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Verapamil HCl

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Overview

What is Verapamil HCl?

Verapamil HCl is a calcium antagonist or slow channel inhibitor. Verapamil Hydrochloride is available in 5 mg/2 mL single dose vials (for intravenous administration). Each mL contains Verapamil HCI 2.5 mg, Sodium Chloride 8.5 mg and Water for Injection q.s. pH adjusted with Hydrochloric Acid and/or Sodium Hydroxide. The pH of the solution is between 4 and 6.5. Protect contents from light. Sterile, nonpyrogenic.

The structural formula of Verapamil HCI is given below:

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 antiarrhythmic drugs.



What does Verapamil HCl look like?



What are the available doses of Verapamil HCl?

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What should I talk to my health care provider before I take Verapamil HCl?

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How should I use Verapamil HCl?

Intravenous Verapamil HCI is indicated for the following:

In controlled studies in the United States, about 60% of patients with supraventricular tachycardia converted to normal sinus rhythm within 10 minutes after intravenous verapamil. Uncontrolled studies reported in the world literature describe a conversion rate of about 80%. About 70% of patients with atrial flutter and/or fibrillation with a fast ventricular rate respond with a decrease in ventricular rate of at least 20%. Conversion of atrial flutter or fibrillation to sinus rhythm is uncommon (about 10%) after verapamil and may reflect the spontaneous conversion rate, since the conversion rate after placebo was similar. Slowing of the ventricular rate in patients with atrial fibrillation/flutter lasts 30 to 60 minutes after a single injection.

Because a small fraction (
Cardioversion has been used safely and effectively after intravenous verapamil.

DOSAGE AND ADMINISTRATION (For Intravenous Use Only)

VERAPAMIL HYDROCHLORIDE SHOULD BE GIVEN AS A SLOW INTRAVENOUS INJECTION OVER AT LEAST A TWO MINUTE PERIOD OF TIME UNDER CONTINUOUS ELECTROCARDIOGRAPHIC AND BLOOD PRESSURE MONITORING.

The recommended intravenous doses of verapamil are as follows:

Note:


What interacts with Verapamil HCl?


  • Intravenous Verapamil HCI is contraindicated in:

    • Severe hypotension or cardiogenic shock.
    • Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker).
    • Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker).
    • Severe congestive heart failure (unless secondary to a supraventricular tachycardia amenable to verapamil therapy.)
    • Patients receiving beta adrenergic blocking drugs (e.g., propranolol). verapamil and beta adrenergic blocking drugs should not be administered in close proximity to each other (within a few hours), since both may have a depressant effect on myocardial contractility and AV conduction.
    • Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (i.e. Wolff-Parkinson-White, Lown-Ganong-Levine syndromes) are at risk to develop ventricular tachyarrhythmia including ventricular fibrillation if verapamil is administered. Therefore, the use of verapamil in these patients is contraindicated.
    • Ventricular Tachycardia. Administration of intravenous verapamil to patients with wide-complex ventricular-tachycardia (QRS ≥ 0.12 sec) can result in marked hemodynamic deterioration and ventricular fibrillation. Proper pretherapy diagnosis and differentiation from wide-complex supraventricular tachycardia is imperative in the emergency room setting.
    • Known hypersensitivity to verapamil hydrochloride.



What are the warnings of Verapamil HCl?

Array

Hypotension:

Extreme Bradycardia/Asystole:

Heart Failure:

Concomitant Antiarrhythmic Therapy:

Digitalis:

Procainamide:

Quinidine:

Beta Adrenergic Blocking Drugs:

intravenous

intravenous

Array

Disopyramide:

Flecainide:

Heart Block:

Hepatic and Renal Failure:

Premature Ventricular Contractions:

Duchenne's Muscular Dystrophy:

Increased Intracranial Pressure:


What are the precautions of Verapamil HCl?

Drug Interactions:

intravenous

OTHER:

Cimetidine:

Lithium:

Carbamazepine:

Rifampin:

Phenobarbital:

Cyclosporin:

InhalatIon Anesthetics:

Neuromuscular Blocking Agents:

Dantrolene:

Pregnancy:

Labor and Delivery:

Nursing Mothers:

Pediatric Use:

In rare instances, however, severe hemodynamic side effects - some of them fatal - have occurred following the intravenous administration of verapamil to neonates and infants. Caution should therefore be used when administering verapamil to this group of pediatric patients.

The most commonly used single doses in patients up to 12 months of age have ranged from 0.1 to 0.2 mg/kg of body weight, while in patients aged 1 to 15 years, the most commonly used single doses ranged from 0.1 to 0.3 mg/kg of body weight. Most of the patients received the lower dose of 0.1 mg/kg once but, in some cases, the dose was repeated once or twice every 10 to 30 minutes.


What are the side effects of Verapamil HCl?

The following reactions were reported with intravenous Verapamil HCI used in controlled U.S. clinical trials involving 324 patients.

Cardiovascular:

Central Nervous System Effects:

Gastrointestinal:

In rare cases of hypersensitive patients, broncho/laryngeal spasm accompanied by itch and urticaria have been reported.

