Verapamil

The Verapamil tablet is an intravenous calcium channel blocker, used for the treatment of angina, hypertension, and supraventricular tachyarrhythmias. It is considered a class IV antiarrhythmic, being more effective than digoxin in controlling atrial fibrillation. Verapamil reduces post-load and therefore may be useful in the treatment of left ventricular hypertrophy. Verapamil may be beneficial in hypertrophic cardiomyopathy and has been shown to reduce the percentage of reinfarctions, although it does not reduce mortality in patients with left ventricular dysfunction.

Verapamil hydrochloride inhibits the entry of extracellular calcium through the membranes of myocardial and smooth muscle cells, as well as contractile cells and the conduction system of the heart. Plasma calcium levels remain unchanged. Verapamil binds to slow calcium channels by deforming them, preventing calcium entry, thereby acting on ionic mechanisms that regulate automation. Inside cells, verapamil interferes with the release of intracellular calcium that is stored in the sarcoplasmic reticulum. The reduction of intracellular calcium levels affects the contractile mechanism of the myocardial tissue, causing dilation. The same effect on vascular smooth muscle cells, with consequent vasodilation, reduces peripheral resistance and therefore afterload. These mechanisms explain the beneficial effects of verapamil on angina and hypertension. However, these effects are less potent than those produced by calcium antagonists of the 1,4-dihydropyridine family.

The Verapamil drug group belongs to the group of calcium channel blockers. These drugs have a vasodilatory effect and an effect on the rhythm of the heart. This allows more oxygen to reach the heart and a drop in blood pressure also occurs. Use chest pain (angina), especially in patients who should not take beta-blockers. Beta-blockers are certain medications for heart disease and high blood pressure, for example, propranolol, atenolol, metoprolol; - mild to moderate high blood pressure; - certain cardiac arrhythmias; - certain heart muscle disease, which includes an increase in heart muscle tissue (hypertrophic obstructive cardiomyopathy);  - prevention of a new heart attack if you have had a heart attack in the past and are not allowed to use a beta-blocker. Verapamil uses include being indicated to treat hypertension (high blood pressure), angina (chest pain), and some heart rhythm disorders.

The recommended verapamil dosage for treatment of ischemic heart disease (including Prinzmetal's angina, unstable angina, and stable chronic angina):

Oral administration:

adults: initially 80-120 mg orally every 8 hours, which can be increased to 480 mg / day administered in 3 or 4 doses. In patients with liver disease or small stature, the initial doses will be reduced to 40 mg every 8 hours.

elderly: lower initial doses are recommended (eg 40 mg orally every 8 hours).

The doses should then be adjusted depending on the clinical response, up to a maximum of 480 mg/day.

In delayed-action formulations, follow manufacturer's directions up to a maximum of 540 mg/day

The recommended verapamil dosage for treatment of ischemia after acute myocardial infarction when b-blockers are ineffective or contraindicated:

Oral administration:

Adults: Initially between 80-120 mg orally every 8 hours. These doses can be increased up to 480 mg/day divided into 3 or 4 doses.

Elderly: generally lower doses are used (120 mg/day orally).

The recommended verapamil dosage for treatment of supraventricular tachyarrhythmias:

Adults: The adult dose ranges from 240-480 mg/day for non-digitized patients, and between 120-360 mg/day for digitized patients.

Children: maximum 10 mg / kg / day in several doses.

Like all medicines, this medicine can also have side effects, although not everyone has them.

If any of the following side effects occur, stop taking verapamil immediately and contact your doctor or go to the nearest hospital emergency department:

• severe hypersensitivity reaction with fever (high), red spots on the skin, joint pain, and/or eye inflammation (Stevens-Johnson syndrome).

The above reactions are very serious side effects. If these reactions occur, then you may have a severe hypersensitivity reaction to verapamil. You need urgent medical attention or hospitalization. The following section details the known verapamil side effects and their respective frequency.

Immune system Frequency not known: hypersensitivity.

Nervous system Common: headache, dizziness.

Uncommon: causeless tremors (tremor), tingling, itching, or tingling (paresthesia).

Frequency not known: certain movement disorders (extrapyramidal disorders), paralysis (paralysis).

A case of paralysis has been reported after the use of verapamil in combination with colchicine.

Psychic Sometimes: nervousness.

Ear and labyrinth disorders Frequency not known: vertigo, ringing in the ears.

Common heart: slow heart rate ((sinus) bradycardia), certain cardiac arrhythmia, i.e. delayed stimulus conduction (first degree AV block).

Uncommon: fluid accumulation in the ankles, legs or arms, decreased heart pumping function, palpitations (palpitations), increased heart rate (tachycardia), slow heart rate due to interrupted stimulation (sinus arrest ).

Rare: certain cardiac arrhythmia, i.e., a stimulus conduction block that may lead to failure or loss of contraction of the heart muscle (second or third-degree AV block).

Frequency not known: heart failure.

Blood vessels Uncommon: redness and burning in the extremities of the extremities (erythromelalgia), decrease in blood pressure (hypotension), redness.

Stomach and intestines Common: constipation.

Uncommon: nausea, vomiting, abdominal pain, blockage in the intestine (ileus), additional growth (hyperplasia) of the gums.

Frequency not known: discomfort in the abdomen.

Skin and subcutaneous tissue Very rare: hypersensitivity reactions of the skin (redness, itching, and itchy rash and severe bumps (urticaria or hives), severe hypersensitivity reaction with fever (high), red patches on the skin, pain in the joints and/or inflammation of the eyes (Stevens-Johnson syndrome).

Frequency not known: sudden accumulation of fluid on the skin and mucous membranes (for example, throat or tongue), shortness of breath and/or itching and rash, often as an allergic reaction (angioedema), rash with irregular red spots ( erythema multiforme), rash with spots and bumps, hair loss, skin rash with severe itching and bumps (hives or hives), pinched bruises (purpura), itching and excessive sweating.

Very rare bones and muscles: muscle pain or joint pain.

Frequency not known: muscle weakness.

Urinary tract and kidneys Frequency not known: kidney failure (kidney failure)

Reproductive system and breast disorders Very rare: erectile dysfunction, excessive milk secretion, breast formation in elderly patients, especially after prolonged use.

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