Verapamil radar instructions for use. Medicinal product OAO "Irbit Chemical-Pharmaceutical Plant" verapamil - "verapamil review on the use of the drug

Gross formula

C27H38N2O4

Pharmacological group of the substance Verapamil

Nosological classification (ICD-10)

CAS code

53-53-9

Characteristics of the substance Verapamil

Phenylalkylamine derivative. Verapamil hydrochloride is a white crystalline powder. Soluble in water, chloroform, methanol.

Pharmacology

pharmachologic effect- antianginal, hypotensive, antiarrhythmic.

Blocks calcium channels (acts from the inside of the cell membrane) and reduces transmembrane calcium current. Interaction with the channel is determined by the degree of membrane depolarization: it more effectively blocks open calcium channels of a depolarized membrane. To a lesser extent it affects closed channels of the polarized membrane, preventing their activation. Has little effect on sodium channels and alpha-adrenergic receptors. Reduces contractility, pacemaker frequency of the sinus node and conduction velocity in the AV node, sinoatrial and AV conduction, relaxes smooth muscles (more so in arterioles than veins), causes peripheral vasodilation, lowers peripheral vascular resistance, and reduces afterload. Increases myocardial perfusion, reduces the imbalance between the need and supply of oxygen to the heart, promotes regression of left ventricular hypertrophy, and lowers blood pressure. Prevents the development and eliminates spasm of the coronary arteries in case of variant angina. In patients with uncomplicated hypertrophic cardiomyopathy, it improves the outflow of blood from the ventricles. Reduces the frequency and severity of headaches of vascular origin. Inhibits neuromuscular transmission in pseudohypertrophic Duchenne myopathy and prolongs the recovery period after the use of vecuronium. In vitro blocks the P170 enzyme and partially eliminates the resistance of cancer cells to chemotherapeutic agents.

After oral administration, more than 90% of the dose is absorbed, bioavailability is 20–35% due to “first pass” metabolism through the liver (increases with long-term use in large doses). Tmax is 1-2 hours (tablets), 5-7 hours (extended-release tablets) and 7-9 hours (extended-release capsules). Binds to plasma proteins by 90%. Metabolized in the liver to form norverapamil, which has 20% of the antihypertensive activity of verapamil, and 11 other metabolites (determined in trace amounts). T1/2 when taken orally in a single dose - 2.8-7.4 hours, with repeated doses - 4.5-12 hours (due to saturation of liver enzyme systems). With intravenous administration, T1/2 is two-phase: early - about 4 minutes, final - 2-5 hours. When taken orally, the onset of action is noted after 1-2 hours. Under conditions of intravenous administration, the antiarrhythmic effect develops within 1-5 min (usually less than 2 minutes), hemodynamic effects - within 3-5 minutes. The duration of action is 8-10 hours (tablets) or 24 hours (capsules and extended-release tablets). When administered intravenously, the antiarrhythmic effect lasts about 2 hours, the hemodynamic effect lasts 10-20 minutes. Excreted mainly by the kidneys and feces (about 16%). Penetrates into breast milk, passes through the placenta and is detected in the blood of the umbilical vein during childbirth. Rapid IV administration causes maternal hypotension leading to fetal distress. With long-term use, clearance decreases and bioavailability increases. Against the background of severe liver dysfunction, plasma clearance decreases by 70% and T1/2 increases to 14-16 hours.

According to the results obtained in 2-year experiments on rats when administered in doses 12 times higher than the MRDC, and in the Ames bacterial test (5 test strains, dose - 3 mg per cup, with or without metabolic activation), it is not carcinogenic and mutagenic activity. In experiments on rats, at doses 6 times higher than those recommended for humans, it slows down fetal growth and increases the frequency of intrauterine fetal death.

Use of the substance Verapamil

Paroxysmal supraventricular tachycardia (except WPW syndrome a), sinus tachycardia, atrial extrasystole, atrial fibrillation and flutter, angina pectoris (including Prinzmetal, tension, post-infarction), arterial hypertension, hypertensive crisis, idiopathic hypertrophic subaortic stenosis, hypertrophic cardiomyopathy.

Contraindications

Hypersensitivity, severe hypotension (SBP less than 90 mm Hg), cardiogenic shock, AV block II and III degrees, myocardial infarction (acute or recent and complicated by bradycardia, hypotension, left ventricular failure), severe bradycardia (less than 50 beats ./min), chronic heart failure stage III, atrial flutter and fibrillation and WPW syndrome or Lown-Ganong-Levine syndrome (except for patients with a pacemaker), sick sinus syndrome (if a pacemaker is not implanted), sinoatrial block, Morgagni syndrome - Adams-Stokes, digitalis intoxication, severe stenosis of the aortic mouth, pregnancy, breastfeeding.

Restrictions on use

AV blockade of the first degree, chronic heart failure of stages I and II, mild or moderate hypotension, severe myopathy (Duchenne syndrome), renal and/or liver failure, ventricular tachycardia with a wide QRS complex (for intravenous administration).

Use during pregnancy and breastfeeding

The use of verapamil during pregnancy is possible only when the expected benefit to the mother outweighs the potential risk to the fetus.

During treatment, breastfeeding should be stopped (verapamil is excreted in breast milk).

Side effects of the substance Verapamil

From the cardiovascular system and blood (hematopoiesis, hemostasis): arterial hypotension, bradycardia (sinus), AV block, the appearance of symptoms of heart failure (when used in high doses).

