Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Verapamil belongs to a class of medications called
calcium channel blockers. These medications block the movement of calcium into the muscle
cells of the coronary arteries (the arteries supplying the heart) as well as the
other arteries of the body. Since calcium is what triggers contraction of
muscles, blocking entry of calcium relaxes the arterial muscles. This relaxation
allows the arteries to become larger so that more blood can flow through them.
Thus, verapamil is useful in treating and preventing chest pain
(angina) resulting from
spasm (contraction) of the coronary arteries that reduces the flow of blood to
the heart. Relaxing the muscles lining the arteries in the rest of the body
lowers blood pressure and thereby reduces the pressure against which the heart
must pump blood. As a result, the heart works less and requires less
oxygen-carrying blood. This allows the heart to work with the reduced flow of
blood caused by coronary artery disease and prevents angina
(which occurs whenever the flow of blood to the heart is inadequate). For more
detailed information related to coronary artery disease, please read the Chest
Pain, Cholesterol, and Heart Attack articles.
Verapamil also decreases the conduction of electrical impulses through the heart
that control the coordination of contraction. As a result, the rate of
contraction slows. Verapamil was approved by the FDA in March, 1982.
STORAGE: Store at room temperature 15° to 30°C (59° to 86°F) in tight, light-
resistant container.
PRESCRIBED FOR: Chest pain (angina) occurs because insufficient
oxygen-carrying blood is delivered to the muscles of the heart. Insufficient
oxygen-carrying blood may be a result of blockage of blood flow in the coronary
arteries due to coronary artery disease or spasm, or an increase in physical
exertion that increases the workload of the heart and the demand by the heart
for oxygen. Verapamil is used for the treatment and prevention of angina
resulting from coronary artery disease and spasm as well as from exertion.
Verapamil also is used in the treatment of high blood pressure.
Verapamil slows electrical conduction of the electrical impulses through the
heart and has been used to in treat abnormally fast heart rhythms such as atrial
fibrillation, and
in the prevention of recurrent episodes of rapid heart rhythm originating from
the atria. For further information about abnormal heart rhythms, please read the
Atrial Fibrillation and Palpitation articles.
DOSING: The usual oral dose is 180-480 mg/day. Verapamil may be given once,
twice or three times daily depending on the formulation used. Verapamil can be
taken with food.
DRUG INTERACTIONS: Concurrent use of verapamil with a beta blocker (another class of medications
that slow heart rate) can occasionally cause profound and dangerous heart
slowing.
Verapamil can raise the levels of some drugs in blood including digoxin
(Lanoxin), theophylline (Slo-Bid), and carbamazepine (Tegretol). Therefore,
monitoring of the levels of these drugs is important to avoid toxicity.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Mitral valve prolapse (MVP) is also also known as "click murmur syndrome" and "Barlow's syndrome." Mitral valve prolapse is the most common heart valve abnormality. Signs and symptoms of mitral valve prolapse include: fatigue, palpitations, chest pain, anxiety, and migraine headaches. Echocardiography is the most useful test for mitral valve prolapse. Most patients do not need any treatment, however, patients with severe prolapse may need treatment.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Peyronie's disease is a condition characterized by a hard lump, or plaque, that forms within the penis. Symptoms of Peyronie's disease range from mild to severe. Treatment for Peyronie's disease includes medication, and often surgery.
Chest pain is a common symptom that is caused by many different conditions. Some causes require prompt medical attention, such as angina,
heart attack, or tearing of the aorta. Other causes of chest pain that may not require immediate medical intervention include spasm of the esophagus, gallbladder attack, or inflammation of the chest wall. An accurate diagnosis is important in providing proper treatment to patients with chest pain.
The diagnosis and treatment of angina is discussed below, as well as the diagnosis of other causes of chest pain that can mimic angina.
What is angina, and what are the symptoms of angina?
Angina (angina pectoris - Latin for squeezing of the chest) is chest discomfort
that occurs when there is a decreased blood oxygen supply to an area of the
heart muscle. In most cases, the lack of blood supply is due to a narrowing of
the coronary arteries as a result of arterioscler...
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