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Verapamil

Medical and Pharmacy Editor:

Brand Name: Isoptin SR, Calan SR, Covera HS, Isoptin, Isoptin IV, Calan, Verap, Verapamil SR, Verelan, Verelan PM

Generic Name: verapamil

Drug Class: Antidysrhythmics, IV; Calcium Channel Blockers; Calcium Channel Blockers, Non-dihydropyridine

What Is Verapamil and How Does It Work?

Verapamil is indicated to treat hypertension, to treat and prevent chest pain (angina), supraventricular arrhythmia and atrial fibrillation/flutter, chronic atrial fibrillation and paroxysmal supraventricular tachycardia, supraventricular tachycardia (pediatric), and tardive dyskinesia.

Verapamil may also be used to treat Migraines.

Verapamil is available under the following different brand names: Isoptin SR, Calan SR, Covera HS, Isoptin, Isoptin IV, Calan, Verap, Verapamil SR, Verelan, and Verelan PM.

Dosages of Verapamil:

Adult and Pediatric Dosage Forms and Strengths

Injectable solution

  • 2.5 mg/mL

Tablet

  • 40 mg
  • 80 mg
  • 120 mg

Tablet/capsule, extended release

  • 100 mg
  • 120 mg
  • 180 mg
  • 200 mg
  • 240 mg
  • 300 mg
  • 360 mg

Dosage Considerations – Should be Given as Follows:

Angina

  • Adult, Immediate release: 80 mg orally every 8 hours initially; usual range: 80-120 mg orally every 8 hours; not to exceed 480 mg/day
  • Adult, Extended release: Covera-HS: 180 mg/day orally at bedtime initially; maintenance: 180-540 mg/day orally at bedtime
  • Geriatric, Immediate release: 80 mg orally every 8 hours initially; usual range: 80-120 mg orally every 8 hours; not to exceed 480 mg/day
  • Geriatric, Extended release (Covera-HS): 180 mg orally at bedtime initially; maintenance: 180-540 mg orally at bedtime

Hypertension

Adult, Immediate release: 80 mg orally every 8 hours initially; maintenance: 80-320 mg orally every 12 hours

Adult, Extended release

  • Calan, Isoptin SR: 180 mg/day orally given in morning (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day, then to 360 mg/day (either 180 mg every 12 hours or 240 mg in morning and 120 mg in evening)
  • Verelan: 180 mg/day orally (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day orally, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day
  • Verelan PM: 200 mg/day orally at bedtime (100 mg/day if patient elderly or of small stature); may be increased by 100 mg/day at weekly intervals as needed; not to exceed 400 mg/day
  • Covera-HS: 180 mg/day orally at bedtime (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day

Geriatric

  • Immediate release: 40 mg orally every 8 hours initially; maintenance: 80-320 mg orally every 12 hours
  • Extended release (Calan SR, Isoptin SR, Verelan): 120 mg/day orally given in morning
  • Extended release (Covera-HS): 180 mg/day orally at bedtime
  • Extended release (Verelan PM): 100 mg/day orally at bedtime

Supraventricular Arrhythmia and Atrial Fibrillation/Flutter

  • 2.5-5 mg intravenously (IV) over 2 minutes; 5-10 mg dose may be repeated after 15-30 minutes
  • Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose

Chronic Atrial Fibrillation and Paroxysmal Supraventricular Tachycardia

  • Treatment of chronic atrial fibrillation (rate control); prevention of paroxysmal supraventricular tachycardia
  • Immediate release: 240-480 mg/day orally divided every 6-8 hours

Supraventricular Tachycardia, Pediatric

  • Children 1-15 years old: 0.1-0.3 mg/kg (not to exceed 5 mg) intravenously (IV) over 2 minutes; second dose (not to exceed 10 mg) may be given after 30 minutes
  • Alternatively (not well established), 4-8 mg/kg/day orally divided every 8 hours

Tardive Dyskinesia

  • 40 mg orally every 8 hours; may be titrated to 120 mg every 8 hours

Migraine (Off-label)

Dosing Modifications

  • Renal impairment: Use with caution; monitor ECG; for Verelan PM, manufacturer recommends 100 mg at bedtime initially; if CrCl less than 10 mL/min, reduce dose by 25-50%
  • Hepatic impairment: In cirrhosis, reduce dose by 20-50% of normal for oral and intravenous (IV) administration
  • Geriatric: In general, lower initial doses are warranted; doses should be adjusted on basis of clinical response
Medically Reviewed by a Doctor on 4/11/2017



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