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Isoptin SR

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Overview

What is Isoptin SR?

ISOPTIN SR (verapamil hydrochloride) is a calcium ion influx inhibitor (slow channel blocker or calcium ion antagonist). ISOPTIN SR is available for oral administration as light green, capsule shaped, scored, film-coated tablets containing 240 mg verapamil hydrochloride, as light pink, oval shaped, scored, film-coated tablets containing 180 mg verapamil hydrochloride, and as light violet, oval shaped, film-coated tablets containing 120 mg verapamil hydrochloride. The tablets are designed for sustained release of the drug in the gastrointestinal tract, sustained release characteristics are not altered when the tablet is divided in half.

The structural formula of verapamil HCI is given below:

CHNO•HCl M.W. 491.08

Benzeneacetronitrile, α [3-[[2-(3, 4-dimethoxyphenyl) ethyl] methylamino] propyl]-3, 4- dimethoxy-α-(1-methylethyl) hydrochloride

Verapamil HCI is an almost white, crystalline powder, practically free of odor, with a bitter taste.

It is soluble in water, chloroform and methanol. Verapamil HCI is not chemically related to other cardioactive drugs.

In addition to verapamil HCI, the ISOPTIN SR tablet contains the following ingredients: alginate, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl pyrrolidone, talc, and titanium dioxide. The following are the color additives per tablet strength:

Strength (mg) Color Additive(s)

120 Iron Oxide

180 Iron Oxide

240 D&C yellow #10 Lake dye, and FD&C blue #2 Lake dye



What does Isoptin SR look like?



What are the available doses of Isoptin SR?

Sorry No records found.

What should I talk to my health care provider before I take Isoptin SR?

Sorry No records found

How should I use Isoptin SR?

Sorry No records found


What interacts with Isoptin SR?

Verapamil HCI is contraindicated in:


1. Severe left ventricular dysfunction (see WARNINGS)


2. Hypotension (systolic pressure less than 90 mmHg) or cardiogenic shock


3. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)


4. Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker).


5. Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes). (see WARNINGS).


6. Patients with known hypersensitivity to verapamil hydrochloride.



What are the warnings of Isoptin SR?

Array

Heart Failure:

Hypotension:

Elevated Liver Enzymes:

Accessory Bypass Tract (Wolff-Parkinson-White or Lown-Ganong-Levine):

Treatment is usually DC-cardioversion. Cardioversion has been used safely and effectively after oral ISOPTIN.

Atrioventricular Block:

Patients with Hypertrophic Cardiomyopathy (IHSS):


What are the precautions of Isoptin SR?

General

Use in Patients with Impaired Hepatic Functions:

Use in Patients with Attenuated (Decreased) Neuromuscular Transmission:

Use in Patients with Impaired Renal Function:

Drug Interactions

In vitro

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Aspirin:

Array

Grapefruit juice:

Array

Beta Blockers:

Asymptomatic bradycardia (36 beats/min) with a wandering atrial pacemaker has been observed in a patient receiving concomitant timolol (a beta-adrenergic blocker) eyedrops and oral verapamil.

A decrease in metoprolol and propranolol clearance has been observed when either drug is administered concomitantly with verapamil. A variable effect has been seen when verapamil and atenolol were given together.

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Digitalis:

Array

Antihypertensive Agents:

Array

Antiarrhythmic Agents

Disopyramide:

Flecainide:

Quinidine:

The electrophysiological effects of quinidine and verapamil on AV conduction were studied in 8 patients. Verapamil significantly counteracted the effects of quinidine on AV conduction. There has been a report of increased quinidine levels during verapamil therapy.

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Nitrates:

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Other

Alcohol:

Cimetidine:

Lithium:

Carbamazepine:

Rifampin:

Phenobarbital:

Cyclosporine:

Theophylline:

Inhalation Anesthetics:

Neuromuscular Blocking Agents:

Carcinogenesis and Mutagenesis

An 18-month toxicity study in rats, at a low multiple (6 fold) of the maximum recommended human dose, and not the maximum tolerated dose, did not suggest a tumorigenic potential. There was no evidence of a carcinogenic potential of verapamil administered in the diet of rats for two years at doses of 10, 35, and 120 mg/kg per day or approximately 1x, 3.5x, and 12x, respectively, the maximum recommended human daily dose (480 mg per day or 9.6 mg/kg/day).

