Composition
Inj: Per ml: Verapamil HCI 2.5 mg; 2 ml amp, 5 ml amp. Tab40 mg/80 mg/120 mg/200 mg: Verapamil HCI 40 mg/80 mg/120 mg/200 mg. Tab240 mg: Verapamil HCI 240 mg; sustained release.
Indications & Dosage
Treatment of supraventricular arrhythmias: Adult: 40-120 mg 3 times a day BY SLOW IV INJ: Adult: 5-10 mg, given over 2 minutes, preferably with ECG monitoring BY SLOW IV INJ: Elderly: 5-10 mg, to be given over 3 minutes, preferably with ECG monitoring BY SLOW IV INJ: Children1-18 yrs: 100-300 mcg/kg (max 5 mg) as a single dose,IV injection over 2-3 minutes; repeated after 30 minutes if necessary. Paroxysmal tachyarrhythmias: BY SLOW IV INJ: Adult: Initially 5-10 mg, followed by 5 mg after 5-10 minutes if required, to be given over 2 minutes, preferably with ECG monitoring Elderly: Initially 5-10 mg, followed by 5 mg after5-10 minutes if required, to be given over 3 minutes, preferably with ECG monitoring. Angina: Adult: 80-120 mg 3 times a day. Hypertension: Adult: 240-480 mg daily in 2-3 divided doses. Children 1-2 yrs: 20 mg 2-3 times daily; 2-18 yrs: 40-120 mg 2-3 times daily. Modified release preparation not licensed for use in children. Prophylaxis of cluster headache: Adult: 240-960 mg daily in 3-4 divided doses. Prophylaxis after myocardial infarction where beta-blockers not appropriate: Adult: 360 mg daily in divided doses, started at least 1 week after infarction, given as either 240mg SR tab in the morning and 120mg in the evening or 120mg 3 times daily.
Administration
For IV use only. Give as a slow IV injection over at least a 2 min time period under continuous ECG and blood pressure monitoring. Disopyramide or flecainide should not be given within 48 hours before or 24 hours after verapamil because additive negative inotropic effects can result.
Compatibility
Stable in Ringers solution, D5W, NS. For stability reason, this product is not recommended for dilu-tion with sodium lactate injection in polyvinyl chloride bags. Verapamil injection will precipitate in any solution with a pH above 6.
Stability
Store at controlled room temperature 15C-30C (59F-86F). Protect from light.
Contraindications
Acute porphyrias, second- and third-degree AV block, sick sinus syndrome, sino-atrial block, atrial flutter or fibrillation associated with accessory conductingpathways (e.g. Wolff-Parkinson-White-syndrome), bradycardia, cardiogenic shock, history of heart failure (even if controlled by therapy), history of significantly impaired left ventricular function (even if controlled by therapy),hypotension,
Precautions
Acute phase of myocardial infarction, 1st degree AV block, poor cardiac reserve should be controlled with digitalis and diuretics,conduction disturbances, Atrial flutter/fibrillation with an accessory pathway, Hepatic or renal impairment.
Interactions
Beta-blockers, digoxin or antiarrhythmics, cyclo-sporin, theophylline, muscle relaxants, carbamazepine, rifampicin, lithium, phenobarbitone, phenytoin, cimetidine, inhaled anaesthetics, alcohol, antihypertensives, grapefruitjuice.
Side Effects
Constipation, ankle oedema, dizziness, fatigue, flushing, headache, nausea, vomiting, allergic reactions, angioedema, arthralgia, asystole, bradycardia, erythema, erythromelalgia, gingival hyperplasia after long-term treatment, gynaecomastia after long-term treatment, heart block, heart failure, hypotension, increased prolactin concentration, myalgia, paraesthesia, pruritus, Stevens-Johnson syndrome, urticaria