VERAPAMIL

Posology:

Adults: Hypertension 240mg verapamil daily. For patients new to verapamil therapy, the physician should consider halving the initial dose to 120mg. Most patients respond to 240mg daily given as a single dose. If control is not achieved after a period of at least one week, the dosage may be increased to a maximum of 480mg (in divided doses of 240mg in the morning and 240mg in the evening, at an interval of about twelve hours).

A further reduction in blood pressure may be achieved by combining verapamil with other antihypertensive agents, in particular diuretics. 120mg may be used for dose titration purposes. Angina pectoris: 120 mg twice a daily. A small number of patients respond to a lower dose and where indictaed, adjustment down to 120mg daily could be made.

120mg may be used for dose titration purposes. Supraventricular tachycardia: 40-120 mg three times a day according to the severity of the condition.

Elderly:

The adults dose is recommended unless renal and hepatic function is impaired. 4, Special Warnings and Precautions for Use) Children: Up to 2 years: 20 mg 2-3 times daily. 2 years and above: 40-120 mg 2-3 times daily.

Adults:

Liver impairment In patients with impaired liver function, metabolism of the drug is delayed to a greater or lesser extent depending on the severity of hepatic dysfunction, thus potentiating and prolonging the effects of verapamil hydrochloride.

Therefore the dosage needs to be adjusted with special caution in patients with impaired liver function and low doses should be given initially (see Special Warnings and Precautions for Use).

Method of administration:

For oral use only. Verapamil tablets should be taken without sucking or chewing, with sufficient liquid, preferably with or shortly after meals.

g. erythema, pruritis, urticaria) are very rarely seen. g. parkinsonism), dystonia. Ear and labyrinth disorders: vertigo and tinnitus. Cardiac disorders: bradycardic arrhythmias such as sinus bradycardia, sinus arrest with asystole, 2nd and 3rd degree AV block, bradyarrhythmia in atrial fibrillation, peripheral oedema, palpitations, tachycardia, development or aggravation of heart failure and hypotension.

Vascular disorders: flushing, peripheral oedema. Gastrointestinal disorders: nausea and vomiting, constipation is not uncommon, ileus and abdominal pain/discomfort. Gingival hyperplasia may occur very rarely when the drug is administered over prolonged periods.

This is fully reversible when the drug is discontinued. Skin and subcutaneous tissue disorders: ankle oedema, Quincke's oedema, Steven-Johnson syndrome, erythema multiforme, erythromelalgia, alopecia and purpura. Musculoskeletal and connective tissue disorders: muscular weakness, myalgia, arthralgia.

Reproductive system and breast disorders: impotence (erectile dysfunction) has been rarely reported and isolated cases of galactorrhoea. Gynaecomastia may occur in older male patients under long-term verapamil treatment, which was fully reversible in all cases when the drug was discontinued.

General disorders and administration site conditions: fatigue.

Investigations:

On very rare occasions, a reversible impairment of liver function characterised by an increase of transaminase and/or alkaline phosphatase may occur on very rare occasions during verapamil treatment and is most probably a hypersensitivity reaction.

Rises in blood prolactin levels have been reported. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

Since verapamil is extensively metabolised in the liver, careful dose titration is required in patients with liver disease. Although the pharmacokinetics of verapamil in patients with renal impairment are not affected, caution should be exercised and careful patient monitoring is recommended.

Verapamil is not removed during dialysis. Heart Block/ 1st Degree AV block/Bradycardia/Asystole Verapamil hydrochloride affects the AV and SA nodes and prolongs AV conduction time. Use with caution as development of second-or third-degree AV block (contraindication) or unifascicular, bifascicular or trifascicular bundle branch block requires discontinuation in subsequent doses of verapamil hydrochloride and institution of appropriate therapy, if needed.

Verapamil hydrochloride affects the AV and SA nodes and rarely may produce second- or third-degree AV block, bradycardia, and, in extreme cases, asystole. This is more likely to occur in patients with a sick sinus syndrome (SA nodal disease), which is more common in older patients.

Asystole in patients other than those with sick sinus syndrome is usually of short duration (few seconds or less), with spontaneous return to AV nodal or normal sinus rhythm. 8). Verapamil may affect impulse conduction and should therefore be used with caution in patients with bradycardia or first degree atrioventricular block.

Verapamil may affect left ventricular contractility; this effect is small and normally not important but cardiac failure may be precipitated or aggravated. g. digitalis. When treating hypertension with verapamil, monitoring of the patient's blood pressure at regular intervals is required.

Hypotension Intravenous verapamil hydrochloride often produces a decrease in blood pressure below baseline levels that is usually transient and asymptomatic but may result in dizziness. , simvastatin, atorvastatin or lovastatin) for patients taking verapamil.

1. • Cardiogenic shock: Acute myocardial infarction complicated by bradycardia, marked hypotension or left ventricular failure; Second or third degree atrioventricular block; sino-atrial block; sick sinus syndrome (except in patients with a functioning artificial pacemaker); uncompensated heart failure; marked bradycardia (less than 50 beats/minute).

g. Wolff-Parkinson-White syndrome) may develop increased conduction across the anomalous pathway and ventricular tachycardia may be precipitated. 5).