GENERIC NAME: verapamil

BRAND NAMES: Calan, Verelan, Isoptin

DRUG CLASS AND MECHANISM: Verapamil belongs to a class of medications called calcium channel blockers. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, verapamil is useful in treating and preventing chest pain (angina) resulting from coronary artery spasm. Relaxing the muscles lining the arteries of the rest of the body lowers blood pressure, which reduces the burden on the heart as it pumps blood to the body. Reducing heart burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina in patients with coronary artery disease. For more detailed information related to coronary artery disease, please read the Chest Pain , Cholesterol , and Heart Attack articles. Verapamil can decrease electrical conduction in the heart and slow heart rate.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: tablets of 40, 80, 120mg; sustained release caplets of 120, 180, 240mg (Calan SR, Isoptin SR, Verelan, Verelan PM)

A controlled onset, extended-release verapamil delivery system (Covera-HS) was approved for the treatment of angina and hypertension in 1996. This preparation is designed to release active drug according to the body's natural circadian rhythm. Specifically, a night-time dose reaches its peak effectiveness in the early morning when surges in blood pressure often occur.}

STORAGE: Store at room temperature in tight, light- resistant container.

PRESCRIBED FOR: Chest pain (angina) occurs because insufficient oxygen is delivered to the heart muscles. Insufficient oxygen may be a result of a coronary artery blockage or spasm, or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. Verapamil is used for the treatment and prevention of angina resulting from coronary artery spasm as well as from exertion. Verapamil is also used in the treatment of high blood pressure. Verapamil slows electrical conduction in the heart. It has been used in treating abnormally fast heart rhythms such as atrial fibrillation, and in the prevention of recurrent episodes of rapid heart rhythm originating from the atria. For further information about abnormal heart rhythms, please read the Atrial Fibrillation and Palpitation articles.

PROPER USE: Verapamil can be taken with food. Since verapamil is excreted by the kidney and metabolized by the liver, dosages may need to be reduced in patients with liver or kidney dysfunction. Otherwise, excess accumulation of verapamil in the body can cause profoundly slow heart rate and low blood pressure.

PRECAUTIONS: Verapamil slows heart electrical conduction, and can cause a dangerously slow heart rate in patients with existing electrical conduction disease of the heart. Concurrent use of verapamil with a beta blocker (another class of medications that slow heart rate) can occasionally cause profound heart slowing. A small group of patients with irregular heart rhythms has a condition called Wolff-Parkinson-White (WPW) syndrome. Verapamil can cause a dangerously rapid heart rate in these individuals. Verapamil can aggravate heart failure, especially in patients with poor ventricle muscle function. Verapamil can also cause excessive lowering of blood pressure in rare instances.

Concurrent administration of verapamil with digoxin (Lanoxin), theophylline (Slo-Bid), and carbamazepine (Tegretol) can increase blood drug levels of these other medications. Therefore, monitoring of drug levels is important to avoid toxicity. (Digoxin is commonly used in treating heart failure and fast heart rhythms. Theophylline is used in treating asthma. Carbamazepine is an anti-seizure medication.) Safety in children has not been established.

PREGNANCY: Safety during pregnancy has not been established.

NURSING MOTHERS: Safety in nursing mothers has not been established.

SIDE EFFECTS: Side effects are generally mild and transient. Verapamil can cause difficulty breathing or wheezing as a result of worsening heart failure. It can cause dizziness, weakness or fainting because of slow heart rate or low blood pressure. Other side effects include swelling of the lower extremities, rash, headache, and constipation. Verapamil can also cause mildly abnormal liver tests that are generally reversible with discontinuation of the medication.

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