Verapamil - instructions for use, reviews, analogs and formulations (tablets and pills, 40 mg and 80 mg, 240 mg (fort), injections in ampoules for injections) drugs for the treatment of heart rhythm disorders in adults, children and pregnancy

In this article, you can read the instructions for using the drug Verapamil. Comments of visitors of the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Verapamil in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Verapamil in the presence of existing structural analogues. Use to treat heart rhythm disturbances in adults, children,as well as during pregnancy and lactation.

Verapamil - refers to the group of blockers of "slow" calcium channels. Has antiarrhythmic, anti-anginal and antihypertensive activity.

Reduces the need for myocardium in oxygen by decreasing myocardial contractility and reducing the heart rate. Causes the enlargement of the coronary vessels of the heart and increases coronary blood flow; reduces the tone of the smooth muscles of peripheral arteries and the general peripheral vascular resistance.

Verapamil significantly slows the atrioventricular conduction, depresses the automatism of the sinus node, which allows the use of the drug for the treatment of supraventricular arrhythmias.

Has an effect in angina pectoris, as well as in the treatment of angina with supraventricular rhythm disorders. Suppresses metabolism involving cytochrome P450.

Composition

Verapamil hydrochloride + excipients.

Pharmacokinetics

It binds to blood plasma proteins by 90%. Penetrates through the blood-brain and placental barrier and into breast milk (in small amounts).Rapidly metabolized in the liver by N-dealkylation and O-demethylation with the formation of several metabolites. Accumulation of the drug and its metabolites in the body explains the increased effect of course treatment. It is excreted by the kidneys 70% (unchanged 3-5%), with bile 25%.

Indications

Treatment and prevention of cardiac arrhythmias:

• paroxysmal supraventricular tachycardia;
• flutter and atrial fibrillation (tachyarrhythmic variant);
• supraventricular extrasystole.

Treatment and prevention:

• chronic stable angina (stress angina);
• unstable angina;
• vasospastic angina (Prinzmetal angina);

Treatment of arterial hypertension.

Forms of release

The tablets covered with a cover, and dragees of 40 mg and 80 mg.

The tablets covered with a cover, the prolonged action of 240 mg.

Solution for intravenous administration (injections in ampoules for injection).

Instructions for use and dosage

Pills

Verapamil is taken orally during or after a meal, with a small amount of water.

The dosage regimen and duration of treatment are set individually, depending on the patient's condition, severity, the features of the course of the disease and the effectiveness of therapy.

To prevent attacks of angina pectoris, arrhythmia and in the treatment of hypertension, the drug is prescribed to adults at an initial dose of 40-80 mg 3-4 times a day. If necessary, increase the single dose to 120-160 mg. The maximum daily dose of the drug is 480 mg.

In patients with severe hepatic impairment, withdrawal of verapamil from the body is slow, so it is advisable to start treatment with minimal doses. The daily dose of the drug should not exceed 120 mg.

Ampoules

Enter intravenously (in the form of a dropper), slowly, for at least 2 minutes, with continuous monitoring of the electrocardiogram, heart rate and blood pressure. In elderly patients, the introduction is carried out for at least 3 minutes to reduce the risk of unwanted effects.

To stop paroxysmal arrhythmias, intravenous, jet (under the control of ECG and AD) 2-5 ml of 0.25% solution (5-10 mg) is administered. If there is no effect, re-administration after 30 minutes at the same dose is possible. A solution of verapamil is prepared by diluting 2 ml of 0.25% solution of the drug in 100-150 ml of 0.9% sodium chloride solution.

Side effect

• pronounced bradycardia (not less than 50 beats per minute);
• marked decrease in blood pressure;
• development or exacerbation of heart failure;
• tachycardia;
• possibly the development of angina, up to myocardial infarction (especially in patients with severe obstructive lesion of the coronary arteries);
• arrhythmias (including fibrillation and flutter of the ventricles);
• atrioventricular blockade of the 3rd degree;
• asystole;
• collapse;
• dizziness;
• headache;
• fainting;
• anxiety;
• retardation;
• increased fatigue;
• asthenia;
• drowsiness;
• depression;
• extrapyramidal disorders;
• nausea;
• itching;
• rash;
• hyperemia of the facial skin;
• multiforme exudative erythema (including Stevens-Johnson syndrome);
• transient loss of vision against a background of maximum concentration;
• pulmonary edema;
• thrombocytopenia is asymptomatic;
• peripheral edema (edema of the ankles, feet and shins).

