Verapamil pills 80mg №30

Indications

Treatment and prevention of coronary artery disease: chronic stable angina (exertional angina), unstable angina, vasospastic angina (Prinzmetal angina / variant angina).

Treatment and prevention of cardiac arrhythmias: paroxysmal supraventricular tachycardia, chronic atrial flutter and atrial fibrillation (tachyarrhythmic variant), supraventricular extrasystole.

Arterial hypertension. Hypertensive crisis.

Hypertrophic cardiomyopathy.

Dosage and administration

Individual. Inside adults - in the initial dose of 40-80 mg 3 times / day. For dosage forms of prolonged action, a single dose should be increased, and the frequency of administration should be reduced. Children aged 6-14 years - 80-360 mg / day, up to 6 years - 40-60 mg / day; reception frequency - 3-4 times / day.

If necessary, Verapamil can be administered intravenously (slowly, under the control of blood pressure, heart rate, and ECG). A single dose for adults is 5-10 mg, in the absence of effect after 20 minutes it is possible to re-enter in the same dose. A single dose for children aged 6-14 years is 2.5-3.5 mg, 1-5 years - 2-3 mg, up to 1 year - 0.75-2 mg. For patients with severely impaired liver function, the daily dose of verapamil should not exceed 120 mg.

Maximum Daily Dose for adults, ingestion is 480 mg.

Side effect

Cardiovascular: bradycardia (less than 50 beats / min), pronounced decrease in blood pressure, development or worsening of heart failure, tachycardia; rarely - angina, up to the development of myocardial infarction (especially in patients with severe obstructive damage to the coronary arteries), arrhythmia (including flicker and ventricular flutter); with a rapid on / in the introduction - AV-blockade III degree, asystole, collapse.

From the side of the central nervous system and peripheral nervous system: dizziness, headache, fainting, anxiety, lethargy, fatigue, asthenia, drowsiness, depression, extrapyramidal disorders (ataxia, mask-like face, shuffling gait, stiffness of arms or legs, hand and finger shake, difficulty in swallowing).

Gastrointestinal: nausea, constipation (rarely - diarrhea), gingival hyperplasia (bleeding, soreness, swelling), increased appetite, increased activity of hepatic transaminases and alkaline phosphatase.

Allergic reactions: skin itch, skin rash, flushing of the skin of the face, erythema multiforme exudative (including Stevens-Johnson syndrome).

Other: weight gain, very rarely - agranulocytosis, gynecomastia, hyperprolactinemia, galactorrhea, arthritis, transient vision loss against the background of maximum plasma concentration (with intravenous administration), pulmonary edema, asymptomatic thrombocytopenia, peripheral edema.

Contraindications

Cardiogenic shock,heart failure, marked impairment of the contractile function of the left ventricle, severe hypotension (systolic blood pressure less than 90 mm Hg), bradycardia; SSS, sinoatrial block, AV block II and III degrees (except for patients with a pacemaker); atrial flutter and atrial fibrillation in combination with WPW syndrome or Laun-Ganng-Levine syndrome (except for patients with a pacemaker); simultaneous administration with colchicine, dantrolene, aliskiren, sertindole; pregnancy, lactation (breastfeeding); hypersensitivity to verapamil.

Use during pregnancy and lactation

Verapamil is contraindicated during pregnancy and lactation.

Application for violations of the liver

C caution should be used for liver failure.

Application for violations of kidney function

C caution should be used in renal failure.

Use in children

C caution should be used in children and adolescents under the age of 18 years (efficacy and safety of use have not been investigated).

Use in elderly patients

C caution should be used in elderly patients.

Special notes

C caution should be used for AV block I degree, bradycardia, severe aortic stenosis, chronic heart failure, with mild or moderate arterial hypotension, in the acute phase of myocardial infarction, obstructive hypertrophic cardiomyopathy, with hepatic and / or renal failure, in elderly patients age, in children and adolescents under the age of 18 years (efficacy and safety of use have not been studied).

If necessary, combination therapy of angina and arterial hypertension with verapamil and beta-blockers is possible. However, it should be avoided in / in the introduction of beta-blockers against the background of the use of verapamil.

Influence on ability to drive motor transport and control mechanisms

After taking verapamil, individual reactions (drowsiness, dizziness) are possible, affecting the patient's ability to perform work that requires high concentration of attention and speed of psychomotor reactions.

Drug interaction

With simultaneous use with antihypertensive drugs (vasodilators, thiazide diuretics, ACE inhibitors), there is a mutual reinforcement of antihypertensive action.

