Isoptin/Isoptin SR

Verapamil HCl

CAD including chronic stable angina pectoris, unstable angina pectoris (crescendo angina, angina at rest), vasospastic angina pectoris (Prinzmetal's angina, variant angina), post MI angina in patients w/o heart failure if β-blockers are not indicated; disturbance of cardiac rhythm in paroxysmal supraventricular tachycardia, atrial fibrillation/atrial flutter w/ rapid AV conduction [except Wolf-Parkinson-White (W-P-W) or Lown-Ganong-Levine (L-G-L) syndromes]; high BP (HTN).

Adult CAD, paroxysmal supraventricular tachycardia, atrial flutter/fibrillation Isoptin 120-480 mg in 3 or 4 divided doses; Isoptin SR 120-480 mg in 1 or 2 divided doses. HTN Isoptin 120-480 mg in 3 divided doses; Isoptin SR 120-480 mg in 1 or 2 divided doses. Childn 6-14 yr 80-360 mg in 2-4 divided doses, up to 6 yr 80-120 mg in 2-3 divided doses.

Should be taken with food: Take w/ or shortly after meals. Swallow whole, do not suck/chew.

Hypersensitivity. Cardiogenic shock. 2nd- or 3rd-degree AV block & sick sinus syndrome (except in patients w/ a functioning artificial pacemaker). Heart failure w/ reduced ejection fraction of <35% &/or pulmonary wedge pressure >20 mmHg (unless secondary to a supraventricular tachycardia amenable to verapamil therapy). Atrial fibrillation/flutter in the presence of an accessory bypass tract (W-P-W or L-G-L syndromes). Combination w/ ivabradine.

Acute MI complicated by bradycardia, marked hypotension, or left ventricular dysfunction.; Discontinue subsequent doses & institute appropriate therapy if 2nd- or 3rd-degree AV block or unifascicular, bifascicular or trifascicular bundle branch block develops. Compensate heart failure patients w/ ejection fraction >35% before starting treatment & should be adequately treated throughout. Presence of diseases in which neuromuscular transmission is affected (myasthenia gravis, Lambert-Eaton syndrome, advanced Duchenne muscular dystrophy). Concomitant use w/ timolol eye drops, digoxin, HMG-CoA reductase inhibitors. May impair ability to drive or operate machinery. Renal & severe liver impairment. Pregnancy & lactation.

Dizziness, headache; bradycardia; flushing, hypotension; constipation, nausea; peripheral edema.

Additive hypotensive effect w/ prazosin, terazosin. Additive effects reducing myocardial contractility, prolonging AV conduction & prolonging repolarization w/ flecainide. Hypotension w/ quinidine. Reduced clearance w/ theophylline, digitoxin. Increased levels of carbamazepine, tacrolimus, atorvastatin, lovastatin. Decreased plasma conc w/ phenytoin. Increased AUC of imipramine, sirolimus. Increased C_max & AUC of glyburide, colchicine, doxorubicin, buspirone, midazolam, everolimus, simvastatin, almotriptan. Reduced efficacy of metformin. Possible increased levels w/ clarithromycin, erythromycin, telithromycin. Reduced BP lowering effect w/ rifampicin, sulfinpyrazone. Increased clearance w/ phenobarb. Slowed AV conduction w/ digoxin. Increased AUC, C_ss & C_max of cyclosporine. Additional heart rate lowering effect of ivabradine. Increased AUC w/ grapefruit juice. Decreased AUC w/ St. John's wort. Increased plasma conc w/ HIV antivirals (eg, ritonavir). Increased neurotoxicity w/ lithium. May potentiate the activity of neuromuscular-blocking agents (eg, curare-like & depolarizing). Increased tendency to bleed w/ ASA. Elevation of ethanol plasma levels. Potentiation of the hypotensive effects of antihypertensives, diuretics, vasodilators. Isoptin Increased risk of bleeding w/ dabigatran. Increased absorption of direct oral anticoagulants.

Calcium Antagonists

C08DA01 - verapamil ; Belongs to the class of phenylalkylamine derivative selective calcium-channel blockers with direct cardiac effects. Used in the treatment of cardiovascular diseases.

Rx