Verapamil was not mutagenic in the Ames test in 5 test strains at 3 mg per plate, with or without metabolic activation.

Studies in female rats at daily dietary doses up to 5.5 times (55 mg/kg/day) the maximum recommended human dose did not show impaired fertility. Effects on male fertility have not been determined.

Pregnancy

Pregnancy Category C. Reproduction studies have been performed in rabbits and rats at oral doses up to 1.5 (15 mg/kg/day) and 6 (60 mg/kg/day) times the human oral daily dose, respectively, and have revealed no evidence of teratogenicity. In the rat, however, this multiple of the human dose was embryocidal and retarded fetal growth and development, probably because of adverse maternal effects reflected in the reduced weight gains of the dams. This oral dose has also been shown to cause hypotension in rats. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Verapamil crosses the placental barrier and can be detected in umbilical vein blood at delivery.

Labor and Delivery

It is not known whether the use of verapamil during labor or delivery has immediate or delayed adverse effects on the fetus, or whether it prolongs the duration of labor or increases the need for forceps delivery or other obstetric intervention. Such adverse experiences have not been reported in the literature, despite a long history of use of verapamil in Europe in the treatment of cardiac side effects of beta-adrenergic agonist agents used to treat premature labor.

Nursing Mothers

Verapamil is excreted in human milk. Because of the potential for adverse reactions in nursing infants from verapamil, nursing should be discontinued while verapamil is administered.

Pediatric Use

Safety and efficacy of ISOPTIN tablets in pediatric patients below the age of 18 years have not been established.

Animal Pharmacology and/or Animal Toxicology

In chronic animal toxicology studies verapamil caused lenticular and/or suture line changes at 30 mg/kg/day or greater and frank cataracts at 62.5 mg/kg/day or greater in the beagle dog but not the rat. Development of cataracts due to verapamil has not been reported in man.


What are the side effects of Isoptin SR?

Serious adverse reactions are uncommon when verapamil therapy is initiated with upward dose titration within the recommended single and total daily dose. See WARNINGS for discussion of heart failure, hypotension, elevated liver enzymes, AV block, and rapid ventricular response. Reversible (upon discontinuation of verapamil) non-obstructive, paralytic ileus has been infrequently reported in association with the use of verapamil. The following reactions to orally administered verapamil occurred at rates greater than 1.0% or occurred at lower rates but appeared clearly drug-related in clinical trials in 4,954 patients.

Constipation 7.3%

Fatigue 1.7%

Dizziness 3.3%

Dyspnea 1.4%

Nausea 2.7%

Bradycardia (HR
Hypotension 2.5%

AV Block-total (1 °, 2 °, 3 °) 1.2%

Headache 2.2%

2 ° and 3 ° 0.8%

Edema 1.9%

Rash 1.2%

CHF/Pulmonary Edema 1.8%

Flushing 0.6%

Elevated Liver Enzymes (see WARNING)

In clinical trials related to the control of ventricular response in digitalized patients who had atrial fibrillation or atrial flutter, ventricular rates below 50/min at rest occurred in 15% of patients and asymptomatic hypotension occurred in 5% of patients.

The following reactions, reported in 1.0% or less of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are listed to alert the physician to a possible relationship.

Cardiovascular:

Digestive System:

Hemic and Lymphatic:

Nervous System:

Skin:

Special Senses:

Urogenital:

Treatment of Acute Cardiovascular Adverse Reactions:


What should I look out for while using Isoptin SR?

Verapamil HCI is contraindicated in:

1. Severe left ventricular dysfunction (see WARNINGS)

2. Hypotension (systolic pressure less than 90 mmHg) or cardiogenic shock

3. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)

4. Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker).

5. Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes). (see WARNINGS).

6. Patients with known hypersensitivity to verapamil hydrochloride.

Heart Failure:

Hypotension:

Elevated Liver Enzymes:

Accessory Bypass Tract (Wolff-Parkinson-White or Lown-Ganong-Levine):

Treatment is usually DC-cardioversion. Cardioversion has been used safely and effectively after oral ISOPTIN.

Atrioventricular Block:

Patients with Hypertrophic Cardiomyopathy (IHSS):


What might happen if I take too much Isoptin SR?

