Verapamil - instructions for use, dose, side effects, contraindications

Each tablet contains an active substance - verapamil hydrochloride 0.04 g or 0.08 g and auxiliaries: calcium phosphate disubstituted, starch, butyl hydroxy anisole, talc purified, magnesium stearate, gelatin, methylparaben, hydroxypropylmethylcellulose, titanium dioxide, talc purified, indigo carmine.

Pharmacotherapeutic group:Calcium channel blocker

ATX: & nbsp

C.08.D.A.01 Verapamil

C.08.D.A Phenylalkylamine derivatives

Pharmacodynamics:

Verapamil is one of the main drugs group of calcium channel blockers. It has antiarrhythmic, anti-anginal and antihypertensive activity.

The drug reduces the need for myocardium in oxygen by decreasing myocardial contractility and reducing the heart rate. Causes the enlargement of the coronary vessels of the heart and increases coronary blood flow; reduces the tone of the smooth muscles of peripheral arteries and the general peripheral vascular resistance.

Verapamil significantly slows the atrioventricular conductivity,inhibits the automatism of the sinus node, which allows the use of the drug for the treatment of supraventricular arrhythmias.

Verapamil is the drug of choice for the treatment of angina of vasospastic genesis (Prinzmetal angina). Has an effect in angina pectoris, as well as in the treatment of angina with supraventricular rhythm disorders.

Pharmacokinetics:When ingested, more 90% of the dose. It is metabolized at the first pass through the liver. Binding to proteins - 90%. Half-life with a single dose is 2,8- 7.4 hours; at reception of repeated doses - 4,5 - 12 hours. It is mainly kidney and 9-16% through the intestines. The main metabolites are noravapamil,which has less pronounced hypotensive activity than unchanged verapamil.

Indications:

1. Treatment and prevention of cardiac arrhythmias:

paroxysmal supraventricular tachycardia;
flutter and atrial fibrillation (tachyarrhythmic variant);
supraventricular extrasystole;

2. Treatment and prevention

chronic stable angina (stress angina);
unstable angina (rest angina);
vasospastic angina (Prinzmetal angina, variant angina);

3. Treatment of arterial hypertension.

Contraindications:

Contraindications to the use of Verapamil are: increased sensitivity to the components of the drug, pronounced bradycardia, chronic heart failure of II B - III stage, cardiogenic shock (except for caused by arrhythmia), sinoauric blockade, atrioventricular blockade of II and III degree (excluding patients with an artificial pacemaker) ; syndrome of weakness of the sinus node, Wolff-Parkinson-White syndrome, Morgagni-Adams-Stokes syndrome, acute heart failure, simultaneous use of beta-blockers intravenously, children under 18 years of age.

Carefully:

With care, it is necessary to prescribe the drug to patients with atrioventricular blockade of I degree, chronic heart failure of I and II degrees, arterial hypotension (systolic pressure below 100 mm Hg), bradycardia, marked violations of liver function.

Pregnancy and lactation:

The use of verapamil in pregnancy is possible only if the expected benefit for the mother,exceeds the potential risk to the fetus.

If it is necessary to use the drug during the feeding period, it should be taken into account that verapamil is excreted in breast milk, so breastfeeding should be discontinued.

Dosing and Administration:

Verapamil is taken orally during or after a meal, with a small amount of water.

The dosage regimen and duration of treatment are set individually, depending on the patient's condition, severity, the features of the course of the disease and the effectiveness of therapy.

To prevent attacks of angina pectoris, arrhythmia and in the treatment of hypertension, the drug is prescribed to adults at an initial dose of 40-80 mg 3-4 times a day. If necessary, increase the single dose to 120-160 mg.

The maximum daily dose of the drug is 480 mg.

In patients with severe hepatic impairment, the excretion of verapamil from the body is slowed, so it is advisable to start treatment with minimal doses. The daily dose of the drug should not exceed 120 mg.

Side effects:

from the cardiovascular system: possible reddening of the face, pronounced bradycardia, atrioventricular block,arterial hypotension, the appearance of symptoms of heart failure when using the drug in high doses, especially in predisposed patients;

from the gastrointestinal tract: nausea, vomiting, constipation; in some cases - a transient increase in the activity of hepatic transaminases in the blood plasma;

from the side of the central nervous system: dizziness, headache, in rare cases - increased nervous excitability, inhibition, increased fatigue.

allergic reactions: skin rash, itching.

Other: development of peripheral edema.

Overdose:

Large doses (taking up to 6 g of the drug) can cause a deep loss of consciousness, arterial hypotension, sinus bradycardia, turning into an atrioventricular block, sometimes asystole.

When there is arterial hypotension and / or complete AV blockade - intravenous fluids, dopamine (dopamine), calcium gluconate, isoproterenol or norepinephrine. Treatment is symptomatic and depends on the clinical picture of the overdose. Hemodialysis is not effective.

Interaction:

With the simultaneous use of verapamil with:

antiarrhythmic agents, beta-blockers and inhalation anesthetics, cardiotoxic effect increases (increased risk of atrioventricular blockade, sharp decrease in heart rate, development of heart failure, sharp drop in blood pressure);
antihypertensive agents and diuretics - it is possible to intensify the hypotensive effect of verapamil;
digoxin may increase the level of digoxin concentration in the blood plasma due to the deterioration of its excretion by the kidneys (therefore it is necessary to monitor the level of digoxin in the blood plasma in order to determine its optimal dosage and prevent intoxication); cimetidine and ranitidine elevates the level of concentration of verapamil in blood plasma;
rifampicin, phenobarbital may reduce the concentration in the blood plasma and weaken the action of verapamil;
theophylline, prazosin, cyclosporin, an increase in the concentration of these substances in the blood plasma is possible;
muscle relaxants may enhance the muscle relaxant effect; Acetylsalicylic acid increases the possibility of bleeding;
quinidine increases the level of concentration of quinidine in blood plasma, the threat of lowering blood pressure increases, and in patients with hypertrophic cardiomyopathy, the occurrence of severe arterial hypotension is possible;
carbamazepine and lithium increases the risk of neurotoxic effects.

Special instructions:In the treatment it is necessary to monitor the function of the cardiovascular and respiratory systems, the level of sugar and electrolytes in the blood, the volume of circulating blood and the amount of urine released.

Form release / dosage:

Tablets, film-coated, 40 and 80 mg.

Storage conditions:

Store in a dry, dark place at a temperature of no higher than 25 ° C. The drug should be stored in places inaccessible to children.

Shelf life:

3 years.

Do not use the drug after the expiry date,theof the on the package.

Terms of leave from pharmacies:On prescription

Registration number:П N013974 / 01-2002

Date of registration:14.08.2008

Expiration Date:Unlimited

The owner of the registration certificate:Shraya Life Senses Pvt. Ltd.Shraya Life Senses Pvt. Ltd. India

Manufacturer: & nbsp

SERENA PHARMA, Pvt.Ltd. India

Representation: & nbspSHREYA LIFE SENENSIZ Pvt.Ltd. SHREYA LIFE SENENSIZ Pvt.Ltd. India

Information update date: & nbsp28.01.2017

Illustrated instructions

Instructions

Verapamil (Verapamil)