With simultaneous use with beta-blockers, antiarrhythmic drugs, means for inhalation anesthesia increases the risk of bradycardia, AV blockade, severe arterial hypotension, heart failure, due to the mutual intensification of the inhibitory effect on the sinoatrial node automatism and AV conductivity, contractility and conductivity myocardium.

With parenteral administration of verapamil to patients who have recently received beta-blockers, there is a risk of arterial hypotension and asystole.

At simultaneous use with nitrates antianginal action of verapamil amplifies.

With simultaneous use with aliskiren, its concentration in plasma increases and the risk of side effects increases.

With simultaneous use with Amiodarone, the negative inotropic effect, bradycardia, conduction disturbance, and AV blockade increase.

Since verapamil inhibits the CYP3A4 isoenzyme, which is involved in the metabolism of Atorvastatin, lovastatin and Simvastatin, it is theoretically possible manifestations of drug interactions, due to increased concentrations of statins in plasma. Cases of the development of rhabdomyolysis are described.

With simultaneous use with Acetylsalicylic acid, cases of increased bleeding time due to additive antiplatelet action are described.

With simultaneous use with buspirone, the concentration of buspirone in the blood plasma increases, its therapeutic and side effects increase.

With the simultaneous introduction of verapamil and dantrolen (IV) in experimental studies in animals, ventricular fibrillation was observed with a fatal outcome. This combination is potentially dangerous.

With simultaneous use with Digoxin, cases of increasing the concentration of digitoxin in the blood plasma are described.

With simultaneous use of digoxin, the concentration of digoxin in the blood plasma increases.

With simultaneous use with disopyramide, severe hypotension and collapse are possible, especially in patients with cardiomyopathy or decompensated heart failure. The risk of developing severe manifestations of drug interactions is apparently associated with an increase in negative inotropic action.

With simultaneous use with Diclofenac decreases the concentration of verapamil in the blood plasma; with doxorubicin - the concentration of doxorubicin in the blood plasma increases and its effectiveness increases.

With simultaneous use with imipramine, the concentration of imipramine in the blood plasma increases and there is a risk of undesirable changes on the ECG. Verapamil increases the bioavailability of imipramine by reducing its clearance. The changes on the ECG are due to an increase in the concentration of imipramine in the blood plasma and the additive inhibitory effect of verapamil and imipramine on AV conduction.

With simultaneous use with Carbamazepine, the effect of carbamazepine increases and the risk of side effects from the central nervous system increases due to inhibition of carbamazepine metabolism in the liver under the influence of verapamil.

With simultaneous use with clonidine described cases of cardiac arrest in patients with arterial hypertension.

Increases the plasma concentration of colchicine (CYP3A isoenzyme substrate and P-glycoprotein).

With simultaneous use of lithium carbonate, drug interactions are ambiguous and unpredictable. Cases of enhancing the effects of lithium and the development of neurotoxicity, reducing the concentration of lithium in the blood plasma, severe bradycardia are described.

The vasodilating action of alpha-blockers and Calcium channel blockers may be additive or synergistic.With simultaneous use of terazosin or prazosin and verapamil, the development of severe arterial hypotension is partly due to the pharmacokinetic interaction: an increase in C_max and AUC of terazosin and prazosin.

With simultaneous use of rifampicin induces the activity of liver enzymes, accelerating the metabolism of verapamil, which leads to a decrease in its clinical efficacy.

With simultaneous use with sertindol increases the risk of ventricular heart rhythm, especially ventricular arrhythmias such as pirouette.

With simultaneous use increases the concentration of theophylline in the blood plasma.

With simultaneous use with tubocurarine chloride, vecuronium chloride, it is possible to enhance the muscle relaxant action.

With simultaneous use of phenytoin, phenobarbital, a significant decrease in plasma plasma verapamil is possible.

With simultaneous use with Fluoxetine, the side effects of verapamil are enhanced by slowing its metabolism under the influence of fluoxetine.

With simultaneous use, the clearance of quinidine decreases, its plasma concentration increases and the risk of side effects increases. There have been cases of arterial hypotension.

With simultaneous use of verapamil inhibits the metabolism of cyclosporine in the liver, which leads to a decrease in its excretion and an increase in plasma concentration.This is accompanied by an increase in the immunosuppressive effect, a decrease in manifestations of nephrotoxicity is noted.

When applied simultaneously with cimetidine, the effects of verapamil are enhanced.

With simultaneous use with enflurane, prolongation of anesthesia is possible.

With simultaneous use with etomidom increases the duration of anesthesia.