From the nervous system and sensory organs: headache, dizziness, nervousness, lethargy, drowsiness, weakness, fatigue, paresthesia.

From the gastrointestinal tract: nausea, dyspeptic symptoms, constipation; rarely - gingival hyperplasia, increased activity of liver transaminases, alkaline phosphatase.

Allergic reactions: skin rash, urticaria, itching; rarely - angioedema, Stevens-Johnson syndrome.

Other: facial skin flushing, bronchospasm (with intravenous administration), peripheral edema, very rarely - gynecomastia, increased prolactin secretion (isolated cases).

Interaction

Increases plasma levels of digoxin, cyclosporine, theophylline, carbamazepine, and decreases lithium. Weakens the antibacterial activity of rifampicin, the depressing effect of phenobarbital, reduces the clearance of metoprolol and propranolol, and enhances the effect of muscle relaxants. Rifampicin, sulfinpyrazone, phenobarbital, calcium salts, vitamin D - weaken the effect. The hypotensive effect is enhanced by antihypertensive drugs (diuretics, vasodilators), tricyclic and tetracyclic antidepressants and antipsychotics: antianginal - nitrates. Beta-blockers, class IA antiarrhythmics, cardiac glycosides, inhalational anesthetics, radiopaque agents potentiate a (mutually) inhibitory effect on the automatism of the sinoatrial node, AV conductivity and myocardial contractility. With the simultaneous use of verapamil with acetylsalicylic acid - increased bleeding. Cimetidine increases the plasma levels of verapamil.

Overdose

Symptoms: arterial hypotension, bradycardia, AV block, cardiogenic shock, coma, asystole.

Treatment: calcium gluconate (10-20 ml of 10% IV solution) is used as a specific antidote; for bradycardia and AV block, atropine, isoprenaline or orciprenaline are administered; for hypotension - plasma-substituting solutions, dopamine, norepinephrine; if signs of heart failure appear, dobutamine.

Precautions for the substance Verapamil

Prescribe with caution to patients with hypertrophic cardiomyopathy complicated by left ventricular obstruction, high wedge pressure in the pulmonary capillaries, paroxysmal nocturnal dyspnea or orthopnea, dysfunction of the sinoatrial node. When prescribed to patients with severe impairment of liver function and neuromuscular transmission (Duchenne myopathy), constant medical supervision and possibly a dose reduction are required. Use with caution while working for drivers of vehicles and people whose profession is associated with increased concentration (reaction speed decreases), it is recommended to avoid drinking alcohol.

special instructions

The injection form is incompatible with albumin, injectable forms of amphotericin B, hydralazine, sulfamethoxazole, trimethoprim and may precipitate in solutions with a pH above 6.0.

Interactions with other active ingredients

Trade names

Name	The value of the Vyshkowski Index ®

The antihypertensive, antiarrhythmic and antianginal properties of Verapamil ensure effectiveness in the treatment of primary hypertension and hypertensive crises, angina pectoris and tachycardia. The drug is prescribed if there is a history of vascular pathologies and heart rhythm problems.

Composition of Verapamil and release forms

The main active ingredient is verapamil hydrochloride. The composition also includes a number of excipients in the form of starch, calcium phosphate, butylated hydroxyanisole, magnesium stearate, gelatin, methylparaben, purified talc, titanium dioxide, etc.

Verapamil, as a representative of the group of calcium channel blockers, ensures dilation of coronary vessels, reduces myocardial oxygen demand, increases coronary blood flow, and normalizes peripheral hemodynamics.

Verapamil hydrochloride reduces calcium reabsorption, which allows it to achieve a hypotensive effect due to its pronounced diuretic and natriuretic effect. Due to the inhibition of Ca ions, the drug has a positive effect on the cardiac conduction system, significantly reduces afterload, has a depressant effect on atrioventricular and sinoatrial conduction, and promotes vasodilation.

Verapamil is able to be completely absorbed from the gastrointestinal tract - 95%. The connection of the main component with plasma proteins is up to 90%. After using the product, its concentration in plasma reaches its maximum within 1-2 hours.

Verapamil – as metabolites 70%, unchanged 3-4%; up to 25% - with bile. The half-life depends on the method of taking the drug: with a one-time use - from 3 to 7 hours, with regular use - 4-12 hours.

The medicine has various forms: Verapamil solution for intravenous administration, capsules, dragees, Verapamil ampoules for injection, tablets 40 mg, 80 mg and prolonged action 240 mg.

Indications for use

Treatment with Verapamil is prescribed for the following diseases:

• Hypertension;
• Heart rhythm problems, including extrasystole, atrial fibrillation and flutter, tachycardia;
• Angina: unstable, vasospastic, exertional angina.

Verapamil is also taken to achieve a pronounced preventive effect.

Instructions for use

Verapamil tablets should be taken during meals or immediately after meals. The medicine should be taken with a small amount of water.

To lower blood pressure, Verapamil is prescribed to adult patients 3-4 doses per day. The initial single dose is 40 mg or 80 mg. The maximum volume of the drug per day should not be higher than 480 mg. Patients with severe liver failure should limit daily intake of Verapamil to 120 mg.

Taking Verapamil according to a similar scheme is prescribed for the prevention of arrhythmia and various types of angina pectoris.

