Verapamil 2.5mg/ml Inj, 4ml
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, Antianginal
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 is a medication given by injection, usually in a hospital setting, to quickly slow down a very fast or irregular heartbeat. It works by relaxing blood vessels and slowing down electrical signals in the heart, which helps the heart beat more regularly and efficiently.
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and carefully read all accompanying information. Adhere to the guidelines provided to ensure safe and effective use. This medication 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 appropriate storage method.
In the event that you miss a dose, contact your doctor promptly to receive guidance on the next steps to take.
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the appropriate storage method.
In the event that you miss a dose, contact your doctor promptly to receive guidance on the next steps to take.
Lifestyle & Tips
- This medication is typically administered in an acute care setting, so lifestyle modifications are not directly applicable during administration.
- Patients should follow their doctor's advice regarding diet, exercise, and avoidance of alcohol or grapefruit products if they are later prescribed oral verapamil.
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 30 minutes after initial dose if inadequate response.
Dose Range:
5 - 10 mg
Condition-Specific Dosing:
Supraventricular Tachyarrhythmias (PSVT, Atrial Fibrillation/Flutter with rapid ventricular response):
Initial: 5-10 mg IV bolus over 2-3 minutes. If response is inadequate, 10 mg may be administered 30 minutes after the initial dose. Alternatively, a continuous IV infusion of 0.005 mg/kg/min (5 mcg/kg/min) may be initiated after the bolus.
Pediatric Dosing
Neonatal:
Not established (use with extreme caution due to risk of severe bradycardia, hypotension, and cardiac arrest)
Infant:
0.1-0.2 mg/kg (max 2 mg) IV bolus over 2-3 minutes. May repeat in 30 minutes if needed (max 10 mg total). Use with extreme caution.
Child:
0.1-0.3 mg/kg (max 5 mg) IV bolus over 2-3 minutes. May repeat in 30 minutes if needed (max 10 mg total).
Adolescent:
0.1-0.3 mg/kg (max 5 mg) IV bolus over 2-3 minutes. May repeat in 30 minutes if needed (max 10 mg total).
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment required, but monitor for exaggerated effects.
Moderate:
No specific adjustment required, but monitor for exaggerated effects.
Severe:
No specific adjustment required, but monitor for exaggerated effects.
Dialysis:
Not significantly removed by hemodialysis. Monitor for exaggerated effects.
Hepatic Impairment:
Mild:
Consider dose reduction (e.g., 25-50% of normal dose) and careful titration due to prolonged half-life and increased bioavailability.
Moderate:
Consider dose reduction (e.g., 25-50% of normal dose) and careful titration due to prolonged half-life and increased bioavailability.
Severe:
Contraindicated in severe hepatic impairment due to extensive hepatic metabolism and risk of accumulation.
Pharmacology
Mechanism of Action
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 relaxation of vascular smooth muscle, resulting in vasodilation and decreased peripheral vascular resistance. In the heart, it decreases myocardial contractility, slows sinoatrial (SA) node automaticity, and prolongs atrioventricular (AV) node conduction, thereby decreasing heart rate and prolonging the PR interval. These actions reduce myocardial oxygen demand and can terminate re-entrant supraventricular tachycardias.
Pharmacokinetics
Absorption:
Bioavailability:
100% (IV)
Tmax:
Not applicable (IV bolus, immediate effect)
FoodEffect:
Not applicable (IV)
Distribution:
Vd:
1.8-5.5 L/kg
ProteinBinding:
90%
CnssPenetration:
Limited
Elimination:
HalfLife:
2-5 hours (IV, single dose); 4.5-12 hours (multiple oral doses)
Clearance:
Not available
ExcretionRoute:
Renal (70%), Fecal (16%)
Unchanged:
<4% (renal)
Pharmacodynamics
OnsetOfAction:
1-5 minutes (IV)
PeakEffect:
3-5 minutes (IV)
DurationOfAction:
10-20 minutes (IV)
Safety & Warnings
Side Effects
Urgent 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, contact 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, contact 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 lightheadedness
- Fainting
- Slow or irregular heartbeat
- Shortness of breath
- Swelling in the ankles or feet
- Chest pain
Before Using This Medicine
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
- Wolff-Parkinson-White syndrome
+ Low blood pressure
+ A slow heartbeat
Medications you are currently taking, including:
+ Dofetilide
+ Ivabradine
+ Quinidine
+ Beta blockers, such as:
- Atenolol
- Metoprolol
- 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
Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure it is safe to take this medication. Never start, stop, or change the dose of any medication without consulting your doctor first.
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
- Wolff-Parkinson-White syndrome
+ Low blood pressure
+ A slow heartbeat
Medications you are currently taking, including:
+ Dofetilide
+ Ivabradine
+ Quinidine
+ Beta blockers, such as:
- Atenolol
- Metoprolol
- 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
Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure it is safe to take this medication. 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, 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 taking 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 planning to become pregnant, consult 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, 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 taking 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 planning to become pregnant, consult your doctor to discuss the benefits and risks of using this medication during pregnancy.
Overdose Information
Overdose Symptoms:
- Profound hypotension (very low blood pressure)
- Severe bradycardia (very slow heart rate)
- High-degree AV block (heart block)
- Asystole (cardiac arrest)
- Cardiogenic shock
- Metabolic acidosis
- Hyperglycemia
What to Do:
Immediate medical attention is required. Treatment is supportive and may include IV calcium gluconate/chloride, atropine, vasopressors (e.g., norepinephrine), glucagon, high-dose insulin-glucose therapy, and cardiac pacing. Call 911 or emergency services immediately.