Overdose with verapamil may lead to pronounced hypotension, bradycardia, and conduction system abnormalities (e.g., junctional rhythm with AV dissociation and high degree AV block, including asystole). Other symptoms secondary to hypoperfusion (e.g., metabolic acidosis, hyperglycemia, hyperkalemia, renal dysfunction, and convulsions) may be evident.

Treat all verapamil overdoses as serious and maintain observation for at least 48 hours [especially ISOPTIN SR (verapamil hydrochloride)] preferably under continuous hospital care. Delayed pharmacodynamic consequences may occur with the sustained release formulation. Verapamil is known to decrease gastrointestinal transit time.

In overdose, tablets of ISOPTIN SR have occasionally been reported to form concretions within the stomach or intestines. These concretions have not been visible on plain radiographs of the abdomen, and no medical means of gastrointestinal emptying is of proven efficacy in removing them. Endoscopy might reasonably be considered in cases of massive overdose when symptoms are unusually prolonged.

Treatment of overdosage should be supportive. Beta adrenergic stimulation or parenteral administration of calcium solutions may increase calcium ion flux across the slow channel, and have been used effectively in treatment of deliberate overdosage with verapamil. Continued treatment with large doses of calcium may produce a response. In a few reported cases, overdose with calcium channel blockers that was initially refractory to atropine became more responsive to this treatment when the patients received large doses (close to 1 gram/hour for more than 24 hours) of calcium chloride. Verapamil cannot be removed by hemodialysis. Clinically significant hypotensive reactions or high degree AV block should be treated with vasopressor agents or cardiac pacing, respectively. Asystole should be handled by the usual measures including cardiopulmonary resuscitation.


How should I store and handle Isoptin SR?

Store the kit at 2°-8°C (36°-46°F) and protect from light.ArrayStore the kit at 2°-8°C (36°-46°F) and protect from light.ArrayISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005ISOPTIN SR 240 mg tablets are supplied as light green, capsule shaped, scored, film-coated tablets containing 240 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side and “ST” on the other side. ISOPTIN SR 180 mg tablets are supplied as light pink, oval shaped, scored, film-coated tablets containing 180 mg of verapamil hydrochloride. The tablet is embossed with “pp” on one side, and “SK” on the other side. The ISOPTIN SR 120 mg tablets are supplied as light violet, oval shaped, film-coated tablets containing 120 mg of verapamil hydrochloride. The tablet is embossed with “p” on one side and “SC” on the other side.240 mg (light green) -Bottle of 100-NDC # 10631-490-01 Bottle of 500- NDC # 10631-490-05180 mg (light pink) -Bottle of 100- NDC # 10631-489-01120 mg (light violet) -Bottle of 100- NDC # 10631-488-01Storage:Protect from light and moisture.Dispense in a tight, light-resistant container as defined in the USP.Manufactured by:Abbott LaboratoriesNorth Chicago, IL 60064 USAManufactured for:FSC Laboratories, Inc.Charlotte, NC 28210 USAJanuary 2005


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Clinical Information

Chemical Structure

No Image found
Clinical Pharmacology

ISOPTIN (verapamil HCl) is a calcium ion influx inhibitor (slow channel blocker or calcium ion antagonist) that exerts its pharmacologic effects by modulating the influx of ionic calcium across the cell membrane of the arterial smooth muscle as well as in conductile and contractile myocardial cells.

Mechanism of Action

Essential Hypertension

ISOPTIN exerts antihypertensive effects by decreasing systemic vascular resistance, usually without orthostatic decreases in blood pressure or reflex tachycardia; bradycardia (rate less than 50 beats/min) is uncommon (1.4%). During isometric or dynamic exercise ISOPTIN does not alter systolic cardiac function in patients with normal ventricular function. ISOPTIN does not alter total serum calcium levels. However, one report suggested that calcium levels above the normal range may alter the therapeutic effect of ISOPTIN.

