Uses of Hypover: - Hypertension (high blood pressure) - Angina (heart-related chest pain) - Arrhythmia Essential hypertension, Angina pectoris, and prevention of re-infarction, Supraventricular arrhythmias, Paroxysmal supraventricular tachycardias, Atrial fibrillation, with rapid ventricular response (except WPWS), Atrial flutter with rapid conduction, Extrasystoles, Acute hypertension, Acute coronary insufficiency, For the prophylaxis and / or therapy of ectopic arrhythmias (predominantly ventricular extrasystoles) in halothane anaesthesia and in the application of adrenaline in halothane anaesthesia respectively. Cardiogenic shock, hypotension (systolic pressure <90 mmHg), marked bradycardia, uncompensated heart failure, 2nd- or 3rd-degree AV block (unless pacemaker is fitted), sick-sinus syndrome, severe ventricular dysfunction, atrial flutter or atrial fibrillation and accessory bypass tract (e.g. Wolff-Parkinson-White, Lown-Ganong-Levine syndromes).

Calcium-channel blockers

Verapamil inhibits entry of Ca ions into the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarisation. It relaxes coronary vascular smooth muscle and coronary vasodilation, increases myocardial oxygen delivery, and slows automaticity and AV node conduction.

How to use Verapamil Hydrochloride: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Verapamil Hydrochloride is to be taken with food. Administration: Should be taken with food. Adult Dose: Oral Hypertension Adult: Immediate release 80 mg PO q8hr initially; maintenance: 80-320 mg PO q12hr Extended release 180 mg/day PO (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day PO, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day Angina Immediate release 80 mg PO q8hr initially; usual range: 80-120 mg PO q8hr; not to exceed 480 mg/day Extended release 180 mg/day PO at bedtime initially; maintenance: 180-480 mg/day PO at bedtime Chronic Atrial Fibrillation & Paroxysmal Supraventricular Tachycardia Treatment of chronic atrial fibrillation (rate control); prevention of paroxysmal supraventricular tachycardia Immediate release: 240-480 mg/day PO divided q6-8hr Tardive Dyskinesia 40 mg PO q8hr; may be titrated to 120 mg q8hr Intravenous 2.5-5 mg IV over 2 minutes; 5-10 mg dose may be repeated after 15-30 minutes Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose Hepatic impairment: In cirrhosis, reduce dose by 20-50% of normal for oral and IV administration Child Dose: Supraventricular Tachycardia 1-15 years old: 0.1-0.3 mg/kg (not to exceed 5 mg) IV over 2 minutes; second dose (not to exceed 10 mg) may be given after 30 minutes Alternatively (not well established), 4-8 mg/kg/day PO divided q8hr Renal Dose: Renal impairment: Use with caution; monitor ECG; for Verelan PM, manufacturer recommends 100 mg at bedtime initially; if CrCl <10 mL/min, reduce dose by 25-50%

Increased cardiac depressant effects with beta-blockers and flecainide. Increased risk of additive bradycardia, conduction disturbances and digoxin toxicity with digoxin. Increased risk of bradycardia and hypotension with remifentanil and sufentanil. Increased levels of both everolimus and verapamil on concurrent use. May increase doxorubicin, buspirone, carbamazepine, ciclosporin, epirubicin, eplerenone, quinidine, statins, sirolimus, tacrolimus, quinupristin/dalfopristin levels. Verapamil increase blood alcohol levels. Unpredictable interactions with lithium. Decreased verapamil concentrations with phenobarbital, sulfinpyrazone, rifampicin, rifabutin and rifapentine. Increased verapamil concentrations with protease inhibitors and cimetidine. Potentially Fatal: Increased cardiac depressant effects with amiodarone. Increased risk of QT prolongation with dofetilide, ranolazine, sertindole. Additive bradycardia with ivabradine. Increased risk of heart block with clonidine. Increased risk of acute hyperkalaemia and CV collapse with dantrolene.

Cardiogenic shock, hypotension (systolic pressure <90 mmHg), marked bradycardia, uncompensated heart failure, 2nd- or 3rd-degree AV block (unless pacemaker is fitted), sick-sinus syndrome, severe ventricular dysfunction, atrial flutter or atrial fibrillation and accessory bypass tract (e.g. Wolff-Parkinson-White, Lown-Ganong-Levine syndromes).

Common - Headache - Constipation - Infection - Dizziness - Sinus infection - Flu-like symptoms - Peripheral edema >10% Headache,Gingival hyperplasia 1-10% Constipation (9%),Dizziness (4%),Hypotension (4%),Dyspepsia (3%),Nausea (3%),Edema (2%),Rash (2%),Increased liver enzymes (1%),Sleep disturbance (1%),Dyspnea

Verapamil carries the potential to produce fetal hypoxia associated with maternal hypotension. Verapamil should not be administered intravenously during the first six months of pregnancy. There are no data on use in the first and second trimester. Verapamil should not be used in the final trimester unless the benefits clearly outweigh the risks. Verapamil should not be administered intravenously during lactation. If a nursing mother requires intravenous Verapamil, breast feeding should be discontinued for the duration of treatment.

Precaution: Patient w/ bradycardia or 1st-degree AV block, attenuated neuromuscular transmission, hypertrophic cardiomyopathy. Avoid abrupt withdrawal. Renal and hepatic impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor BP, heart rate, ECG, LFTs (periodically). Lactation: Distributed in milk; nursing infant doses range from <0.01% to 0.1% of mother’s dose; manufacturer suggests refraining from nursing (though American Academy of Pediatrics committee states that drug is compatible with nursing)

Treatment of overdose should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solution may increase calcium ion flux across the slow channel and have been used in the treatment of overdose with Verapamil. Verapamil cannot be removed by hemodialysis.

Do not store above 30°C. Keep away from light and out of the reach of children.

Calcium-channel blockers

Verapamil inhibits entry of calcium ions into arterial smooth muscle cells as well as the myocytes and conducting tissue. These actions lead to reversal and preventions of coronary artery spasm, reduction in afterload through peripheral vasodilatation and reduction in ventricular rate in patients with chronic atrial flutter or fibrillation and reduction in the occurrence of paroxysmal supraventricular tachycardia. Verapamil reduces BP, relieves angina and slows AV conduction.

There are no adequate and well-controlled studies in pregnant women, so this drug should be used during pregnancy only if clearly needed. Verapamil crosses the placental barrier and can be detected in umbilical vein blood during delivery. Verapamil is excreted in breast milk. So nursing should be discontinued while Verapamil is administered.