verapamil (Calan, Verelan, Verelan PM [Discontinued: Isoptin, Isoptin SR, Covera-HS]) (cont.)

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PREPARATIONS: Immediate release tablets: 40, 80, and 120 mg; sustained release caplets: 120, 180, 240,and 360 mg; extended release tablets: 100, 120, 180, 200, 240, and 300 mg; Injection: 2.5 mg/mL

STORAGE: Verapamil should be stored at room temperature 15 C - 30 C (59 F - 86 F) in a tight, light- resistant container.

DOSING: Verapamil can be taken with food.

  • Angina (immediate release formulations): 80-160 mg three times daily. Angina (extended release formulations): 180-540 mg at bedtime.
  • Hypertension (immediate release): 80-320 mg twice daily. Hypertension (extended release): 120-480 mg once or twice daily depending on the brand.
  • Migraine: 160-320 mg three to four times daily.

DRUG INTERACTIONS: Concurrent use of verapamil with a beta blocker (another class of medications that slow heart rate) can cause profound and dangerous reductions in heart rate. Verapamil can raise the levels of some drugs in blood including digoxin (Lanoxin), theophylline (Slo-Bid), cyclosporin, and carbamazepine (Tegretol). Therefore, monitoring of the levels of these drugs is important to avoid toxicity.

Verapamil may reduce blood levels of lithium (Eskalith, Lithobid) in some patients. For unclear reasons some patients who took both verapamil and lithium have noticed increased side effects of lithium without increases in their blood levels of lithium.

The use of "statins" (for example, simvastatin or lovastain) in combination with verapamil has been associated with reports of myopathy/rhabdomyolysis because verapamil reduces the break down of these statins in the liver. The dose of simvastatin in patients on verapamil should not exceed 10 mg daily and the dose of lovastatin (Mevacor, Altoprev) should not exceed 40 mg daily. Lower starting and maintenance doses of other statins (for example, atorvastatin [Liptor]) may be required since verapamil also may increase the plasma concentration of these drugs also. Rifampin and phenobarbital increase the elimination of verapamil, potentially reducing the effect of verapamil.

PREGNANCY: Safety of verapamil during pregnancy has not been established. Verapamil crosses the placenta and enters the fetus.

NURSING MOTHERS: Safety in nursing mothers has not been established. Verapamil is excreted in human milk.

Medically reviewed by Eni Williams, PharmD

Reference: FDA Prescribing Information

Medically Reviewed by a Doctor on 10/13/2015

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