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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