Verapamil 2.5mg/ml Inj, 2ml
It is used to treat certain types of abnormal heartbeats.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antiarrhythmic, Antihypertensive
Pharmacologic Class
Calcium Channel Blocker, Non-dihydropyridine
Pregnancy Category
Category C
FDA Approved
Jun 1981
DEA Schedule
Not Controlled
Overview
What is this medicine?
Verapamil injection is a medicine given into a vein to quickly slow down a fast or irregular heartbeat. It works by relaxing blood vessels and affecting the electrical signals in your heart.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Take this medication exactly as directed, and adhere to all guidelines provided. This drug is administered intravenously over a specified period.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
In the event that you miss a dose, contact your doctor immediately to receive guidance on the appropriate course of action.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
In the event that you miss a dose, contact your doctor immediately to receive guidance on the appropriate course of action.
Lifestyle & Tips
- This medication is given in a hospital or clinic setting. No specific lifestyle changes are typically required for the acute IV administration.
- If transitioning to oral verapamil, avoid grapefruit juice as it can increase drug levels.
- Report any dizziness, lightheadedness, or shortness of breath immediately.
Available Forms & Alternatives
Available Strengths:
- Verapamil 120mg ER Capsules
- Verapamil 240mg ER Capsules
- Verapamil 180mg ER Capsules
- Verapamil 40mg Tablets
- Verapamil 360mg SR Capsules
- Verapamil 2.5mg/ml Inj, 4ml
- Verapamil 80mg Tablets
- Verapamil 120mg Tablets
- Verapamil ER 100mg Caps PM (24 Hr)
- Verapamil ER 200mg Capsules (24 Hr)
- Verapamil ER 300mg Capsules (24 Hr)
- Verapamil ER 240mg Tablets
- Verapamil 2.5mg/ml Inj, 2ml
- Verapamil ER 180mg Tablets
- Verapamil ER 120mg Tablets
- Verapamil 80mg Tablets
- Verapamil 2.5mg/ml Inj, 4ml
- Verapamil 2.5mg/ml Inj, 5x2ml Vial
- Verapamil 40mg Tablets
- Verapamil 120mg Tablets
- Verapamil ER 300mg Capsules
Dosing & Administration
Adult Dosing
Standard Dose:
Initial: 5-10 mg IV bolus over 2-3 minutes. May repeat 10 mg IV bolus 30 minutes after initial dose if inadequate response. Maintenance: Not typically used as continuous infusion for acute SVT, but can be considered for rate control in AF/AFL (e.g., 0.005 mg/kg/min up to 0.01 mg/kg/min after bolus, though less common than diltiazem).
Dose Range:
5 - 10 mg
Condition-Specific Dosing:
Supraventricular Tachyarrhythmias (SVT):
Initial: 5-10 mg IV bolus over 2-3 minutes. If inadequate response, 10 mg IV bolus 30 minutes after initial dose. Max total initial dose: 20 mg.
Atrial Fibrillation/Flutter (rate control):
Initial: 5-10 mg IV bolus over 2-3 minutes. If inadequate response, 10 mg IV bolus 30 minutes after initial dose. Max total initial dose: 20 mg. Continuous infusion not standard for acute rate control but may be used in specific cases (e.g., 0.005 mg/kg/min to 0.01 mg/kg/min after bolus).
Pediatric Dosing
Neonatal:
Not established. Use with extreme caution due to risk of severe hypotension and bradycardia.
Infant:
0.1-0.2 mg/kg (max 5 mg) IV bolus over 2-3 minutes. May repeat in 30 minutes if needed. Close monitoring required.
Child:
0.1-0.3 mg/kg (max 10 mg) IV bolus over 2-3 minutes. May repeat in 30 minutes if needed. Close monitoring required.
Adolescent:
Similar to adult dosing: 5-10 mg IV bolus over 2-3 minutes. May repeat 10 mg IV bolus 30 minutes after initial dose if inadequate response.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment required, but monitor for exaggerated effects.
Moderate:
No specific dose adjustment required, but monitor for exaggerated effects.
Severe:
Use with caution. Consider lower initial doses and slower administration. Monitor closely for adverse effects.
Dialysis:
Verapamil is not significantly removed by hemodialysis. No specific supplemental dose needed, but monitor for exaggerated effects.
Hepatic Impairment:
Mild:
Consider lower initial doses (e.g., 2.5-5 mg) and slower administration. Monitor closely.
Moderate:
Reduce initial dose by 30-50% (e.g., 2.5-5 mg) and administer slowly. Monitor closely for adverse effects.
Severe:
Contraindicated or use with extreme caution and significant dose reduction (e.g., 2.5 mg initial dose) due to extensive hepatic metabolism. Monitor closely for adverse effects.