Acute conditions (paroxysmal cardiac arrhythmias) can be relieved by intravenous jet administration of 5-10 mg of solution in a volume of 2-4 ml. To enhance the effect, repeated administrations of an identical dose are allowed after half an hour. Intravenous use of Verapamil requires constant monitoring of blood pressure, ECG and heart rate.

The use of Verapamil is also prescribed to children with hypertensive and arrhythmic problems. The drug is taken in 2-3 doses per day. The daily dose for children 5 years of age is up to 60 mg, for children 6-14 years old – up to 80-360 mg. Intravenous administration of the drug is recommended for infants and under 5 years of age. A single dosage in this case will be 0.75-2 mg for infants, 2-3 mg for children 1-5 years of age.

The instructions for Verapamil also separately provide for the specifics of using prolonged forms. For the treatment of hypertension, adults are prescribed a single dose of 240 mg; a gradual reduction can be achieved by taking half the dose in the morning - 120 mg per day.

You can increase the dose of Verapamil after taking it for two weeks, gradually increasing it to 480 mg or taking long-acting tablets twice a day every 12 hours.

The duration of the course of treatment and the dosage regimen of the drug Verapamil are established by the attending doctor individually after assessing the patient’s condition, the severity of his disease and the characteristics of its course. Analysis of the effectiveness of the prescribed therapy may also lead to changes in the dosage regimen of the drug Verapamil.

Contraindications for use

Contraindications to the use of Verapamil include:

• Bradycardia;
• Hypotension;
• Aortic stenosis;
• Sinoatrial block;
• Cardiogenic shock;
• Chronic heart failure (stage IIIB-III);
• Myocardial infarction;
• Morgagni-Adams-Stokes, Wolff-Parkinson-White syndromes.

Prescribing the drug to children is allowed only if the expected benefits exceed the health risks..

During pregnancy, Verapamil should not be prescribed in the first semester; in subsequent periods, drug therapy must be prescribed, adequately assessing the threat to the fetus.

For nursing mothers, it is recommended not to breastfeed while taking Verapamil, since the active substance is excreted along with milk.

Side effects of verapamil hydrochloride

The most common side effects include: dizziness, angioedema, general weakness, dyspeptic disorders, drowsiness, lethargy, allergic skin reactions, bronchospasm.

The use of Verapamil can also lead to problems with hematopoiesis, as well as disturbances in the functioning of the cardiovascular system in the form of arterial hypotension, signs of heart failure, severe bradycardia, and AV block.

An unreasonable increase in the dose of the drug or taking Verapamil without a doctor's prescription leads to an overdose, the main symptoms of which are bradycardia, coma, cardiogenic shock, hypotension, and asystole.

A specific antidote that can reduce the symptoms of overdose is calcium gluconate, 10-20 ml of a ten percent solution of which must be administered intravenously.

If there are signs of AV block and bradycardia, atropine, orciprenaline or isoprenaline should be administered; dopamine and norepinephrine will help relieve hypotension; Dobutamine is administered to relieve heart failure.

Features of drug interactions

When prescribing Verapamil, it is necessary to take into account changes in the properties of the drug due to the simultaneous use of other drugs:

1. and other blood pressure-lowering drugs enhance the hypotensive effect of Verapamil tablets;
2. The cardiotoxic effect is significantly enhanced by the addition of therapy with inhalational anesthetics, various beta-blockers and antiarrhythmic drugs;
3. Taking ranitidine and cimetidine helps increase the concentration of the substance;
4. Phenobarbital and rifampicin weaken the effect of Verapamil and reduce plasma concentrations;
5. Simultaneous use with prazonin, theophylline, cyclosporine, quinidine, muscle relaxants increases the concentration of these drugs and enhances their effect;
6. Taking acetylsalicylic acid during therapy with Verapamil may cause bleeding;
7. The therapeutic properties of lithium and carbamazepine, increased by Verapamil, can cause neurotoxic reactions.

Additional instructions for instructions

Treatment should be accompanied by constant monitoring of all basic functions of the heart, vascular system and respiratory organs, blood volume, glucose levels, amount of urine output and electrolytes in the blood.

Verapamil is dispensed strictly according to doctor's prescription.

The shelf life is limited to 5 years if stored at a temperature of 15 to 25 degrees in a dark and dry place.

Analogues of the drug

According to the main action of Verapamil - the prevention and treatment of hypertension, angina attacks and arrhythmias - there are many analogues in modern pharmaceuticals:

• Veracard;
• Isoptin;
• Verohalid;
• Kaveril;
• Lekoptin;
• Atsupamil;
• Finoptin;
• Verapabene;
• Danistol;
• Falicard;
• Flamon.

Verapamil tablets to normalize blood pressure

Prices for Verapamil

In addition to its therapeutic effectiveness, the widespread use of the drug is also due to its fairly affordable cost. The price of the medicine, depending on the number of tablets in the package and the manufacturer, is:

• Tablets 40 mg: No. 20 – from 50 rubles, No. 30 – from 40 rubles, No. 50 – from 35 rubles;
• Tablets 80 mg: No. 30, No. 50 – from 50 rubles;
• Verapamil ampoules 0.25% 2 ml: No. 10 – from 45 rubles;
• Long-acting tablets 240 mg: No. 20 – from 150 rub.

Today you can buy Verapamil both in pharmacies engaged in the retail trade of pharmaceuticals and on special online platforms. Virtual online pharmacies allow you to compare offers from different manufacturers and select the option that best meets the specific requirements for the drug and corresponds to the individual financial capabilities of the patient.

