Verapamil SR

Class
Antiarrhythmics
Subclass
Nondihydropyridine calcium channel blockers
Substance name
Verapamil hydrochloride SR
Brand names
Verelan®, Calan SR®
Common formulations
Capsule, Film-coated tablet
See also
Verapamil
Verapamil ER (Verelan PM®)
Verapamil DR (Verelan®)
Verapamil COER (Covera-HS®)
Dosage and administration
Adults patients
Hypertension
•
120-360 mg PO daily, in 1-2 divided doses
Alternative
•
Start at: 120 mg PO qAM
•
Maintenance: 240 mg PO qAM
•
Maximum: 480 mg per day
Titrate in 60 mg increments to 180 mg daily, then in 120 mg increments up to the maximum dose based on response.
Idiopathic fascicular left VT • Off-label
•
240-480 mg PO daily
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
Off-label indications
Adults
•
Treatment of idiopathic fascicular left VT
Safety risks
Contraindications
Hypersensitivity to verapamil or its components
Hypotension or cardiogenic shock
Second- or third-degree AV block
•
Do not use verapamil in patients with second- or third-degree AV block except in the presence of a functioning ventricular pacemaker.
Severe LV dysfunction
Sick sinus syndrome
•
Do not use verapamil in patients with sick sinus syndrome except in the presence of a functioning ventricular pacemaker.
WPW syndrome or Lown-Ganong-Levine syndrome
•
Do not use verapamil in patients with AF or atrial flutter associated with an accessory bypass tract, such as in WPW syndrome or Lown-Ganong-Levine syndrome.
Warnings and precautions
Drug-induced liver injury
•
Maintain a high level of suspicion, as verapamil may cause acute liver injury with elevations in liver enzymes.
Pulmonary edema
•
Use caution in patients with HCM.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use with caution. Monitor blood pressure. Monitor heart rate. Monitor PR interval.
Renal replacement therapy
Any modality
•
Use with caution. Monitor blood pressure. Monitor heart rate. Monitor PR interval.
Hepatic impairment
Child-Pugh A (mild)
•
Use with caution. Monitor blood pressure. Monitor heart rate. Monitor PR interval.
Child-Pugh B (moderate)
•
Use with caution. Monitor blood pressure. Monitor heart rate. Monitor PR interval.
Child-Pugh C (severe)
•
Use with caution. Reduce dose by 70%. Monitor blood pressure. Monitor heart rate. Monitor PR interval.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Use only if clearly needed. Evidence of fetal harm in animals. Consider safer alternatives for hypertension in pregnancy.
Breastfeeding
Halt breastfeeding temporarily.
Low excretion in breastmilk (5-25%).
Undetectable levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Bradycardia
Common 1-10%
•
AV block, congestive heart failure, hypotension, lethargy, peripheral edema, pulmonary edema, constipation, dizziness, dyspepsia, fatigue, headache, myalgia, nausea, skin rash, sleeping disorder
Uncommon < 1%
•
Atrioventricular dissociation, myocardial infarction, vasculitis, cerebrovascular accident, erythema multiforme, Stevens-Johnson syndrome, angina pectoris, chest pain, claudication, palpitations, purpura, syncope, diarrhea, dry mouth, gingival swelling, ecchymosis, confusion, loss of balance, extrapyramidal signs, insomnia, muscle cramps, paresthesia, psychosis, shaking, somnolence, dyspnea, arthralgia, hair loss, skin macules, hyperkeratosis, urticaria, sweating, blurred vision, tinnitus, erectile dysfunction, gynecomastia, urinary frequency, intermenstrual bleeding, skin flushing
Unknown frequency
•
↑ liver enzymes
Interactions
Drug(s)
Check Interactions
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