Confidence:
Medium
Pharmacology
Mechanism of Action
Verapamil is a non-dihydropyridine calcium channel blocker. It inhibits the transmembrane 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 myocardial oxygen demand. 2) Depression of SA node automaticity and AV node conduction, prolonging the effective refractory period and slowing conduction through the AV node, which is beneficial in treating supraventricular tachyarrhythmias.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
3-5 minutes (IV)
FoodEffect:
Not applicable for IV formulation
Distribution:
Vd:
1.8-5.5 L/kg
ProteinBinding:
90%
CnssPenetration:
Limited
Elimination:
HalfLife:
2-5 hours (single IV dose); 4.5-12 hours (multiple oral doses)
Clearance:
Not available (highly variable)
ExcretionRoute:
70% renal, 16% fecal
Unchanged:
3-4% (renal)
Pharmacodynamics
OnsetOfAction:
1-5 minutes (IV)
PeakEffect:
3-5 minutes (IV)
DurationOfAction:
10-20 minutes (IV, for acute effects on AV node conduction)
Safety & Warnings
Side Effects
Serious Side Effects: Seek Medical Attention Immediately
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience 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. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Dizziness or headache
Constipation
Reporting Side Effects
This list is not exhaustive, and you may experience other 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.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience 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. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Dizziness or headache
Constipation
Reporting Side Effects
This list is not exhaustive, and you may experience other 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.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Very slow heartbeat
- Shortness of breath or difficulty breathing
- Swelling in ankles or feet
- Chest pain or discomfort
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is crucial to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced.
Certain health conditions, such as:
+ Heart failure (a weakened heart)
+ Specific types of abnormal heart rhythms, including 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
If you have taken disopyramide or flibanserin 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 essential to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions 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 crucial to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced.
Certain health conditions, such as:
+ Heart failure (a weakened heart)
+ Specific types of abnormal heart rhythms, including 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
If you have taken disopyramide or flibanserin 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 essential to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions 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.
Precautions & Cautions
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, stand up slowly after sitting or lying down, and exercise caution 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 supplements.
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 plan to become pregnant, inform your doctor to discuss the benefits and risks of using this medication during pregnancy.
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, stand up slowly after sitting or lying down, and exercise caution 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 supplements.
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 plan to become pregnant, inform your doctor to discuss the benefits and risks of using this medication during pregnancy.
Overdose Information
Overdose Symptoms:
- Profound hypotension
- Severe bradycardia
- High-degree AV block (complete heart block)
- Asystole
- Cardiogenic shock
- Metabolic acidosis
- Hyperglycemia
- Seizures
- Coma
What to Do:
Call 911 immediately. Treatment involves supportive care, IV fluids, calcium gluconate/chloride, atropine, vasopressors (e.g., norepinephrine), glucagon, high-dose insulin-glucose, and potentially cardiac pacing or ECMO. Call 1-800-222-1222 for Poison Control.
Drug Interactions
Contraindicated Interactions
- Beta-blockers (IV, concurrent use due to risk of severe bradycardia, AV block, and myocardial depression)
- Disopyramide (within 48 hours before or 24 hours after verapamil due to severe myocardial depression)
- Dantrolene (IV, due to risk of hyperkalemia and cardiovascular collapse)
- Ivabradine (risk of excessive bradycardia)
- Quinidine (in patients with hypertrophic obstructive cardiomyopathy due to severe hypotension)
- Patients with wide complex tachycardias (unless known to be supraventricular with aberrancy, as it can cause hemodynamic collapse in ventricular tachycardia)
Major Interactions
- Digoxin (increases digoxin levels, risk of toxicity)
- Amiodarone (risk of bradycardia, AV block, hypotension)
- Flecainide (additive negative inotropic effects)
- Statins (e.g., simvastatin, lovastatin - increased statin levels, risk of myopathy/rhabdomyolysis)
- Cyclosporine, Tacrolimus, Sirolimus (increased immunosuppressant levels)
- Carbamazepine (increased carbamazepine levels, toxicity)
- Theophylline (increased theophylline levels)
- Rifampin (decreased verapamil levels)
- Phenobarbital, Phenytoin (decreased verapamil levels)
- Grapefruit juice (increases verapamil levels, not relevant for acute IV use but important for oral)
Moderate Interactions
- Alpha-blockers (e.g., prazosin - additive hypotensive effects)
- Clonidine (additive bradycardia/hypotension)
- Lithium (neurotoxicity)
- Cimetidine (increased verapamil levels)
- Erythromycin, Clarithromycin (increased verapamil levels)
- Midazolam, Triazolam (increased benzodiazepine levels)
- Fentanyl (additive bradycardia/hypotension)
Minor Interactions
- Aspirin (may increase bleeding risk with other antiplatelets)
- NSAIDs (may reduce antihypertensive effect)
Monitoring
Baseline Monitoring
Electrocardiogram (ECG)
Rationale: To assess baseline rhythm, PR interval, QRS duration, and rule out contraindications like wide complex tachycardia or high-degree AV block.