Doctors' ratings and patient reviews

The opinions of doctors in assessing the effectiveness of Verapamil include among its main advantages:

1. Pronounced hypotensive, antianginal and antiarrhythmic effect;
2. Wide range of therapeutic and preventive effects;
3. Ability to prescribe both regular dosages and extended-release tablets;
4. Variability of drug forms.

Patients using a course of Verapamil also noted the benefits of the drug in the form of:

• Ease of administration;
• Availability of instructions;
• No side effects if you strictly follow the doctor’s recommendations;
• Prescription of the product, which minimizes its uncontrolled use;
• Acceptability of cost, etc.

Tatiana: “Verapamil was prescribed to my mother when primary hypertension was diagnosed. Effectiveness was noted after the first week of therapy. We started taking it with a minimum dosage, gradually increasing the daily dose. Today my mother takes Verapamil 80 mg twice a day and can completely control her blood pressure.”

Alexander: “I have been taking Verapamil for the second month now. I am very pleased with the results of the treatment. However, at first I had to somewhat coordinate the daily dose, since headaches began. Having reduced the dosage in the first two weeks of use, my body got used to the drug and can now take more concentrated doses. "At the beginning of this month I switched to long-acting tablets. One dose of 120 mg in the morning helps protect me from possible hypertensive crises. The medicine is effective, but it is still necessary to start taking it under the supervision of a doctor."

Film-coated tablets.

20, 30, 50 pcs.

Composition and active substance

Verapamil contains:

1 tablet contains 80 mg, 40 mg verapamil.

pharmachologic effect

Verapamil is a selective class I calcium channel blocker. The main pharmacological properties of the drug are due to its ability to prevent the entry of calcium ions into cardiomyocytes and smooth muscle cells of the vascular wall through slow calcium channels of the membrane. Verapamil has antiarrhythmic, antianginal and hypotensive activity. Reduces myocardial oxygen demand by reducing myocardial contractility and reducing heart rate. Causes dilatation of the coronary arteries and an increase in coronary blood flow. The antihypertensive effect of Verapamil is associated with a decrease in the tone of the smooth muscles of peripheral arteries and with the ability to reduce peripheral vascular resistance. By slowing down AV conduction, Verapamil has an antiarrhythmic effect in supraventricular arrhythmias; normal heart rate remains unchanged or decreases slightly.
Verapamil also has some natriuretic and diuretic effects by reducing tubular reabsorption.

What Verapamil helps with: indications

• prevention of angina attacks (including Prinzmetal angina)
• treatment and prevention of supraventricular arrhythmias (paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extrasystole)
• arterial hypertension.

Contraindications

• ardiogenic shock
• severe bradycardia
• sick sinus syndrome
• AV block II-III degree
• Wolff-Parkinson-White syndrome
• arterial hypotension
• chronic heart failure stage II B - III, acute heart failure
• hypersensitivity to the drug.

Verapamil during pregnancy and breastfeeding

Not described.

Verapamil: instructions for use

The dosage regimen for Verapamil is determined individually. Adults are prescribed an initial dose of 40-80 mg 3 times a day. The maximum daily dose is 480 mg. Children aged 6-14 years are prescribed 80-360 mg per day, children under 6 years old - 40-60 mg per day, frequency of use 3-4 times a day. Dragees are taken during meals or immediately after meals with a small amount of water.

Side effects

From the cardiovascular system: bradycardia (less than 50 beats/min), marked decrease in blood pressure, development or worsening of heart failure, tachycardia rarely - angina pectoris, up to the development of myocardial infarction (especially in patients with severe obstructive lesions of the coronary arteries), arrhythmia (including ventricular fibrillation and flutter) with rapid intravenous administration - third degree AV block, asystole, collapse.
From the central nervous system and peripheral nervous system: dizziness, headache, fainting, anxiety, lethargy, fatigue, asthenia, drowsiness, depression, extrapyramidal disorders (ataxia, mask-like face, shuffling gait, stiffness of the arms or legs, trembling of the hands and fingers, difficulty swallowing).
From the digestive system: nausea, constipation (rarely - diarrhea), gum hyperplasia (bleeding, pain, swelling), increased appetite, increased activity of liver transaminases and alkaline phosphatase.
Allergic reactions: skin itching, skin rash, facial skin flushing, erythema multiforme exudative (including Stevens-Johnson syndrome).
Other: weight gain, very rarely - agranulocytosis, gynecomastia, hyperprolactinemia, galactorrhea, arthritis, transient loss of vision against the background of Cmax, pulmonary edema, asymptomatic thrombocytopenia, peripheral edema.

special instructions

The drug is prescribed with caution to patients with impaired liver function or acute myocardial infarction. The use of Verapamil during pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus. When using the drug during lactation, the issue of stopping breastfeeding should be decided.
Verapamil is prescribed with caution to patients engaged in potentially hazardous activities that require increased attention and speed of motor and mental reactions.

