Verapamil

💊 What is Verapamil used for?

• •The label says verapamil extended-release capsules are used to treat high blood pressure (hypertension) and lower blood pressure. Lowering blood pressure can reduce the risk of fatal and nonfatal heart and blood vessel events, mainly strokes and heart attacks. The label notes that blood pressure control works best as part of a wider plan that may include cholesterol control, diabetes management, not smoking, exercise, and limiting sodium. It also says many people need more than one medicine to reach their blood pressure goals.

How it works

The label describes verapamil as a calcium ion influx inhibitor. It says verapamil affects how calcium moves into cells, and this affects the heart and blood vessels. The label also says the medicine lowers blood pressure, which is the main reason it helps reduce cardiovascular risk.

How it is usually taken

• •The label says the capsule should be swallowed whole. It should not be crushed or chewed. The label also describes a method where the capsule is carefully opened and the pellets are sprinkled onto applesauce, which is then swallowed right away without chewing. The label says that when this method is prescribed, the person should be taught the proper technique. The medicine is taken once a day at bedtime. The label says the blood pressure effects are seen within the first week. Follow the instructions from your prescriber or pharmacist about how and when to take it.

Comes as

• •100 mg extended-release capsules (white opaque cap with amethyst body)

⚠️ Verapamil side effects

🛑 Who should not take Verapamil, and who should be careful

The label says not to take it if

• 🚨You have severe left ventricular dysfunction, as the label lists this as a contraindication.
• 🚨You have low blood pressure (systolic below 90 mm Hg) or cardiogenic shock.
• 🚨You have sick sinus syndrome, unless you have a functioning artificial pacemaker.
• 🚨You have second- or third-degree AV block, unless you have a functioning artificial pacemaker.
• 🚨You have atrial flutter or atrial fibrillation with an accessory bypass tract (such as Wolff-Parkinson-White or Lown-Ganong-Levine syndromes).

Tell your doctor before taking it if

• •The label says heart failure can develop with verapamil. For people with milder heart muscle weakness, it says to control the condition with the best doses of digitalis and/or diuretics before verapamil is started, if possible.
• •The label says liver function should be checked periodically in people taking verapamil.
• •The label says that in people with atrial flutter or atrial fibrillation and an accessory bypass tract, verapamil is contraindicated.
• •The label says that people with hypertrophic cardiomyopathy had sinus bradycardia, pulmonary edema, severe hypotension, second-degree AV block, sinus arrest, and death in the studies described.
• •Tell your prescriber about all medicines you take, including over-the-counter products and supplements, because the label lists many interactions.

🔀 Verapamil with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •CYP3A4 inhibitors, such as erythromycin and ritonavir, can raise verapamil levels. The label also mentions telithromycin, which was linked with low blood pressure, slow heart rate, and lactic acidosis.
• •CYP3A4 inducers, such as rifampin, can lower verapamil levels.
• •Ivabradine: the label says to avoid using it with verapamil.
• •Simvastatin: the label says to limit simvastatin to 10 mg daily when used with verapamil. Lovastatin: limit to 40 mg daily. Other statins, such as atorvastatin, may need lower starting and maintenance doses.
• •Grapefruit juice: the label says it may significantly increase verapamil levels.
• •Beta blockers: the label reports excess slow heart rate and AV block, including complete heart block, so the heart should be monitored closely.
• •Digoxin: the label says digoxin levels can rise by 50 to 75 percent, and the digoxin dose may need to be reduced.
• •Alcohol: the label says verapamil can inhibit alcohol elimination, which leads to higher blood alcohol levels.

Alcohol and food

The label says grapefruit juice may significantly increase verapamil levels. It also says verapamil can inhibit alcohol elimination, leading to elevated ethanol levels. The capsule can be swallowed whole or its contents sprinkled on applesauce, as described in the how-taken section.

🤰 Verapamil in pregnancy and breastfeeding

Pregnancy

The label says verapamil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It also says there are no adequate and well-controlled studies in pregnant women. The label notes that verapamil crosses the placenta. Animal studies showed no evidence of harm to the developing fetus at the doses tested, but effects on embryo and fetal growth were seen in rats at high doses. The label classifies verapamil as Pregnancy Category C.

Breastfeeding

The label says to discontinue nursing while verapamil is administered.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 25°C (77°F), with short excursions permitted between 15 and 30°C (59 and 86°F). It also says to protect the capsules from moisture and to keep them in a tight, light-resistant container.

If a dose is missed

The label does not say.

If too much is taken

The label says there is no specific antidote for verapamil overdose, and treatment is supportive. It says delayed effects can occur with extended-release forms, so patients should be observed for at least 48 hours, preferably under continuous hospital care. Reported effects include low blood pressure, slow heart rate, heart conduction problems, irregular heartbeat, high blood sugar, and decreased mental status. If you think someone has taken too much, get emergency medical help right away.

🗒️ Questions to ask about Verapamil

• What is the right way for me to take this capsule, and should I swallow it whole or use the applesauce method?
• Do I need my liver checked during treatment, and how often?
• Which of my current medicines, including statins, digoxin, and beta blockers, could interact with verapamil?
• Should I avoid grapefruit juice while taking this medicine?
• What signs of heart failure or low blood pressure should I watch for?
• If I am pregnant or planning to breastfeed, what does the label advise?

❓ Verapamil: frequently asked questions