Verapamil

What is Verapamil

Verapamil is an oral and intravenous calcium-channel blocking (CCB) agent. It is useful for the treatment of angina, hypertension, and for supraventricular tachyarrhythmias.

Verapamil is considered a class IV antiarrhythmic agent and it is more effective than digoxin for controlling ventricular rate in patients with atrial fibrillation.

Verapamil can be effective in decreasing left ventricular hypertrophy, presumably due to its afterload-reducing effects, and has been shown to decrease reinfarction in patients with uncompromised left ventricular function, although no reduction in mortality was observed.

Verapamil may provide beneficial hemodynamic effects in selected patients with hypertrophic cardiomyopathy. Verapamil was synthesized in 1962 and, in 1981, became the first CCB to be approved by the FDA.

Some data suggest verapamil may actually attenuate the atherosclerotic process. Although verapamil is commonly regarded as a cardiovascular agent, it has a variety of other uses, including mania and migraine prophylaxis. Clinicians should note that verapamil is marketed in several oral dosage forms that are not completely interchangeable.

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 in accord with the body’s natural circadian rhythm, in order to target early morning blood pressure surges. An ophthalmic preparation is currently under investigation for the treatment of ocular hypertension and glaucoma.

Research is under way to determine if constipation, which is frequently a dose-limiting effect, can be eliminated by administering only one of the verapamil isomers.

Indications

1. acute myocardial infarction
2. atrial fibrillation
3. atrial flutter
4. claudication
5. hypertension
6. mania
7. migraine prophylaxis
8. paroxysmal supraventricular tachycardia (PSVT)
9. paroxysmal supraventricular tachycardia (PSVT) prophylaxis
10. peripheral vascular disease (PVD)
11. unstable angina
12. variant angina

Side Effects

1. abdominal pain
2. alopecia
3. arthralgia
4. asthenia
5. asystole
6. AV block
7. blurred vision
8. bradycardia
9. breakthrough bleeding
10. bronchospasm
11. chest pain (unspecified)
12. confusion
13. constipation
14. diaphoresis
15. diarrhea
16. dizziness
17. drowsiness
18. dyspepsia
19. dyspnea
20. ecchymosis
21. edema
22. elevated hepatic enzymes
23. erythema multiforme
24. fatigue
25. flushing
26. galactorrhea
27. gingival hyperplasia
28. gynecomastia
29. headache
30. heart failure
31. hyperbilirubinemia
32. hyperkeratosis
33. hyperprolactinemia
34. hypotension
35. impotence (erectile dysfunction)
36. insomnia
37. laryngospasm
38. maculopapular rash
39. muscle cramps
40. nausea
41. nystagmus
42. orthostatic hypotension
43. palpitations
44. paresthesias
45. peripheral edema
46. peripheral vasodilation
47. PR prolongation
48. pruritus
49. pulmonary edema
50. purpura
51. rash
52. seizures
53. sinus tachycardia
54. Stevens-Johnson syndrome
55. stroke
56. syncope
57. tinnitus
58. tremor
59. urticaria
60. vasculitis
61. ventricular fibrillation
62. vertigo
63. xerostomia

Monitoring Parameters

• blood pressure
• ECG
• heart rate

Contraindications

• acute myocardial infarction
• aortic stenosis
• AV block
• bradycardia
• breast-feeding
• cardiogenic shock
• cardiomyopathy
• children
• constipation
• fecal impaction
• gastroesophageal reflux disease (GERD)
• geriatric
• GI obstruction
• heart failure
• hepatic disease
• hiatal hernia
• hypotension
• ileus
• infants
• Lown-Ganong-Levine syndrome
• myasthenia gravis
• neonates
• neuromuscular disease
• pregnancy
• renal disease
• renal failure
• renal impairment
• sick sinus syndrome
• ventricular dysfunction
• ventricular tachycardia
• Wolff-Parkinson-White syndrome

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