Compatibility with other drugs

The simultaneous use of Verapamil and beta-blockers, antiarrhythmic drugs, inhalation anesthesia can lead to a mutual enhancement of their cardiodepressive effects (AV blockade, bradycardia, hypotension, heart failure). When used simultaneously with quinidine in patients with hypertrophic obstructive cardiomyopathy, severe hypotension and pulmonary edema may develop.
When Verapamil is prescribed simultaneously with other antihypertensive drugs, mutual potentiation of their effects is observed. Verapamil can significantly increase the concentration of digoxin in plasma, which requires a reduction in the dose of the cardiac glycoside when administered together. The neurotoxic effect of Verapamil is potentiated by carbamazepine and lithium salts, and the psychotropic effect of lithium when administered together with verapamil is weakened. The concentration of cyclosporine or theophylline in the blood plasma increases when administered together with Verapamil. Rifampicin, phenytoin, phenobarbital and cimetidine can reduce the concentration of Verapamil in plasma and reduce the effectiveness of the latter. Verapamil potentiates the effect of muscle relaxants.

Overdose

Symptoms: bradycardia, AV block, marked decrease in blood pressure, heart failure, shock, asystole, SA block.
Treatment: in case of early detection - gastric lavage, activated charcoal for rhythm and conduction disturbances - IV isoprenaline, norepinephrine, atropine, 10-20 ml of 10% calcium gluconate solution, artificial pacemaker, IV infusion of plasma-substituting solutions.
To increase blood pressure in patients with IHSS, alpha-agonists (phenylephrine) are prescribed; isoprenaline and norepinephrine should not be used.
Hemodialysis is ineffective.

Storage conditions and shelf life

Not described.

Not described.

Analogs and prices

Among foreign and Russian analogues of Verapamil there are:

Isoptin cp 240. Manufacturer: Abbott (USA). Price in pharmacies from 417 rubles.
Verapamil hydrochloride solution for injection 0.25%. Manufacturer: Alkaloid 81 rub.
Verapamil retard. Manufacturer: Alkaloid (Macedonia). Price in pharmacies from 179 rubles.

Antiarrhythmic, antianginal.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Pharmacological group of drugs to which Verapamil belongs - calcium channel blockers . They have antiarrhythmic, hypotensive and antianginal effects. The mechanism of action is associated with the blockade of “slow” calcium channels, which are located in the myocardial cells, cardiac conduction system and vascular smooth muscle cells. In addition, these channels are present in the smooth muscles of the urinary tract, bronchi and uterus. As a result of the blockade, the pathologically increased flow of calcium ions into the cells is normalized. By reducing the transmembrane entry of Ca2+ into cardiomyocytes, the drug reduces the strength of myocardial contractions and heart rate, and, consequently, the myocardial oxygen demand decreases.

Reduces the muscle tone of the vascular wall and causes dilatation mainly arterioles , which entails a decrease in resistance in the large circle and a decrease in afterload. It also increases coronary blood flow. Slows down AV conduction, inhibits the automatism of the sinus node, which makes it possible to use it for treatment supraventricular arrhythmias .

Verapamil has a more pronounced effect on the conduction system (sinus and atrioventricular node), and the effect on blood vessels is less pronounced. Improves kidney excretory function. It should be remembered that the drug aggravates heart failure , provokes pronounced bradycardia And atrioventricular block .

Pharmacokinetics

Almost completely absorbed from the gastrointestinal tract. The maximum concentration in the blood is determined after 1-2 hours. 90% binds to blood proteins. Rapidly metabolized in the liver. During a course of treatment, the effect increases, which is associated with the accumulation of the drug and its metabolites .

The half-life for a single dose is 3-6 hours, for a long-term dose it is up to 12 hours. Excreted through the kidneys (about 74%).

Indications for use of Verapamil

• ;
• stable;
• angina pectoris with supraventricular rhythm disturbances;
• supraventricular extrasystole ;
• atrial fibrillation ;
• hypertensive crisis (IV application);
• arterial hypertension .

Contraindications

• severe bradycardia ;
• severe LV dysfunction;
• AV block II-III stage;
• hypersensitivity;
• arterial hypotension ;
• SSSU;

Prescribed with caution when bradycardia , AV block I stage, sinoatrial block, CHF, in old age, with liver and/or kidney failure.

Side effects

Most common adverse reactions:

• bradycardia ;
• pronounced decrease in blood pressure;
• nausea , ;
• facial redness;

Less common adverse reactions:

• gingival hyperplasia ;
• nervousness;
• fatigue;
• lethargy;
• , rash;
• AV blockade, stage III, with rapid intravenous administration;
• , thrombocytopenia ;
• galactorrhea , gynecomastia ;
• peripheral edema;
• pulmonary edema .

Instructions for use of Verapamil (Method and dosage)

Verapamil tablets, instructions for use

Tablets of normal duration of action are taken orally before meals, 40-80 mg three times a day at and. At high blood pressure - in 2 doses, while the daily dose can reach 480 mg. The daily dose for children under 5 years of age is 40-60 mg.

Prolonged forms with arterial hypertension Prescribe 240 mg in the morning. It is advisable to start treatment with a lower dose - 120 mg 1 time per day. Subsequently, after 2 weeks, the dose is increased. It is possible to increase it to 480 mg per day in two doses every 12 hours. The dose should not exceed 480 mg per day if there is a question of long-term therapy.

For cupping hypertensive crisis Verapamil is used intravenously in a dose of 5–10 mg. For paroxysmal rhythm disturbances, it is also administered intravenously in a bolus at a dose of 5-10 mg. Repeat at the same dose after 20-30 minutes if there is no effect. For maintenance therapy, they switch to intravenous drip administration with a solution. A single dose for intravenous administration for children from 1 to 5 years is 2-3 mg.