Other Pharmacological Actions of ISOPTIN Include the Following

ISOPTIN (verapamil HCI) dilates the main coronary arteries and coronary arterioles, both in normal and ischemic regions, and is a potent inhibitor of coronary artery spasm, whether spontaneous or ergonovine-induced. This property increases myocardial oxygen delivery in patients with coronary artery spasm, and is responsible for the effectiveness of ISOPTIN in vasospastic (Prinzmetal’s or variant) as well as unstable angina at rest. Whether this effect plays any role in classical effort angina is not clear, but studies of exercise tolerance have not shown an increase in the maximum exercise rate-pressure product, a widely accepted measure of oxygen utilization. This suggests that, in general, relief of spasm or dilation of coronary arteries is not an important factor in classical angina.

ISOPTIN regularly reduces the total systemic resistance (afterload) against which the heart works both at rest and at a given level of exercise by dilating peripheral arterioles.

Electrical activity through the AV node depends, to a significant degree, upon calcium influx through the slow channel. By decreasing the influx of calcium, ISOPTIN prolongs the effective refractory period within the AV node and slows AV conduction in a rate related manner.

Normal sinus rhythm is usually not affected, but in patients with sick sinus syndrome, ISOPTIN may interfere with sinus node impulse generation and may induce sinus arrest or sinoatrial block.

Atrioventricular block can occur in patients without preexisting conduction defects (see WARNINGS).

ISOPTIN does not alter the normal atrial action potential or intraventricular conduction time, but depresses amplitude, velocity of depolarization and conduction in depressed atrial fibers. ISOPTIN may shorten the antegrade effective refractory period of accessory bypass tracts. Acceleration of ventricular rate and/or ventricular fibrillation has been reported in patients with atrial flutter or atrial fibrillation and a coexisting accessory AV pathway following administration of verapamil (see WARNINGS).

ISOPTIN has a local anesthetic action that is 1.6 times that of procaine on an equimolar basis.

It is not known whether this action is important at the doses used in man.

Pharmacokinetics and Metabolism:

In early dose titration with verapamil a relationship exists between verapamil plasma concentrations and the prolongation of the PR interval. However, during chronic administration this relationship may disappear. The mean elimination half-life in single dose studies ranged from 2.8 to 7.4 hours. In these same studies, after repetitive dosing, the half-life increased to a range from 4.5 to 12.0 hours (after less than 10 consecutive doses given 6 hours apart). Half-life of verapamil may increase during titration. No relationship has been established between the plasma concentration of verapamil and a reduction in blood pressure.

Aging may affect the pharmacokinetics of verapamil. Elimination half-life may be prolonged in the elderly.

In multiple dose studies under fasting conditions the bioavailability measured by AUC of ISOPTIN SR was similar to ISOPTIN immediate release; rates of absorption were, of course, different. In a randomized, single-dose, crossover study using healthy volunteers, administration of 240 mg ISOPTIN SR with food produced peak plasma verapamil concentrations of 79 ng/mL, time to peak plasma verapamil concentration of 7.71 hours, and AUC (0-24 hr) of 841 ng-hr/mL. When ISOPTIN SR was administered to fasting subjects, peak plasma verapamil concentration was 164 ng/mL; time to peak plasma verapamil concentration was 5.21 hours; and AUC (0-24 hr) was 1,478 ng-hr/mL. Similar results were demonstrated for plasma norverapamil. Food thus produces decreased bioavailability (AUC) but a narrower peak to trough ratio. Good correlation of dose and response is not available, but controlled studies of ISOPTIN SR have shown effectiveness of doses similar to the effective doses of ISOPTIN (immediate release).

In healthy man, orally administered ISOPTIN undergoes extensive metabolism in the liver. Twelve metabolites have been identified in plasma; all except norverapamil are present in trace amounts only. Norverapamil can reach steadystate plasma concentrations approximately equal to those of verapamil itself. The cardiovascular activity of norverapamil appears to be approximately 20% that of verapamil. Approximately 70% of an administered dose is excreted as metabolites in the urine and 16% or more in the feces within 5 days. About 3% to 4% is excreted in the urine as unchanged drug. Approximately 90% is bound to plasma proteins. In patients with hepatic insufficiency, metabolism of immediate release verapamil is delayed and elimination half-life prolonged up to 14 to 16 hours (see PRECAUTIONS); the volume of distribution is increased and plasma clearance reduced to about 30% of normal. Verapamil clearance values suggest that patients with liver dysfunction may attain therapeutic verapamil plasma concentrations with one third of the oral daily dose required for patients with normal liver function.