The following reactions have been reported at low frequency: emotional depression, rotary nystagmus, sleepiness, vertigo, muscle fatigue, diaphoresis, and respiratory failure.

Suggested Treatment of Acute Cardiovascular Adverse Reactions*The frequency of these adverse reactions was quite low and experience with their treatment has been limited.
*Actual treatment and dosage should depend on the severity of the clinical situation and the judgement and experience of the treating physician.
Adverse ReactionProven Effective TreatmentSupportive Treatment
1. Symptomatic hypotension requiring treatmentCalcium chloride (IV) Norepinephrine bitartrate (IV) Metaraminol bitartrate (IV) Isoproterenol HCI (IV) Dopamine (IV)Intravenous fluids Trendelenburg position
2. Bradycardia, AV block, AsystoleIsoproterenol HCI (IV) Calcium chloride (IV) Cardiac pacing LevarterenoI bitartrate (IV) Atropine (IV)Intravenous fluids (slow drip)
3. Rapid ventricular rate (due to antegrade conduction in flutter/fibrillation with W-P-W or L-G-L syndromes)DC-cardioversion (high energy may be required) Procainamide (IV) Lidocaine (IV)Intravenous fluids (slow drip)



What should I look out for while using Verapamil HCl?

Intravenous Verapamil HCI is contraindicated in:

VERAPAMIL HYDROCHLORIDE SHOULD BE GIVEN AS A SLOW INTRAVENOUS INJECTION OVER AT LEAST A TWO MINUTE PERIOD OF TIME. (See )

Drug Interactions:

Array

WARNINGS: Concomitant Antiarrhythmic Therapy

intravenous


What might happen if I take too much Verapamil HCl?

Treatment of overdosage should be supportive and individualized. Beta-adrenergic stimulation and/or parenteral administration of calcium solutions may increase calcium ion flux across the slow channel, and have been effectively used in treatment of deliberate overdosage with oral Verapamil HCI. 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 isoproterenol hydrochloride, other vasopressor agents or cardiopulmonary resuscitation (see )


How should I store and handle Verapamil HCl?

HOW SUPPLIED:0517-5402-25      2 mL Single Dose Vial (5 mg/2 mL)      packaged in 25Store at controlled room temperature 15°-30°C (59°-86°F) (See USP). Protect from light.IN0501Rev. 1/03AMERICANREGENT, INC.SHIRLEY, NY 11967HOW SUPPLIED:0517-5402-25      2 mL Single Dose Vial (5 mg/2 mL)      packaged in 25Store at controlled room temperature 15°-30°C (59°-86°F) (See USP). Protect from light.IN0501Rev. 1/03AMERICANREGENT, INC.SHIRLEY, NY 11967HOW SUPPLIED:0517-5402-25      2 mL Single Dose Vial (5 mg/2 mL)      packaged in 25Store at controlled room temperature 15°-30°C (59°-86°F) (See USP). Protect from light.IN0501Rev. 1/03AMERICANREGENT, INC.SHIRLEY, NY 11967HOW SUPPLIED:0517-5402-25      2 mL Single Dose Vial (5 mg/2 mL)      packaged in 25Store at controlled room temperature 15°-30°C (59°-86°F) (See USP). Protect from light.IN0501Rev. 1/03AMERICANREGENT, INC.SHIRLEY, NY 11967HOW SUPPLIED:0517-5402-25      2 mL Single Dose Vial (5 mg/2 mL)      packaged in 25Store at controlled room temperature 15°-30°C (59°-86°F) (See USP). Protect from light.IN0501Rev. 1/03AMERICANREGENT, INC.SHIRLEY, NY 11967


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Clinical Information

Chemical Structure

No Image found
Clinical Pharmacology

Mechanism of Action:

In the isolated rabbit heart, concentrations of verapamil that markedly affect SA nodal fibers or fibers in the upper and middle regions of the AV node, have very little effect on fibers in the lower AV node (NH region) and no effect on atrial action potentials or His bundle fibers.

Electrical activity in the SA and AV nodes depends, to a large degree, upon calcium influx through the slow channel. By inhibiting this influx, verapamil slows AV conduction and prolongs the effective refractory period within the AV node in a rate-related manner. This effect results in a reduction of the ventricular rate in patients with atrial flutter and/or atrial fibrillation and a rapid ventricular response.

By interrupting reentry at the AV node, verapamil can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias (PSVT), including PSVT associated with Wolff-Parkinson-White syndrome.

Verapamil does not induce peripheral arterial spasm.

Verapamil 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.

Verapamil does not alter total serum calcium levels.

Non-Clinical Toxicology
Intravenous Verapamil HCI is contraindicated in:

VERAPAMIL HYDROCHLORIDE SHOULD BE GIVEN AS A SLOW INTRAVENOUS INJECTION OVER AT LEAST A TWO MINUTE PERIOD OF TIME. (See )

Array

Drug Interactions:

intravenous

The following reactions were reported with intravenous Verapamil HCI used in controlled U.S. clinical trials involving 324 patients.

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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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Professional

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

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