Generic name: Verapamil hcl

Classification

Anti-Anginal Drugs / Calcium Antagonists / Other Antihypertensives

Indications

Lited in Dosage.

Dosage

Adult Essential hypertension Isoptin tab one 80-mg tab tid.Max: 480 mg/day in divided doses. Isoptin SR tab 1 tab inthe morning. If required, after 1 wk increase up to 2 tab/day in divided doses.Chronic stable & unstable angina, angina at rest including vasospastic angina; angina pectoris after MI; prophylaxis of supraventricular tachyarrhythmias Isoptin tab 80 mg tid-qid; in oral long-term treatment, max: 480 mg daily. Hypertensive crises, treatment of supraventricular tachyarrhythmias, acute coronary insufficiency (coronary spasm) Isoptin amp 5 mg slow IV to be repeated after 5-10 min, if required. Drip infusion to maintain the theapeutic efect: 5-10 mg/hr on ave up to a total dose of 100 mg/day.

Contraindications

CV shock, complicated acuteMI, severe conduction disorders (2nd & 3 rd degree AV block, AV block), sick sinus syndrome, heart failure, atrial fibrillation/flutter & simultaneous preexcitation syndrome. Myasthenia gravis.

Precautions

1st degree AV block, bradycardia, hypotension. May impair ability to drive or operate machinery. Pregnancy, lactation. Severe impairment of liver function. Show down markedly the elimination of alcohol & prolongs the duration of alcohol.

Adverse Reactions

Constipation, dizziness, nausea. Rarely, vertigo, headache, hypotension, ankle edema, flushing, fatigue, nervousness, erythromelalgia, paraesthesia, neuropathy; bradycardiac arrhythmias, CHF, dyspnea, raised prolactin levels, single cases of galactorrhea. Very rarely, myalgia, arthralgia; allergic skin reations; purpura, photosensitisation dermatitis, gynecomastia, reversible increase in transaminases &/or alkaline phosphatase, relevant impairment of glucose tolerance; gingival hyperplasia. Tachycardia, palpitations, impotence. Tinnitus, tremor. Caution should be taken in patients w/ a pacemaker or difibrillator (possible increase in sensing, pacing & fibrillation threshold).

Interactions

Effects enhnced by beta-blockers, antiarrhythmics or inhalation anesth. May intensify effects of other antihypertensives. Lithium (attenuated by verapamil, enhanced neurotoxicity). Increases plasma level of cyclosporing, theophylline, digoxin, carbamazepine. Effecs attenuated by rifampicin, phenytoin & phenobarbital. Effects of muscle relaxants may be potentiated. Rise in plasma levels by grapefruit juice & cimetidine. May increase plasma conc of certain beta-blockers(atenolol, metoprolol, propranolol), quinidine, prazosin, midazolam, aspirin (increased risk of bleeding), alcohol (reduced metabolism, increase in plasm levels).