Verapamil ER 120mg Tablets

Verapamil is a non-dihydropyridine calcium channel blocker that inhibits the transmembrane influx of calcium ions into cardiac and vascular smooth muscle cells. This leads to a reduction in myocardial contractility, slowing of AV nodal conduction, and peripheral arterial vasodilation. These actions result in decreased systemic vascular resistance, reduced blood pressure, decreased myocardial oxygen demand, and prolongation of the effective refractory period of the AV node.

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 about side effects, 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.

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. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, such as:
+ Heart failure (a weakened heart)
+ 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 crucial 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 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 aids.

Before consuming alcohol, discuss it 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. You will need to discuss the benefits and risks of using this medication during pregnancy to make an informed decision.

• Beta-blockers (IV, concurrent use with oral verapamil in patients with severe ventricular dysfunction or AV block)
• Disopyramide (within 48 hours before or 24 hours after verapamil)
• Dantrolene (IV)
• Ivabradine
• Colchicine (in patients with renal or hepatic impairment)
• Flibanserin
• Lomitapide
• Midazolam (oral)
• Naloxegol
• Ranolazine
• Tolvaptan

• Amiodarone (risk of bradycardia, AV block, hypotension)
• Digoxin (increases digoxin levels, risk of toxicity)
• Statins (e.g., simvastatin, lovastatin - increased risk of myopathy/rhabdomyolysis due to CYP3A4 inhibition)
• Fentanyl (increased risk of respiratory depression, hypotension)
• Clonidine (risk of severe bradycardia, AV block)
• Quinidine (risk of hypotension, pulmonary edema)
• Carbamazepine (increased carbamazepine levels, toxicity)
• Theophylline (increased theophylline levels)
• Cyclosporine, Tacrolimus, Sirolimus, Everolimus (increased immunosuppressant levels)
• Buspirone (increased buspirone levels)
• Erythromycin, Clarithromycin (increased verapamil levels)
• Grapefruit juice (increases verapamil levels)
• Phenobarbital, Rifampin (decreased verapamil levels)
• Dofetilide (increased dofetilide levels, risk of QT prolongation)
• Eplerenone (increased eplerenone levels, risk of hyperkalemia)
• Ticagrelor (increased ticagrelor levels)
• Apixaban, Rivaroxaban, Edoxaban (increased anticoagulant levels, bleeding risk)

• Alpha-blockers (e.g., prazosin - additive hypotensive effects)
• Other antihypertensives (additive hypotensive effects)
• Flecainide (additive negative inotropic and dromotropic effects)
• Lithium (increased lithium levels, neurotoxicity)
• Cimetidine (increased verapamil levels)
• Phenytoin (decreased verapamil levels)
• Sulfinpyrazone (decreased verapamil levels)
• Alcohol (increased alcohol levels, additive CNS depression)
• Cannabis (increased verapamil levels)
• St. John's Wort (decreased verapamil levels)
• Dabigatran (increased dabigatran levels, bleeding risk)

• Aspirin (may increase bleeding risk with other antiplatelets)
• NSAIDs (may reduce antihypertensive effect)

• Dizziness
• Lightheadedness
• Fainting (syncope)
• Shortness of breath
• Swelling in ankles/feet (edema)
• Chest pain (worsening angina)
• Palpitations
• Fatigue
• Constipation
• Headache

Verapamil is Pregnancy Category C. Studies in animals have shown adverse effects on the fetus, but there are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus.

Verapamil is excreted into breast milk. The American Academy of Pediatrics considers verapamil to be compatible with breastfeeding. Monitor the infant for bradycardia, hypotension, and constipation. Lactation Risk Category L3 (Moderately Safe).

Safety and efficacy of extended-release verapamil have not been established in pediatric patients. Not generally recommended for use in children due to lack of data and potential for serious adverse effects, particularly in infants and young children.

Use with caution in elderly patients, as they may be more sensitive to the hypotensive and bradycardic effects of verapamil due to age-related decreases in hepatic and renal function. Consider lower initial doses and slower titration. Monitor closely for adverse effects such as constipation, dizziness, and orthostatic hypotension.

• Verapamil ER should be swallowed whole and not crushed, chewed, or broken, as this can lead to rapid release of the drug and potentially serious adverse effects.
• Constipation is a very common side effect; advise patients on dietary fiber, fluid intake, and potential use of stool softeners.
• Avoid concurrent use with IV beta-blockers due to risk of severe bradycardia, AV block, and asystole.
• Grapefruit juice significantly increases verapamil levels; advise patients to avoid it.
• Monitor for signs of heart failure exacerbation, especially in patients with pre-existing left ventricular dysfunction.
• Verapamil is a potent CYP3A4 inhibitor, leading to numerous drug interactions; always check for potential interactions with new medications.
• Patients should be advised to take their blood pressure and heart rate regularly at home, especially during initial therapy and dose adjustments.

• Other non-dihydropyridine calcium channel blockers (e.g., Diltiazem ER)
• Dihydropyridine calcium channel blockers (e.g., Amlodipine, Nifedipine ER, Felodipine)
• ACE inhibitors (e.g., Lisinopril, Ramipril)
• Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
• Beta-blockers (e.g., Metoprolol ER, Atenolol)
• Thiazide diuretics (e.g., Hydrochlorothiazide, Chlorthalidone)
• Other antiarrhythmics (e.g., Digoxin, Amiodarone for rate control in AFib)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further evaluation and guidance. To ensure your safety and the effectiveness of your treatment, never share your medication with others or take someone else's medication. Some medications may come with additional patient information leaflets, so it is a good idea to consult with your pharmacist for more details. If you have any questions or concerns about your medication, do not hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider for clarification and support. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide crucial information, including the name of the medication taken, the amount, and the time it was taken, to facilitate prompt and appropriate treatment.