Overdose

Overdose manifests itself bradycardia , AV blockade And SA blockade , decreased blood pressure, asystole .

Treatment begins with gastric lavage, taking sorbents . In case of conduction disturbances, they are administered intravenously isoprenaline , 10% solution, plasma replacement solutions. An artificial pacemaker is recommended. To increase blood pressure it is prescribed alpha adrenergic agonists .

Interaction

CYP3A4 inhibitors reduce concentrations verapamil , and an increase in its concentration in plasma is caused by grapefruit juice. The drug increases plasma concentrations carbamazepine , cyclosporine , theophylline , quinidine , cardiac glycosides and ethanol. Increases the risk of neurotoxic effects of Li+ drugs.

At nephropathy of mild severity, monotherapy with Verapamil can be used, if preeclampsia - complex therapy, which, in addition to having anticonvulsant, hypotensive and diuretic effects, includes Verapamil 80 mg per day and other drugs.

Therapeutic indications:

• Arrhythmias (in particular supraventricular tachycardia ).
• Arterial hypertension . This is one of the antihypertensive drugs used during pregnancy and can be used for a long time, but it is rarely used as a basic antihypertensive drug in pregnant women.
• Angina pectoris .

Reviews of Verapamil during pregnancy indicate that the drug is effective, is well tolerated in therapeutic doses and does not have a harmful effect on the fetus.

• « ... Tachycardia appeared when taking Ginipral, so this drug was also prescribed. I drank for a very long time, almost until I gave birth. The child was born healthy»;
• « ... I drank from the 28th to the 32nd week along with Ginipral, since my child and I had tachycardia».

An analysis of pregnancy outcomes in women who received this drug in the first trimester did not reveal an increase in the incidence of congenital anomalies in the fetus caused by its use. Children of women who received the drug in the 2nd and 3rd trimesters also showed no undesirable consequences.

Verapamil's analogs

Level 4 ATX code matches:

Synonyms of this drug, having the same active ingredient:, Kaveril , .

Verapamil analogues are calcium channel blockers that have a similar effect: Gallopamil , Nifedipine Retard , Nicardipine , Riodipine , .

Reviews of Verapamil

What are Verapamil tablets for? Indications for the use of Verapamil include the treatment of stable angina pectoris , arterial hypertension , arrhythmias , especially in combination with obstructive pulmonary diseases. The drug is also effective in preventing relapses. It can be combined with nitrates.

Reviews of Verapamil on forums indicate that the drug was most often prescribed in combination paroxysmal supraventricular tachycardia And atrial fibrillation With arterial hypertension .

All reviews boil down to the fact that the drug is inexpensive and effective:

• « ... The drug is effective, so I can confidently recommend it to everyone»;
• « ... I’ve been using it for more than one year, taking it together with Enap. Got rid of extrasystoles and achieved normal blood pressure»;
• « ... I have been taking 40 mg 2 times for many years for arrhythmia. Of course there are breakdowns, but less often than before»;
• « ... Verapamil is my “desktop” medicine. Worried about strong heartbeat (100 - 130). Helps well and is very cheap»;
• « ... Thanks to regular use of Verapamil, the attacks of angina disappeared».

In obstetric practice, this drug is also used for tachycardia , rhythm disturbances in pregnant women, in order to reduce the tone of the uterus.

Reviews about Verapamil during pregnancy vary:

• « ... I didn’t feel any benefit - I just started having severe heartburn and a headache»;
• « ... No benefit, weakness and dizziness»;
• « ... In the second trimester, tachycardia appeared, after taking it it became easier and the child became calmer».

The most common side effects this drug caused were: bradycardia , constipation , flushes of blood to the face.

Verapamil price, where to buy

All forms of the drug can be purchased at any pharmacy. To purchase it you will need a recipe in Latin. The price of Verapamil in 40 mg tablets ranges from 30 to 51 rubles, prolonged-release tablets of 240 mg can be purchased for 153 to 194 rubles, and 10 ampoules of injection solution for 40 to 71 rubles.

• Online pharmacies in Russia Russia
• Online pharmacies in Ukraine Ukraine
• Online pharmacies in Kazakhstan Kazakhstan

WER.RU

Verapamil tablets 40 mg 30 pcs Alkaloid

Verapamil tablets 240 mg 20 pcs Alkaloid [Alkaloid]

Verapamil tablets 80 mg 30 pcs. Alkaloid [Alkaloid]

