Verapamil
- Atc Codes:C08DA01
- CAS Codes:152-11-4
- PHARMGKB ID:152-11-4
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Unlabeled Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Caution and personalized dose adjustment in patients with the following genotypes
- Other genes that may be involved
- Substrate of
- Inhibits
- Induces
- Drug Interactions
- Nutrition/Nutraceutical Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Isoptin, Verapabene, Veroptinstada; Belgium: Isoptine, Lodixal; Bulgaria: Isocor, Isoptin, Verapamil, Verogalid; Cyprus: Caveril, Verpamil; Czech Republic: Isoptin, Lekoptin, Verahexal, Verapamil, Verogalid; Denmark: Hexasoptin, Isoptin, Veraloc, Verapamil; Estonia: Isoptin, Verapamil; Finland: Isoptin, Vermin, Verpamil; France: Isoptine, Verapamil; Germany: Cardioprotect, Durasoptin, Falicard, Isoptin, Vera, Verabeta, Veragamma, Veramex, Verapamil, Verasal, Veroptinstada; Greece: Brovicarpine, Chronovera, Elanver, Isoptin, Ranil, Verapamil; Hungary: Chinopamil, Isoptin, Verahexal, Verapamil; Ireland: Isoptin, Securon, Verapamil, Veripton, Verisop, Zolvera; Italy: Isoptin, Veramil, Verap, Verisop; Latvia: Verapamil; Lithuania: Finoptin, Isoptin, Verapamil; Luxembourg: Devincil, Fibrocard, Isoptin, Verahexal; Netherlands: Isoptin, Verapamil; Poland: Isoptin, Lekoptin, Staveran, Verap, Verapamil; Portugal: Isoptin; Romania: Cordamil, Isoptin, Verapamil, Verogalid; Slovakia: Isoptin, Lekoptin, Veragalid, Verahexal, Verapamil; Slovenia: Lekoptin; Spain: Manidón; Sweden: Isoptin, Verapamil; UK: Securon, Verapamil, Verapress, Vertab, Zolvera.
North America
Canada: Covera, Isoptin, Veramil, Verap, Verapamil, Verelan; USA: Calan, Covera (d), Isoptin, Verapamil, Verelan.
Latin America
Argentina: Isoptino, Veral-Investi, Verapamilo; Brazil: Cordilat, Coronaril, Dilacor-Teuto Bras, Dilacoron, Multicor, Vasoton, Veramil, Verapamil, Verapress, Veraval; Mexico: Cronovera, Dilacorán, Serritén, Vepiltax, Verakén, Verapamilo, Verdilac.
Asia
Japan: Hormitol, Magotiron, Rositol, Vasolan.
Drug combinations
Verapamil and Quinidine
Verapamil and Trandolapril
Verapamil, Hydrochlorothiazide, and Triamterene
Chemistry
Verapamil Hydrochloride: C~27~H~38~N~2~O~4~ HCl. Mw: 491.06. (1) Benzeneacetonitrile, α-[3-[[2-(3,4-dimethoxyphenyl)ethyl]methylamino]propyl]-3,4-dimethoxy-α-(1-methylethyl)-, monohydrochloride, (±)-; (2)(±)-5-[(3,4-Dimethoxyphenethyl)methylamino]-2-(3,4-dimethoxyphenyl)-2-isopropylvaleronitrile monohydrochloride. CAS-152-11-4 (1981).
Pharmacologic Category
Class IV Antiarrhythmics. Vasodilating Agents, Miscellaneous. Calcium Channel Blocking Agents, Miscellaneous. (ATC-Code: C08DA01).
Mechanism of action
Inhibits calcium ions from entering «slow channels» or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization. Produces relaxation of coronary vascular smooth muscle and coronary vasodilation. Increases myocardial oxygen delivery in vasospastic angina. Slows automaticity and conduction of AV node.
Therapeutic use
Orally for treatment of angina pectoris (vasospastic, chronic stable, unstable) and hypertension. I.V. for supraventricular tachyarrhythmias (PSVT, atrial fibrillation, atrial flutter).
Pregnancy and lactiation implications
Use in pregnancy only when clearly needed and when benefits outweigh potential risk to fetus. One report of suspected heart block when used to control fetal supraventricular tachycardia. May exhibit tocolytic effects. Small amounts enter breast milk.
Unlabeled use
Migraine. Hypertrophic cardiomyopathy. Bipolar disorder (manic manifestations).
Contraindications
Hypersensitivity to verapamil or any component of the formulation. Severe left ventricular dysfunction. Hypotension (systolic pressure <90 mm Hg) or cardiogenic shock. Sick sinus syndrome (except with functioning artificial pacemaker). Second- or third-degree AV block (except with functioning artificial pacemaker). Atrial flutter or fibrillation and accessory bypass tract (WPW, Lown-Ganong-Levine syndrome).
Warnings and precautions
Increased angina and/or myocardial infarction occurred with initiation or dosage titration of calcium channel blockers. Can cause first-degree AV block or sinus bradycardia. Symptomatic hypotension with or without syncope can rarely occur. Increased LFTs can be observed. Peripheral edema common. Use I.V. with caution in attenuated neuromuscular transmission (Duchenne’s muscular dystrophy, myasthenia gravis). Avoid use in heart failure (can be exacerbated). Use with caution in hepatic and renal impairment, and in idiopathic hypertrophic subaortic stenosis. Avoid concurrent use of I.V. verapamil with I.V. β-blocker (can result in asystole). Verapamil significantly increases digoxin serum concentrations. May prolong recovery from nondepolarizing neuromuscular-blocking agents.