After four weeks of oral dosing (120 mg q.i.d.), verapamil and norverapamil levels were noted in the cerebrospinal fluid with estimated partition coefficient of 0.06 for verapamil and 0.04 for norverapamil.

In ten healthy males, administration of oral verapamil (80 mg every 8 hours for 6 days) and a single oral dose of ethanol (0.8 g/kg) resulted in a 17% increase in mean peak ethanol concentrations (106.45 ± 21.40 to 124.23 ± 24.74 mg•hr/dL) compared to placebo. The area under the blood ethanol concentration versus time curve (AUC over 12 hours) increased by 30% (365.67 ± 93.52 to 475.07 ± 97.24 mg•hr/dL). Verapamil AUCs were positively correlated (r=0.71) to increased ethanol blood AUC values. (See PRECAUTIONS: Drug Interactions.)

Hemodynamics and Myocardial Metabolism:

Pulmonary Function:

Non-Clinical Toxicology
Verapamil HCI is contraindicated in:

1. Severe left ventricular dysfunction (see WARNINGS)

2. Hypotension (systolic pressure less than 90 mmHg) or cardiogenic shock

3. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)

4. Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker).

5. Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes). (see WARNINGS).

6. Patients with known hypersensitivity to verapamil hydrochloride.

Heart Failure:

Hypotension:

Elevated Liver Enzymes:

Accessory Bypass Tract (Wolff-Parkinson-White or Lown-Ganong-Levine):

Treatment is usually DC-cardioversion. Cardioversion has been used safely and effectively after oral ISOPTIN.

Atrioventricular Block:

Patients with Hypertrophic Cardiomyopathy (IHSS):

















Asymptomatic bradycardia (36 beats/min) with a wandering atrial pacemaker has been observed in a patient receiving concomitant timolol (a beta-adrenergic blocker) eyedrops and oral verapamil.

A decrease in metoprolol and propranolol clearance has been observed when either drug is administered concomitantly with verapamil. A variable effect has been seen when verapamil and atenolol were given together.













Disopyramide:

Flecainide:

Quinidine:

The electrophysiological effects of quinidine and verapamil on AV conduction were studied in 8 patients. Verapamil significantly counteracted the effects of quinidine on AV conduction. There has been a report of increased quinidine levels during verapamil therapy.









Alcohol:

Cimetidine:

Lithium:

Carbamazepine:

Rifampin:

Phenobarbital:

Cyclosporine:

Theophylline:

Inhalation Anesthetics:

Neuromuscular Blocking Agents:

General

Use in Patients with Impaired Hepatic Functions:

Use in Patients with Attenuated (Decreased) Neuromuscular Transmission:

Use in Patients with Impaired Renal Function:

Serious adverse reactions are uncommon when verapamil therapy is initiated with upward dose titration within the recommended single and total daily dose. See WARNINGS for discussion of heart failure, hypotension, elevated liver enzymes, AV block, and rapid ventricular response. Reversible (upon discontinuation of verapamil) non-obstructive, paralytic ileus has been infrequently reported in association with the use of verapamil. The following reactions to orally administered verapamil occurred at rates greater than 1.0% or occurred at lower rates but appeared clearly drug-related in clinical trials in 4,954 patients.

Constipation 7.3%

Fatigue 1.7%

Dizziness 3.3%

Dyspnea 1.4%

Nausea 2.7%

Bradycardia (HR
Hypotension 2.5%

AV Block-total (1 °, 2 °, 3 °) 1.2%

Headache 2.2%

2 ° and 3 ° 0.8%

Edema 1.9%

Rash 1.2%

CHF/Pulmonary Edema 1.8%

Flushing 0.6%

Elevated Liver Enzymes (see WARNING)

In clinical trials related to the control of ventricular response in digitalized patients who had atrial fibrillation or atrial flutter, ventricular rates below 50/min at rest occurred in 15% of patients and asymptomatic hypotension occurred in 5% of patients.

The following reactions, reported in 1.0% or less of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are listed to alert the physician to a possible relationship.

Cardiovascular:

Digestive System:

Hemic and Lymphatic:

Nervous System:

Skin:

Special Senses:

Urogenital:

Treatment of Acute Cardiovascular Adverse Reactions:

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Tips

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Interactions

Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).