Verapamil tablets 40 mg 50 pcs. Ozone LLC

Verapamil- a drug from the group of selective calcium channel blockers L type I class. The drug has a pronounced antianginal and antiarrhythmic effect, and also reduces blood pressure. The mechanism of action of the drug is based on its ability to block the passage of calcium ions into the cell through calcium channels. This effect is most pronounced in relation to myocardial cells and the smooth muscle layer of blood vessels. When using the drug in patients, there is no change in the level of calcium in the blood plasma.
The antianginal effect of the drug is carried out by reducing the tone of the smooth muscle layer of the coronary and peripheral vessels, expanding their lumen and improving blood circulation. At the same time, the drug also reduces the myocardial oxygen demand by reducing afterload.
The antiarrhythmic effect of the drug is due to the blockade of calcium channels in the cells of the sinoatrial and atrioventricular nodes. The drug slightly reduces cardiac conductivity, lengthens the refractory period in the atrioventricular and sinus nodes, and reduces the speed of sinus rhythm and heart rate.
The hypotensive effect of the drug is based on its ability to reduce the tone of the smooth muscle layer of blood vessels and reduce overall peripheral vascular resistance. The drug leads to a decrease in high blood pressure and does not cause the development of arrhythmia and postural hypotension.
After oral administration of the drug, the active component is well absorbed from the gastrointestinal tract. The bioavailability of the drug is 20-35%, the drug is characterized by a first-pass effect through the liver. The peak plasma concentration of the active component is observed 1-2 hours after oral administration. The degree of binding of verapamil to plasma proteins reaches 90%. The drug penetrates the hematoplacental barrier and is excreted in breast milk.
The half-life reaches 3-7.5 hours after a single use and 4.5-12 hours with regular use of the drug. It is excreted mainly by the kidneys, a small part of the drug is excreted by the intestines.
In patients with impaired liver function, an increase in the half-life of verapamil is observed.
When administered parenterally, the effect of the drug develops within 2-5 minutes and lasts for 10-20 minutes.

Indications for use

Verapamil tablets used for the treatment of patients suffering from arterial hypertension, coronary heart disease and angina, in particular stable angina and Prinzmetal's angina.
The drug is prescribed to patients suffering from paroxysmal supraventricular tachycardia, as well as atrial fibrillation and flutter.
Injection Verapamil prescribed to patients with hypertensive crisis, acute coronary insufficiency, as well as paroxysmal supraventricular tachycardia, ventricular extrasystole, as well as tachysystolic paroxysms of atrial fibrillation and flutter, which are caused by ischemia of the heart muscle.

Mode of application

Verapamil tablets intended for oral use. It is recommended to swallow tablets and film-coated tablets whole, without chewing or crushing, with a sufficient amount of liquid. The drug is taken regardless of meals. The duration of the course of treatment and the dose of the drug are determined by the attending physician individually for each patient.
Adults suffering from arterial hypertension are usually prescribed 80 mg of the drug 3 times a day. If the antihypertensive effect of the drug is not sufficiently pronounced 7 days after the start of drug therapy, the dose is gradually increased.
Adults suffering from angina pectoris and arrhythmia are usually prescribed 80-120 mg of the drug 3 times a day.
For patients with impaired liver function, as well as elderly patients and patients with low body weight, the drug is prescribed at an initial dose of no more than 40 mg 3 times a day.
If the therapeutic effect of the drug is not sufficiently expressed, the dose of verapamil is gradually increased.
The maximum daily dose of verapamil hydrochloride is 480 mg.
If long-term use of the drug is necessary, it is recommended to regularly monitor liver function.
Injection Verapamil intended for parenteral administration. The drug is administered intravenously slowly; if necessary, the drug can be administered by infusion. To prepare a solution for infusion, it is allowed to use a 5% glucose solution or a 0.9% sodium chloride solution. The rate of infusion of the drug should not exceed 10 mg of verapamil per hour. The duration of the course of treatment and the dose of the drug are determined by the attending physician individually for each patient.
For adults with supraventricular tachycardia, slow intravenous administration of 2-4 ml of the drug is usually prescribed (duration of administration is at least 2 minutes). When using verapamil parenterally, constant monitoring of blood pressure and ECG is necessary. If the therapeutic effect of the drug is insufficient, a repeat dose is administered after 20-30 minutes. It is also possible to prescribe the drug as an intravenous infusion.

For adults with a hypertensive crisis, slow intravenous administration of the drug is usually prescribed at a dose of 0.05-0.1 mg/kg body weight. If the therapeutic effect of the drug is not sufficiently pronounced, a repeat dose is administered after 30-60 minutes.
The maximum total daily dose of verapamil is 100 mg.
Children under the age of 1 year with a hypertensive crisis are usually prescribed intravenous slow administration of the drug at a dose of 0.1-0.2 mg/kg body weight. If the therapeutic effect of the drug is not sufficiently pronounced, a repeat dose is administered after 30-60 minutes.
Children aged 1 to 15 years with a hypertensive crisis are usually prescribed intravenous slow administration of the drug at a dose of 0.1-0.3 mg/kg body weight. If the therapeutic effect of the drug is not sufficiently pronounced, a repeat dose is administered after 30-60 minutes.
The maximum single dose for children is 5 mg verapamil.

Side effects

When using the drug Verapamil Patients experienced the following side effects:
From the gastrointestinal tract and liver: nausea, vomiting, dry mouth, stool disorders, bleeding gums, intestinal atony, hyperbilirubinemia, increased levels of liver transaminases. In rare cases, mainly with long-term use of the drug, the development of hepatotoxic effects of verapamil was observed.
From the cardiovascular system: angina attack, excessive decrease in blood pressure, sinoatrial or atrioventricular block, heart failure, cardiac arrhythmia, syncope, myocardial infarction, palpitations.
From the central and peripheral nervous system: cerebral circulation disorder, headache, dizziness, increased fatigue, disturbance of sleep and wakefulness, paresthesia, convulsions, mental disorders, visual and hearing impairment.
From the genitourinary system: frequent urination, erectile dysfunction, gynecomastia, menstrual irregularities.
Allergic reactions: skin rash, itching, urticaria, hyperpigmentation, alopecia, Stevens-Johnson syndrome, Lyell's syndrome, bronchospasm, Quincke's edema.
Others: pain in muscles and joints, hematomas.

