VERAPAMIL

s. is recommended. s. can be completely satisfactory in some patients with angina of effort. s. is not likely to be effective in angina at rest and variant angina.

Children:

Not applicable.

Elderly:

As for adults, unless liver or renal function is impaired. s. according to the severity of the condition. s. s. according to age and effect.

Elderly:

It is recommended to commence with lowest dose and adjust as required. s. s. at weekly intervals according to response, either alone or in conjunction with other antihypertensive therapy. g. thiazide diuretics.

Children:

Up to 10 mg per kilo bodyweight per day in divided doses, according to severity of disease.

Elderly:

It is recommended to commence with the lowest dose and adjust as required.

Route of administration:

Oral

Administration of Verapamil is commonly associated with constipation.

Occasionally the fo llowing side- effects may be experi enced:

N ausea a nd v omiting, flus hing, headache, d izziness, fatigue ank le oe dema, m yalgia, ar thralgia, p araesthesia, an d erythromelalgia; increased prolactin concentration. On rare occasions gynaecomastia and g ingival hy perplasia may occur aft er lo ng-term trea tment, aft er i ntravenous administration of high doses, hypotension, heart failure, bradycardia, heart block, and asystole.

Sensitivity o r all ergy t o Verapamil i s ra re. S ymptoms o f a llergy a re er ythema, pruritis, urticaria, angioedema and Stevens-Johnson syndrome.

Care should be exercised when beta-blockers are administered either concurrently or closely together because the effects of beta-blockers and VERAMIL may be additive with respect to both contraction and conduction. This is pa rticularly important when either drug is administered intravenously.

VERAMIL should be used with caution in patients with first-degree atrioventricular block because impulse conduction may be affected. Left ventricular contractility may be affec ted by V ERAMIL because of its mode of action; c ardiac fa ilure m ay the refore be pr ecipitated or, if it a lready exi sts, m ay be aggravated by VERAMIL.

g. digoxin etc. Patients with impaired liver function exhibit reduced drug metabolism and therefore careful attention should be paid to dosage in these patients. The disposition of verapamil in patients with renal impairment has not been fully established an d t herefore careful pa tient m onitoring i s re commended.

Verapamil i s not removed during dialysis. VERAMIL should not be used in children with arrhythmias without specialist advice; some supraventricular arrhythmias in childhood can be accelerated by verapamil with dangerous consequences.

Patients starting therapy with simvastatin should be a dvised of th e risk of m yopathy and told to report promptly unexplained muscle pain, tenderness or weakness. A CPK level ab ove 10x ULN in a pat ient wi th un explained m uscle sy mptoms indicate s myopathy.

Si mvastatin therapy should be di scontinued if m yopathy is diag nosed or suspected. Pe riodic CPK dete rminations m ay be cons idered (see s ection 4. 5 ‘Interactions with other Medicaments and forms of Interaction’). Patients w ith rare her editary prob lems of g alactose in tolerance, L app lac tase deficiency or glucose/galactose malabsorbtion should not take Veramil.

Sick sinus syndrome, sec ond or t hird deg ree at rioventricular block, cardiogenic shock, acute myocardial infarction complicated by bradycardia, marked hypotension or left ventricular failure, sino-atrial block, history of heart failure, bradycardia of less than 50 beats/minute or hypotension of less than 90mmHg systolic.

Atrial flutter or fibrillation complicating Wolff-Parkinson-White syndrome. Porphyria. Concomitant ingestion of grapefruit juice.