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 following side-effects may be experienced:

Nausea and vomiting, flushing, headache, dizziness, fatigue ankle oedema, myalgia, arthralgia, paraesthesia, and erythromelalgia; increased prolactin concentration. On rare occasions gynaecomastia and gingival hyperplasia may occur after long-term treatment, after intravenous administration of high doses, hypotension, heart failure, bradycardia, heart block, and asystole.

Sensitivity or allergy to Verapamil is rare. Symptoms of allergy are erythema, 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 particularly 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 affected by VERAMIL because of its mode of action; cardiac failure may therefore be precipitated or, if it already exists, may 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 and therefore careful patient monitoring is recommended.

Verapamil is 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 advised of the risk of myopathy and told to report promptly unexplained muscle pain, tenderness or weakness. A CPK level above 10x ULN in a patient with unexplained muscle symptoms indicates myopathy.

Simvastatin therapy should be discontinued if myopathy is diagnosed or suspected. 5 ‘Interactions with other Medicaments and forms of Interaction’). Patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose/galactose malabsorbtion should not take Veramil.

Sick sinus syndrome, second or third degree atrioventricular 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.