Generic Name and Formulations:
Verapamil HCl 120mg, 180mg, 240mg, 360mg; sust-rel caps.
Indications for VERELAN:
Take as a single dose in the AM. May sprinkle contents on applesauce; do not crush or chew contents. ≥18yrs: usually 240mg daily; adjust in 120mg increments. Elderly, small people, others with increased sensitivity: 120mg daily; if needed, may increase daily dose to 180mg, then 240mg, then higher in 120mg increments. Max 480mg daily.
<18yrs: not recommended.
Severe left ventricular (LV) dysfunction or LV dysfunction treated with β-blockers. Moderate to severe heart failure. Hypotension. Cardiogenic shock. Sick sinus syndrome, 2nd- or 3rd-degree AV block, unless paced. Atrial flutter or fibrillation and an accessory bypass tract.
Control mild heart failure (eg, with digitalis, diuretics). AV conduction or neuromuscular transmission disorders. Hepatic or renal dysfunction. Monitor liver function. Hypertrophic cardiomyopathy. Pregnancy (Cat.C). Nursing mothers: not recommended.
Potentiates alcohol, β-blockers, other antihypertensives, digitalis, ivabradine (avoid), theophylline, neuromuscular blockers, flecainide, carbamazepine, cyclosporine, doxorubicin. Potentiated by grapefruit juice. Avoid disopyramide; quinidine in cardiomyopathy. Potentiated by CYP3A4 inhibitors (eg, erythromycin, ritonavir); antagonized by CYP3A4 inducers (eg, rifampin, phenobarbital). May potentiate statins; limit simvastatin dose to 10mg/day or lovastatin to 40mg/day. May need to reduce initial and maintenance dose for other CYP3A4 substrates (eg, atorvastatin). Inhalation anesthetics may potentiate cardiac depression. May increase bleeding with aspirin. Monitor theophylline, lithium levels. Monitor heart rate when concomitant clonidine.
Calcium channel blocker (CCB) (diphenylalkylamine).
Hypotension, edema, AV block, bradycardia, CHF, constipation, headache, dizziness, fatigue, dyspepsia, elevated hepatic enzymes, paralytic ileus.