Contraindications

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A drug Verapamil in the form of tablets and film-coated tablets, they are not prescribed to patients with galactosemia, lactase deficiency and glucose-galactose malabsorption; for the treatment of children under 5 years of age due to the lack of data on the safety of the drug in this age category.
The drug is contraindicated in patients suffering from arterial hypotension, severe heart failure, cardiogenic shock, collapse, severe bradycardia; for the treatment of atrial fibrillation and flutter associated with WPW and LGL syndromes; with sinoatrial block, atrioventricular block II-III degree, as well as patients suffering from sick sinus syndrome; for the treatment of women during pregnancy and lactation.
Elderly patients should be prescribed Verapamil hydrochloride with caution in case of increased individual sensitivity to the components of the drug.
The drug should be prescribed with caution to patients suffering from heart failure, hypertrophic cardiomyopathy, including complicated left ventricular obstruction, as well as patients with Duchenne muscular dystrophy, impaired liver and/or kidney function; before carrying out planned surgical interventions; patients whose work involves operating potentially dangerous machinery and driving a car.

Pregnancy

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A drug Verapamil does not have a teratogenic effect. The drug should not be used during pregnancy due to insufficient reliable data on the safety of the drug for the fetus and its effect on the course of labor.
If it is necessary to use the drug during lactation, you should consult with your doctor and decide whether to interrupt breastfeeding.

Interaction with other drugs

When using the drug in combination Verapamil with beta-adrenergic receptor blockers, inhalational anesthetics, radiocontrast agents, neuromuscular transmission blockers and flecainide, an increase in the blockade of the sinoatrial and atrioventricular node is observed, as well as an increase in the severity of side effects from the cardiovascular system. The combined use of these drugs is allowed only under the strict supervision of the attending physician.
When used simultaneously, the drug enhances the therapeutic effects of antihypertensive drugs and muscle relaxants.
Neuroleptic drugs and tricyclic antidepressants enhance the effect of verapamil.
When used in combination, the drug increases plasma concentrations of cyclosporine, tacrolimus, carbamazepine, serotonin receptor inhibitors, colchicine, macrolides and cardiac glycosides. If combined use is necessary, the dose of cardiac glycosides should be adjusted.
The drug should not be prescribed in combination with antiarrhythmic drugs of classes I-III.
The combined use of the drug with disopyramide is contraindicated. An interval of at least 48 hours should be observed between courses of taking these drugs.
When used in combination with quinidine, a significant decrease in blood pressure is possible.
Calcium and cholecalciferol, when used in combination with the drug, reduce its therapeutic effects.
The drug should be prescribed with caution with other drugs that are characterized by a high degree of binding to plasma proteins. With the combined use of these drugs, mutual changes in pharmacokinetic parameters are possible.
Inducers of microsomal liver enzymes reduce the effectiveness of the drug when used in combination.
When used simultaneously, the drug reduces the excretion of propanolol, metoprolol, rifampicin and phenobarbital.
The drug should be prescribed with caution in combination with lithium preparations and theophylline.
Cimetidine, ritonavir and indinavir, when used in combination with the drug, increase plasma concentrations of verapamil.
When the drug is used in combination with simvastatin, dose adjustment of the latter is necessary.
Grapefruit juice, when used simultaneously with the drug, increases the bioavailability of verapamil.
The drug enhances the effects of ethyl alcohol.

Overdose

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When using excessive doses of the drug Verapamil Patients experience the development of heart failure, a significant decrease in blood pressure, asystole and atrioventricular block.
There is no specific antidote. In case of overdose, gastric lavage, enterosorbents and laxatives are indicated. In case of overdose, the patient should be under close medical supervision at all times, including constant monitoring of respiration, blood pressure and ECG.
If the patient develops a pronounced decrease in blood pressure, as well as complete atrioventricular block, intravenous administration of isoproterenol, norepinephrine, metaraminol tartrate, atropine and 10% calcium gluconate solution is indicated. In severe cases, pacemakers are used.
With the development of tachycardia in patients suffering from atrial flutter and fibrillation with WPW and LGL syndrome, the use of electrical cardioversion, as well as the administration of procainamide or lidocaine intravenously, is indicated.
It is also possible to prescribe inotropic drugs.
Hemodialysis in case of an overdose of verapamil hydrochloride is ineffective.

Storage conditions

The drug is in the form of tablets and tablets, Verapamil coated, it is recommended to store in a dry place away from direct sunlight at a temperature of 15 to 25 degrees Celsius.
The drug is in the form of an injection solution Verapamil It is recommended to store in a dry place away from direct sunlight at a temperature of 8 to 25 degrees Celsius.

Release form

Film-coated tablets, 10 pieces in a blister, 1 or 5 blisters in a cardboard pack.
Tablets, 10 pieces in a blister, 1, 2 or 5 blisters in a cardboard box.
Solution for injection, 2 ml in ampoules, 10 ampoules in a cardboard box.

Compound

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1 film-coated tablet of the drug Verapamil 80 contains: verapamil hydrochloride (in terms of pure substance) - 80 mg.
Excipients, including lactose monohydrate.
1 tablet of the drug Verapamil 40 contains: verapamil hydrochloride (in terms of pure substance) - 40 mg.
Excipients, including lactose and sucrose.
1ml solution for injection Verapamil contains: verapamil hydrochloride - 2.5 mg;
Excipients.