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)
- Dantrolene (IV)
- Ivabradine
- Colchicine (in patients with renal or hepatic impairment)
- Fingolimod
Major Interactions
- Digoxin (increases digoxin levels, monitor and reduce digoxin dose)
- Amiodarone (additive bradycardia, AV block, hypotension)
- Flecainide (additive negative inotropic effects)
- Quinidine (hypotension, pulmonary edema)
- Statins (e.g., simvastatin, lovastatin - increased statin levels, risk of myopathy/rhabdomyolysis)
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir - increased verapamil levels)
- CYP3A4 inducers (e.g., rifampin, phenobarbital - decreased verapamil levels)
- Alpha-blockers (e.g., prazosin - increased hypotensive effect)
- Clonidine (risk of severe bradycardia/AV block)
- Neuromuscular blockers (potentiates effects)
- Lithium (neurotoxicity)
Moderate Interactions
- Carbamazepine (increased carbamazepine levels)
- Cyclosporine (increased cyclosporine levels)
- Theophylline (increased theophylline levels)
- Buspirone (increased buspirone levels)
- Midazolam (increased midazolam levels)
- Grapefruit juice (increased verapamil levels)
- Alcohol (potentiates hypotensive effects)
Minor Interactions
- Aspirin (may increase bleeding risk with other antiplatelets)
- Cimetidine (may increase verapamil levels)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and assess risk of hypotension.
Timing: Prior to administration
Heart Rate (HR)
Rationale: To establish baseline and assess risk of bradycardia.
Timing: Prior to administration
Electrocardiogram (ECG)
Rationale: To assess baseline rhythm, PR interval, QRS duration, and identify pre-existing AV block or accessory pathways.
Timing: Prior to administration
Left Ventricular Function
Rationale: To assess for severe LV dysfunction, a contraindication.
Timing: Prior to administration (if not recently assessed)
Routine Monitoring
Blood Pressure (BP)
Frequency: Continuously or every 2-5 minutes during and after administration until stable
Target: Maintain systolic BP >90 mmHg (or patient's baseline)
Action Threshold: Systolic BP <90 mmHg or significant drop from baseline; administer IV fluids, vasopressors if needed.
Heart Rate (HR)
Frequency: Continuously or every 2-5 minutes during and after administration until stable
Target: Maintain HR >50 bpm (or patient's baseline)
Action Threshold: HR <50 bpm or significant bradycardia; administer atropine, consider pacing.
ECG (Rhythm and PR interval)
Frequency: Continuous cardiac monitoring during and for several hours after administration
Target: Normal sinus rhythm or controlled ventricular rate; PR interval <0.20 seconds (unless pre-existing prolonged PR)
Action Threshold: Development of 2nd/3rd degree AV block, asystole, or significant PR prolongation; discontinue verapamil, administer atropine, calcium, glucagon, consider pacing.
Signs/Symptoms of Heart Failure
Frequency: Ongoing clinical assessment
Target: Absence of new or worsening dyspnea, edema, crackles
Action Threshold: Development or worsening of heart failure symptoms; discontinue verapamil, manage heart failure.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fainting (syncope)
- Chest pain
- Shortness of breath
- Swelling in ankles/feet
- Palpitations
- Fatigue
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. Avoid if possible.
Second Trimester:
May be used if clearly needed, with careful monitoring of maternal and fetal heart rate and 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. Consider alternative if possible, especially in preterm or neonates.
Infant Risk:
Low to moderate risk of adverse effects (e.g., bradycardia, hypotension, lethargy) in breastfed infants. Monitor closely.
Pediatric Use
Use with extreme caution, especially in infants and neonates, due to increased risk of severe bradycardia, hypotension, and cardiac arrest. Dosing must be carefully calculated based on weight, and continuous cardiac monitoring is essential. Contraindicated in infants with wide complex tachycardia or 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 several hours after IV administration.
- Have resuscitation equipment (atropine, calcium, vasopressors, pacing equipment) readily available.
- Verapamil is contraindicated in patients with wide complex tachycardia of unknown origin, as it can worsen outcomes in ventricular tachycardia.
- Avoid concurrent IV beta-blocker administration due to synergistic negative inotropic and chronotropic effects.
- Calcium gluconate/chloride can be used to reverse some of the cardiovascular effects of verapamil overdose or severe adverse reactions.
- Carefully assess for signs of heart failure before administration, as verapamil can exacerbate myocardial depression.
Alternative Therapies
- Adenosine (for PSVT)
- Diltiazem (another non-dihydropyridine CCB, for SVT, Afib/flutter rate control)
- Beta-blockers (e.g., metoprolol, esmolol - for SVT, Afib/flutter rate control)
- Digoxin (for Afib/flutter rate control, especially in heart failure)
- Amiodarone (for various arrhythmias, including Afib/flutter rate/rhythm control)
Cost & Coverage
Average Cost:
Not available (varies widely by supplier and contract) per 4ml vial
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic)
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure safe use, never share your medication with others, and do not take medication prescribed to someone else.
Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Properly dispose of unused or expired medications. Unless instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities have drug take-back programs, which your pharmacist can help you locate.
Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to 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 critical information, including the name of the medication, the amount taken, and the time it was taken, to ensure prompt and effective treatment.
Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Properly dispose of unused or expired medications. Unless instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities have drug take-back programs, which your pharmacist can help you locate.
Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to 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 critical information, including the name of the medication, the amount taken, and the time it was taken, to ensure prompt and effective treatment.