With the simultaneous use of the drug VEROGALID EP 240 with carbamazepine the effect of the latter increases and the risk of toxic lesions of the nervous system increases.
The use of the drug EREGALID EP 240 in patients receiving long-term lithium preparations, can lead to a decrease in the concentration of lithium in the blood serum.
Simultaneous application with rifampicin or phenobarbital leads to a decrease in the effectiveness of the drug VERGALID EP 240.
Cimetidine intensifies the effect of the drug VERGALID EP 240, as it increases the bioavailability of verapamil by almost 40-50% (due to a decrease in hepatic metabolism), so it may be necessary to reduce the dose of the latter.
Nicotine, accelerating the metabolism in the liver, leads to a decrease in the concentration of verapamil in the blood plasma, which leads to a decrease in severity antianginal, antihypertensive and antiarrhythmic actions.
When used simultaneously with inhalation anesthetics the risk of bradycardia increases, AV-blockadess, heart failure.
Simultaneous application with antiarrhythmic drugs can lead to an additive effect and to the development of AV-blockade, bradycardia, arterial hypotension, cardiac insufficiency.
With the simultaneous use of verapamil and quinidine in patients with hypertrophic obstructive cardiomyopathy in some cases, there was a development of arterial hypotension and pulmonary edema.
Verapamil may slightly reduce plasma clearance flecainide, while flecainide does not affect the plasma clearance of verapamil. Simultaneous The use of verapamil and flecainide can significantly to enlarge suppressing effect on myocardial contractility and additionally affect AV-conduction.
Simultaneous application with other antihypertensive drugs leads to a mutual reinforcement of their action.
Combination with beta-blockerami can lead to the potentiation of a negative inotropic effect, an increased risk of developing a disorder AV-conduction, bradycardia.
With simultaneous reception of the drug VEROGALID EP 240 and digoxin, theophylline, cyclosporine or quinidine, it is possible to increase the concentration in the serum of the above drugs on the background of therapyverapamil.
FROM lipid-lowering agents: atorvastatin (increased concentration of atorvastatin in the blood serum), lovastatin (increased concentration of lovastatin in the blood serum), simvastatin (increase AUC approximately 2.6 times and a maximum concentration of about 4.6 times simvastatin).
Patients receiving verapamil, treatment inhibitors of HMG-CoA-reductase should start with the lowest possible doses, which gradually increase. If verapamil is needed for patients already receiving HMG-CoA inhibitors-reductase, it is necessary to revise their dose according to the concentration of cholesterol in the blood serum.
When used simultaneously with drugs for the treatment of bronchial asthma, for example, theophylline, decreases oral and systemic clearance theophylline by about 20%, smokers patients - is reduced by about 11%.
Fluvastatin, pravastatin and rosuvastatin not metabolized under isozymes CYP3A4, so their interaction is least likely.
FROM almotriptan - increase AUC approximately 20% and maximum concentration of theiptana approximately by 24%.
Grapefruit juice - increase AUC and the maximum concentration of verapamil.
St. John's wort perforated - decreases AUC verapamil with appropriate decrease in maximum concentration.
Doxorubicin - the period elimination half-life of doxorubicin (approximately 27%) and the maximum concentration (approximately 38%). In patients with progressive neoplasms verapamil does not affect concentration or clearance of doxorubicin. In patients with small cell lung cancer verapamil reduces the half-life and maximum concentration of doxorubicin.
Hypoglycemic agents (glyburide) - increase in the maximum concentration of the glyburandyes (approximately 28%), AUC (approximately by 26%).
Aspirin (acetylsalicylic acid) - increased bleeding.
Ethanol - Increase in the concentration of ethanol in blood plasma.
Colchicine is a substrate for isoenzyme CYP3A and P-glycoprotein, and verapamil inhibits isoenzyme CYP3A and transfer of P-glycoprotein. Simultaneous use with colchicine leads to an increase in the concentration of colchicine in the blood plasma and the penetration of colchicine through the blood-brain barrier.Simultaneous use of verapamil and colchicine is not recommended.