hyperplasia (abnormal gum enlargement). GoToSource Increased intraocular pressure (elevated eye pressure). GoToSource Elevated triglycerides (type of fat in blood). GoToSource Parkinsonian syndrome (movement disorder). GoToSource Hyperprolactinemia (high levels of prolactin a hormone secreted by the pituitary gland). GoToSource Increased risk of cancer. GoToSource AV block (a type of heart block). GoToSource |
| Litigation |
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No major injury lawsuits reported. |
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