Timing: Prior to administration
Blood Pressure (BP)
Rationale: To establish baseline and monitor for hypotension.
Timing: Prior to administration
Heart Rate (HR)
Rationale: To establish baseline and monitor for bradycardia.
Timing: Prior to administration
Cardiac function (e.g., signs of heart failure)
Rationale: Verapamil has negative inotropic effects; assess for pre-existing heart failure.
Timing: Prior to administration
Routine Monitoring
Electrocardiogram (ECG) monitoring
Frequency: Continuous during and after administration for at least 30-60 minutes
Target: Normal sinus rhythm or controlled ventricular rate; PR interval < 0.20 seconds (unless pre-existing AV block)
Action Threshold: Development of new AV block (2nd or 3rd degree), significant bradycardia (<50 bpm), or worsening of arrhythmia
Blood Pressure (BP)
Frequency: Every 2-5 minutes during administration, then every 5-15 minutes for 30-60 minutes post-dose
Target: Maintain systolic BP > 90 mmHg (or patient's baseline)
Action Threshold: Significant hypotension (e.g., SBP < 90 mmHg or symptomatic drop)
Heart Rate (HR)
Frequency: Continuous during and after administration
Target: Maintain HR > 50 bpm (unless target for rate control is lower and tolerated)
Action Threshold: Significant bradycardia (<50 bpm or symptomatic drop)
Peripheral perfusion/mental status
Frequency: Continuously
Target: Normal
Action Threshold: Signs of hypoperfusion (e.g., altered mental status, cool extremities)
Symptom Monitoring
- Dizziness
- Lightheadedness
- Syncope
- Chest pain
- Shortness of breath
- Palpitations
- Signs of heart failure (e.g., edema, dyspnea)
Special Patient Groups
Pregnancy
Category C. Use only if the potential benefit justifies the potential risk to the fetus. Verapamil crosses the placenta.
Trimester-Specific Risks:
First Trimester:
Limited data, but animal studies show some evidence of embryotoxicity/teratogenicity at high doses. Human data are insufficient to rule out risk.
Second Trimester:
Generally considered safer than first trimester, but still Category C. Monitor fetal heart rate and maternal blood pressure.
Third Trimester:
May cause fetal bradycardia, hypotension, and decreased uterine blood flow. Use with caution, especially near term.
Lactation
L3 (Moderately Safe). Verapamil is excreted into breast milk. Monitor breastfed infant for bradycardia, hypotension, and sedation.
Infant Risk:
Low to moderate risk. Potential for bradycardia, hypotension, and sedation in the infant. Observe infant for adverse effects. Consider alternative if infant is premature or has underlying cardiac issues.
Pediatric Use
Use with extreme caution, especially in infants, due to increased risk of severe hypotension and bradycardia. Dosing is weight-based and requires careful titration and continuous monitoring. Contraindicated in infants with wide complex tachycardia or known accessory pathways.
Geriatric Use
Start with lower doses and titrate slowly due to increased sensitivity to hypotensive and bradycardic effects, and potential for decreased hepatic/renal function. Monitor closely for adverse effects.
Clinical Information
Clinical Pearls
- Always administer IV verapamil slowly (over 2-3 minutes) to minimize the risk of hypotension and bradycardia.
- Ensure continuous ECG and blood pressure monitoring during and for at least 30-60 minutes after administration.
- Verapamil is contraindicated in patients with wide complex tachycardias of unknown origin, as it can cause hemodynamic collapse in ventricular tachycardia.
- Avoid concurrent IV beta-blocker administration due to synergistic negative chronotropic and inotropic effects.
- Have calcium gluconate/chloride, atropine, and vasopressors readily available for managing severe hypotension or bradycardia.
- Consider alternative agents (e.g., adenosine) for SVT if contraindications to verapamil exist or if patient is hemodynamically unstable.
- Hepatic impairment significantly prolongs verapamil's half-life; dose reduction is crucial.
Alternative Therapies
- Adenosine (for SVT)
- Diltiazem (another non-dihydropyridine CCB, often preferred for rate control in AF/AFL due to less negative inotropy)
- Beta-blockers (e.g., Metoprolol, Esmolol for rate control in AF/AFL or SVT)
- Digoxin (for rate control in AF/AFL, especially with heart failure)
- Amiodarone (for various arrhythmias, including rate control in AF/AFL with heart failure)
Cost & Coverage
Average Cost:
Highly variable, typically $5 - $20 per 2ml vial (2.5mg/ml) per 2ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic)
General Drug Facts
If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly: do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the quantity, and the time of ingestion to ensure prompt and effective treatment.