Contraindications

• chronic heart failure 2B-3 degree;
• arterial hypotension;
• acute myocardial infarction;
• sinoatrial blockade;
• syndrome of weakness of the sinus node;
• stenosis of the aortic aorta;
• Morgagni-Adams-Stokes syndrome;
• digitalis intoxication;
• atrioventricular block 2 and 3 degrees;
• ventricular tachycardia;
• cardiogenic shock;
• Wolff-Parkinson-White syndrome or Laun-Ganong-Levin syndrome in combination with flutter or atrial fibrillation (except for patients with a pacemaker);
• porphyria;
• pregnancy;
• lactation period;
• parenteral administration during the previous 2 hours of any beta-blocker,
• age under 18 years (effectiveness and safety not established);
• hypersensitivity to the components of the drug.

Application in pregnancy and lactation

Contraindicated during pregnancy and lactation.

special instructions

In the treatment it is necessary to control the function of the cardiovascular and respiratory systems, the content of glucose and electrolytes in the blood, the volume of circulating blood and the amount of excreted urine. Can prolong the PQ interval at a plasma concentration higher than 30 ng / ml. It is not recommended to stop treatment suddenly.

Impact on the ability to drive vehicles and manage mechanisms

With caution apply during work drivers of vehicles and people whose profession is associated with increased concentration of attention (reduces the reaction rate).

Drug Interactions

Increases the concentration in the blood of digoxin, theophylline, prazosin, cyclosporine, carbamazepine, muscle relaxants, quinidine, valproic acid due to suppression of metabolism involving cytochrome P450.

Cimetidine increases the bioavailability of verapamil by almost 40% (due to reduced metabolism in the liver), so it may be necessary to reduce the dose of the latter.

Calcium preparations reduce the effectiveness of verapamil. Rifampicin, barbiturates, nicotine, accelerating metabolism in the liver, lead to a decrease in the concentration of verapamil in the blood, reduce the severity of antianginal, hypotensive and antiarrhythmic action.

With simultaneous use with inhalation anesthetics, the risk of bradycardia, atrioventricular blockade, and heart failure increases. Procainamide, quinidine and other drugs that cause prolongation of the QT interval increase the risk of significant lengthening of the latter.

Combination with beta-blockers can lead to an increase in the negative inotropic effect, an increased risk of developing atrioventricular conduction disorders,bradycardia (the administration of verapamil and beta-blockers should be performed at intervals of several hours).

Prazosin and other alpha-adrenoblockers increase the hypotensive effect. Nonsteroidal anti-inflammatory drugs reduce the hypotensive effect due to suppression of prostaglandin synthesis, delay of sodium ions and fluid in the body.

Increases the concentration of cardiac glycosides (requires careful monitoring and reduction of the dose of cardiac glycosides).

Sympathomimetics reduce the hypotensive effect of verapamil.

Dysopyramide and flecainide should not be administered within 48 hours before and 24 hours after the use of verapamil (summation of a negative inotropic effect, up to a fatal outcome).

Estrogens reduce the hypotensive effect due to fluid retention in the body. It is possible to increase concentrations in the blood plasma of drugs characterized by a high degree of binding to proteins (including coumarin and indanedione derivatives, nonsteroidal anti-inflammatory drugs, quinine, salicylates, sulfinpyrazone).

Drugs that reduce blood pressure, increase the hypotensive effect of verapamil.

Increases the risk of neurotoxic effect of lithium drugs.Strengthens the activity of peripheral muscle relaxants (may require a change in the dosage regimen).

Analogues of the drug Verapamil

Structural analogs for the active substance:

• Veracard;
• Verapamil Mival;
• Verapamil Sopharma;
• Verapamil Lect;
• Verapamil ratopharm;
• Verapamil Eskom;
• Verapamil hydrochloride injection 0.25%;
• Vero Verapamil;
• Verohalide EP 240 mg;
• Isoptin;
• Isoptin SR 240;
• Kaveril;
• Leukoptin;
• Finoptin.

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