Isoptin/Isoptin SR

Verapamil HCl

Tab: CAD including chronic stable angina pectoris, unstable angina pectoris (crescendo angina, angina at rest), vasospastic angina pectoris (Prinzmetal's angina, variant angina), post MI angina in patients w/o heart failure if β-blockers are not indicated; disturbance of cardiac rhythm in paroxysmal supraventricular tachycardia, atrial fibrillation/atrial flutter w/ rapid AV conduction [except Wolf-Parkinson-White (W-P-W) or Lown-Ganong-Levine (L-G-L) syndromes]; high BP (HTN). Inj: Supraventricular tachyarrhythmias which includes rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated w/ accessory bypass tracts (W-P-W or L-G-L syndromes); temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation except when the atrial flutter &/or atrial fibrillation are associated w/ accessory bypass tracts (W-P-W or L-G-L syndromes).

Tab Adult CAD, paroxysmal supraventricular tachycardia, atrial flutter/fibrillation IR: 120-480 mg in 3 or 4 divided doses; SR: 120-480 mg in 1 or 2 divided doses. HTN IR: 120-480 mg in 3 divided doses; SR: 120-480 mg in 1 or 2 divided doses. Childn 6-14 yr 80-360 mg in 2-4 divided doses, up to 6 yr 80-120 mg in 2-3 divided doses. Inj Adult Initially 5-10 mg (0.075-0.15 mg/kg) IV bolus over at least 2 min. Repeat dose: 10 mg (0.15 mg/kg) 30 min after the 1st dose if the initial response is not adequate. Childn 1-15 yr Initially 0.1-0.3 mg/kg (usual single-dose range: 2-5 mg) IV bolus over at least 2 min. Max: 5 mg. Repeat dose: 0.1-0.3 mg/kg (usual single dose range: 2-5 mg) 30 min after the 1st dose if the initial response is not adequate. Max: 10 mg as single dose, 0-1 yr Initially 0.1-0.2 mg/kg (usual single dose range: 0.75-2 mg) IV bolus over at least 2 min under continuous ECG monitoring. Repeat dose: 0.1-0.2 mg/kg (usual single dose range: 0.75-2 mg) 30 min after the 1st dose if the initial response is not adequate.

Should be taken with food: Take w/ or shortly after meals. Swallow whole, do not suck/chew.

Hypersensitivity. Cardiogenic shock. 2nd- or 3rd-degree AV block & sick sinus syndrome (except in patients w/ a functioning artificial pacemaker). Heart failure w/ reduced ejection fraction of <35% &/or pulmonary wedge pressure >20 mmHg (unless secondary to a supraventricular tachycardia amenable to verapamil therapy). Atrial fibrillation/flutter in the presence of an accessory bypass tract (W-P-W or L-G-L syndromes). Combination w/ ivabradine. Inj: Severe hypotension. Patients receiving IV β-adrenergic blocking drugs (eg, propranolol). Patients w/ wide-complex ventricular tachycardia (QRS >0.12 sec).

Acute MI complicated by bradycardia, marked hypotension, or left ventricular dysfunction.; Discontinue subsequent doses & institute appropriate therapy if 2nd- or 3rd-degree AV block or unifascicular, bifascicular or trifascicular bundle branch block develops. Compensate heart failure patients w/ ejection fraction >35% before starting treatment & should be adequately treated throughout. Presence of diseases in which neuromuscular transmission is affected (myasthenia gravis, Lambert-Eaton syndrome, advanced Duchenne muscular dystrophy). Concomitant use w/ timolol eye drops, digoxin, HMG-Coa reductase inhibitors. May impair ability to drive or operate machinery. Renal & severe liver impairment. Pregnancy & lactation. Inj: Administer as slow IV inj over at least 2 min under continuous ECG & BP monitoring. Hypotension. Monitor for AV block or excessive bradycardia. Concomitant use w/ digitalis prep, oral quinidine, flecainide, disopyramide (do not administer w/in 48 hr before or 24 hr after verapamil administration), β-blockers.

Dizziness, headache; bradycardia; flushing, hypotension; constipation, nausea; peripheral edema.

Additive hypotensive effect w/ prazosin, terazosin. Additive effects reducing myocardial contractility, prolonging AV conduction & prolonging repolarization w/ flecainide. Hypotension w/ quinidine. Reduced clearance w/ theophylline, digitoxin. Increased levels of carbamazepine, tacrolimus, atorvastatin, lovastatin. Decreased plasma conc w/ phenytoin. Increased AUC of imipramine, sirolimus. Increased C_max & AUC of glyburide, colchicine, doxorubicin, buspirone, midazolam, everolimus, simvastatin, almotriptan. Possible increased levels w/ clarithromycin, erythromycin, telithromycin. Reduced BP lowering effect w/ rifampicin, sulfinpyrazone. Increased clearance w/ phenobarb. Slowed AV conduction w/ digoxin. Increased AUC, C_ss & C_max of cyclosporine. Additional heart rate lowering effect of ivabradine. Increased AUC w/ grapefruit juice. Decreased AUC w/ St. John's wort. Increased plasma conc w/ HIV antivirals (eg, ritonavir). Increased neurotoxicity w/ lithium. May potentiate the activity of neuromuscular-blocking agents (eg, curare-like & depolarizing). Increased tendency to bleed w/ acetylsalicylic acid. Elevation of ethanol plasma levels. Potentiation of the hypotensive effects of antihypertensives, diuretics, vasodilators. Tab: Increased risk of bleeding w/ dabigatran. Increased absorption of direct oral anticoagulants. Inj: Exaggerated hypotensive response w/ agents that decrease adrenergic function. May depress myocardial contractility or AV conduction w/ β-blockers (eg, metoprolol, propranolol). Reduced clearance w/ cimetidine. Risk of CV depression w/ inhalation anesth. Protein bound drugs.

Calcium Antagonists

C08DA01 - verapamil ; Belongs to the class of phenylalkylamine derivative selective calcium-channel blockers with direct cardiac effects. Used in the treatment of cardiovascular diseases.

Rx