Verapamil 120mg Tablets

Verapamil is a non-dihydropyridine calcium channel blocker that inhibits the influx of extracellular calcium ions across the membranes of myocardial and vascular smooth muscle cells. This leads to: 1) Dilation of coronary and peripheral arteries, reducing afterload and improving myocardial oxygen supply. 2) Reduction in myocardial contractility (negative inotropy). 3) Slowing of SA nodal activity and AV nodal conduction, leading to decreased heart rate and prolonged PR interval.

Urgent Side Effects: Seek Medical Attention Immediately

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of liver problems, including:
+ Dark urine
+ Tiredness
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Slow heartbeat
Abnormal heartbeat that is new or worsening
Severe dizziness or fainting
Shortness of breath, significant weight gain, or swelling in the arms or legs

Other Possible Side Effects

Like all medications, this drug can cause side effects. However, many people do not experience any side effects or only have mild ones. If you are bothered by any of the following side effects or if they do not go away, contact your doctor or seek medical help:

Dizziness or headache
Constipation

Note: This is not an exhaustive list of all possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Heart failure (a weakened heart)
+ Specific types of abnormal heart rhythms, such as heart block, Lown-Ganong-Levine syndrome, sick sinus syndrome, or Wolff-Parkinson-White syndrome
+ Low blood pressure
+ A slow heartbeat
Medications you are currently taking, including:
+ Dofetilide, ivabradine, or quinidine
+ Beta blockers like atenolol, metoprolol, or propranolol
+ Disopyramide or flibanserin, if taken within the last 48 hours
If you are breastfeeding, as you should not breastfeed while taking this medication

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor first.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and be cautious when climbing stairs.

Follow your doctor's instructions for monitoring your blood pressure and heart rate, and undergo blood tests as recommended. Discuss any concerns or questions with your doctor.

If you have high blood pressure, consult your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough and cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.

Before consuming alcohol, discuss its potential effects with your doctor. Additionally, if you regularly drink grapefruit juice or eat grapefruit, talk to your doctor about potential interactions.

If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

If you are pregnant or planning to become pregnant, inform your doctor to discuss the benefits and risks of using this medication during pregnancy.

• Intravenous beta-blockers (risk of severe bradycardia, asystole, heart failure)
• Disopyramide (within 48 hours before or 24 hours after verapamil)
• Dantrolene (risk of hyperkalemia and myocardial depression)

• Beta-blockers (oral - additive negative chronotropic and inotropic effects, AV block)
• Digoxin (increases digoxin serum levels by 50-75%)
• Statins (e.g., simvastatin, lovastatin - verapamil is a CYP3A4 inhibitor, increasing statin exposure and risk of myopathy/rhabdomyolysis)
• Amiodarone (additive effects on heart rate and AV conduction)
• Quinidine (hypotension, AV block, pulmonary edema)
• Fentanyl (severe bradycardia, AV block)
• Rifampin (decreases verapamil levels)
• Grapefruit juice (increases verapamil levels)

• Alpha-blockers (e.g., prazosin, terazosin - additive hypotensive effects)
• Other antihypertensives (additive hypotensive effects)
• Cimetidine (increases verapamil levels)
• Carbamazepine (increases carbamazepine levels)
• Cyclosporine, Tacrolimus, Sirolimus, Everolimus (increases immunosuppressant levels)
• Theophylline (increases theophylline levels)
• Lithium (neurotoxicity)
• Buspirone (increases buspirone levels)
• Midazolam, Triazolam (increases benzodiazepine levels)
• Clonidine (risk of rebound hypertension upon withdrawal of clonidine)

• Aspirin (may increase bleeding risk with high doses)
• NSAIDs (may reduce antihypertensive effect)

• Dizziness
• Lightheadedness
• Fatigue
• Headache
• Swelling in ankles/feet (edema)
• Shortness of breath
• Chest pain (worsening or new)
• Palpitations
• Constipation
• Nausea

Verapamil is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It crosses the placenta.

Verapamil is excreted into breast milk. The American Academy of Pediatrics considers it compatible with breastfeeding. Monitor breastfed infant for bradycardia, hypotension, or sedation. Lactation Risk Category L3 (Moderately Safe).

Safety and efficacy for general pediatric use (e.g., hypertension, angina) have not been established. It is used off-label for supraventricular tachyarrhythmias in children under specialist supervision. Dosing is complex and often weight-based. Contraindicated in infants with Wolff-Parkinson-White (WPW) syndrome and atrial fibrillation/flutter due to risk of ventricular fibrillation.

Elderly patients may be more sensitive to the hypotensive and bradycardic effects of verapamil due to age-related decreases in hepatic and renal function. Lower initial doses and slower titration are recommended. Monitor closely for adverse effects, especially constipation and orthostatic hypotension.

• Verapamil is a non-dihydropyridine CCB, meaning it has significant effects on cardiac conduction and contractility, unlike dihydropyridines (e.g., amlodipine).
• Constipation is a very common side effect (up to 40%) and often requires proactive management (e.g., fiber, stool softeners).
• Avoid in patients with severe left ventricular dysfunction (ejection fraction <30%), sick sinus syndrome (without a pacemaker), or second/third-degree AV block (without a pacemaker).
• Always check for concomitant use of beta-blockers, digoxin, or other AV nodal blocking agents due to increased risk of bradycardia and AV block.
• Grapefruit juice significantly increases verapamil levels; advise patients to avoid it.
• When switching from IV to oral verapamil for arrhythmias, ensure adequate overlap to maintain therapeutic levels.

• Diltiazem (another non-dihydropyridine calcium channel blocker)
• Beta-blockers (e.g., metoprolol, atenolol)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
• Thiazide diuretics (e.g., hydrochlorothiazide)
• Loop diuretics (e.g., furosemide) for heart failure with fluid overload
• Other antiarrhythmics (e.g., amiodarone, flecainide, sotalol) depending on the specific arrhythmia

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it occurred.