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 acheived by combining verapamil with other antihypertensive agents, in particular diuretics. 120mg may be used for dose titration purposes. Angina pectoris: 120mg twice 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 tachycardias: 40-120mg three times daily depending on the severity of the condition. 4, Special Warnings and Precautions for Use).

Paediatric population:

Verapamil tablets are not recommended for children. 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, pruritus, urticaria) are very rarely seen. Nervous system disorders: headaches dizziness, paraesthesia, tremor, extrapyramidal syndrome. Ear and labyrinth disorders: vertigo, tinnitus. Cardiac disorders: bradycardic arrhythmias such as sinus bradycardia, sinus arrest with asystole, 2nd and 3rd degree AV block, bradyarrhythmia in atrial fibrillation, palpitations, tachycardia, development or aggravation of heart failure, hypotension.

Vascular disorders: flushing, peripheral oedema. Gastrointestinal disorders: nausea, vomiting, constipation, ileus and abdominal pain/discomfort. Gingival hyperplasia may very rarely occur when the drug is administered over prolonged periods.

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

Reproductive system and breast disorders: impotence (erectile dysfunction) has been rarely reported and isolated cases of galactorrhoea. Gynaecomastia was observed on very rare occasions in elderly male patients under longer 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 transaminases and/or alkaline phosphatase, may occur 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. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

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). 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. These patients should be started at the lowest possible dose of verapamil and titrated upwards. , simvastatin, atorvastatin or lovastatin), refer to advice in the respective statin product information.

Use with caution in the presence of diseases in which neuromuscular transmission is affected (myasthenia gravis, Lambert-Eaton syndrome, advanced Duchenne muscular dystrophy). Sunset yellow aluminium lake (E110) Verapamil tablets contain sunset yellow aluminium lake (E110) which may cause allergic reactions.

1. • Cardiogenic shock; acute myocardial infarction complicated by bradycardia, marked hypotension or left ventricular failure; second or third degree atrioventricular (AV) block (except in patients with a functioning artificial pacemaker); sino-atrial block; sick sinus syndrome (except in patients with a functioning artificial pacemaker); uncompensated heart failure; bradycardia of less than 50 beats/minute; hypotension of less than 90 mmHg systolic.

g. WPW syndrome) may develop increased conduction across the anomalous pathway and ventricular tachycardia may be precipitated. • Combination with ivabradine (see section Interactions with other medicinal products and other forms of interaction).