Verapamil tabs 80mg #50

Instruction for Verapamil

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Composition

In 1 tablet - verapamil hydrochloride 40 mg or 80 mg.
Wheat starch, lactose, silicon dioxide, MCC, povidone, magnesium stearate, talc - auxiliary components.

Form of release of Verapamil

    tablets in a shell of 40 mg and 80 mg;
    solution for intravenous administration 2.5%;
    prolonged-release tablets 240 mg;
    dragee 40 mg and 80 mg.

pharmachologic effect

Antiarrhythmic, antianginal.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Pharmacological group of drugs, which includes Verapamil - calcium channel blockers. They have antiarrhythmic, antihypertensive and anti-anginal action. The mechanism of action is associated with the blockade of the "slow" calcium channels, which are located in the cells of the myocardium, the conducting system of the heart and the smooth muscle cells of the vessels. In addition, these channels are in the smooth muscles of the urinary tract, bronchus and uterus. As a result of the blockade, the pathologically increased current of calcium ions inside cells is normalized. By decreasing the transmembrane input of Ca2 + into cardiomyocytes, the drug reduces the strength of myocardial contractions and heart rate, and, consequently, myocardial oxygen demand decreases.
Reduces the tone of the musculature of the vessel wall and causes dilatation of predominantly arterioles, which entails a decrease in resistance in a large circle and a decrease in postnagruzka. It also increases coronary blood flow. Slows AV conduction, depresses the automatism of the sinus node, which allows it to be used for the treatment of supraventricular arrhythmias.
Verapamil has more pronounced effect on the conduction system (sinus and atrioventricular node), and the effect on the vessels is less pronounced. Improves the excretory function of the kidneys. It should be remembered that the drug aggravates heart failure, provokes a pronounced bradycardia and an atrioventricular blockade.

Pharmacokinetics

Virtually completely absorbed from the digestive tract. The maximum concentration in the blood is determined after 1-2 hours. 90% bound to blood proteins. Rapidly metabolized in the liver. With the course of treatment, the effect is intensified, which is associated with the accumulation of the drug and its metabolites.
Half-life at a single intake of -3-6 hours, with a long-term up to 12 hours. It is excreted through the kidneys (about 74%).

Indications for use of verapamil

    supraventricular tachycardia;
    stable angina of tension;
    angina with supraventricular rhythm disturbances;
    sinus tachycardia;
    supraventricular extrasystole;
    atrial tachyarrhythmia;
    hypertensive crisis (IV application);
    arterial hypertension.

Contraindications

    severe bradycardia;
    severe LV dysfunction;
    AV blockade of II-III st .;
    hypersensitivity;
    arterial hypotension;
    SSSU;
    pregnancy, breast-feeding.
With caution is prescribed for bradycardia, AV blockade of I st, sinoatrial blockade, CHF, in old age, with hepatic and / or renal insufficiency.

Side effects

More common side reactions:

    bradycardia;
    marked decrease in blood pressure;
    dizziness and headache;
    nausea, constipation;
    redness of the face;
    increase in body weight.

Less common side reactions:

    diarrhea;
    gingival hyperplasia;
    nervousness;
    fatigue;
    retardation;
    skin itching, rash;
    AV blockade of III st., With rapid on / in the introduction;
    agranulocytosis, thrombocytopenia;
    galactorrhea, gynecomastia;
    arthritis;
    peripheral edema;
    pulmonary edema.

Instructions for use Verapamil (Method and dosage)

Tablets Verapamil, instructions for use

Tablets of usual duration of action are taken inside before meals with 40-80 mg three times a day with stenocardia and tachycardia. At increased arterial pressure - in 2 doses, with a daily dose of up to 480 mg. The daily dose for children under 5 years is 40-60 mg.
Prolonged forms with hypertension are prescribed for 240 mg in the morning. It is advisable to start treatment with a lower dose - 120 mg once a day. In the subsequent after 2 weeks, the dose is increased. It is possible to increase it to 480 mg per day in two doses after 12 hours. The dose should not exceed more than 480 mg per day if there is a question about long-term therapy.
To stop the hypertensive crisis, use Verapamil IV in a 5-10 mg jet. In case of paroxysmal disturbances, the rhythm is also injected intravenously in a dose of 5-10 mg. Repeatedly in the same dose after 20-30 minutes, if the effect is absent. For maintenance therapy, I / drip droplets are administered on a solution of dextrose, sodium chloride. A single dose for intravenous administration for children from 1 to 5 years - 2-3 mg.

Overdose

Overdose is manifested by bradycardia, AV blockade and SA blockade, lowering of blood pressure, asystole.
Treatment begins with washing the stomach, taking sorbents. If the conductivity is disturbed, intravenous isoprenaline, Atropine, 10% solution of Calcium gluconate, plasma-substituting solutions are administered. An artificial pacemaker is recommended. To increase blood pressure, alpha-adrenostimulants are prescribed.

Interaction

Inhibitors of CYP3A4 reduce the concentration of verapamil, and an increase in its concentration in the plasma causes grapefruit juice. The drug increases the concentration in the plasma of carbamazepine, cyclosporine, theophylline, quinidine, cardiac glycosides and ethanol. Increases the risk of neurotoxic action of Li + preparations.
Cimetidine increases the bioavailability of verapamil by 50%, so sometimes it becomes necessary to reduce the dose.
Rifampicin significantly reduces its bioavailability.
When combined with inhalation anesthetics, there is a risk of bradycardia, heart failure and AV blockade.
Combination with beta-blockers further reduces myocardial contractility, increases the risk of bradycardia and AV conduction disorders. Alpha-adrenoblockers increase the hypotensive effect.
Negative inotropic effect is summarized in the appointment of disopyramide and flecainide, which can not be prescribed even for 2 days before or 1 day after the use of Verapamil.
Strengthens the effect of peripheral muscle relaxants.

Storage conditions

Storage temperature up to 25 ° C.
Shelf life - 5 years.

Verapamil in pregnancy

At present, there are no data on the emetic and fetotoxicity of this drug. Its use in pregnancy is possible if the expected benefit to the mother is higher than the potential risk to the fetus. Nevertheless, the drug is used quite often during pregnancy. There are obstetric and therapeutic indications for its purpose.

Obstetric evidence:

    the threat of premature birth (as part of complex therapy);
    placental insufficiency;
    nephropathy of pregnant women.
In case of threat of premature birth, this drug is prescribed together with Ginipral, while Verapamil is taken for 20-30 minutes. Judging by the reviews, Ginipral does not all cause tachycardia and then pregnant women do without Verapamil. But most often it has to be taken.
    "... I have a tachycardia and my hands are shaking after taking Ginipral, the child also has a palpitations. We have to take the second drug ";
    "... I drink Verapamil if necessary, if the pulse is more than 100. It usually only happens in the morning";
    "... Since the 26th week, Ginipral and Verapamil have been drinking - he helped well with tachycardia."
Since the drug affects calcium metabolism, it is widely used in the therapy of threatening premature births. It is proved that tocolytic therapy can be performed only by calcium channel blockers. When taken orally significantly reduces the amplitude of uterine contractions, until the complete cessation of activity. However, given the strength of the inhibitory effect on the uterus, Nitrendipine and Nifedipine outperform Verapamil and Diltiazem from this group.
With nephropathy of mild severity, monotherapy with verapamil can be used, with pre-eclampsia - complex therapy, in addition to magnesium sulphate, which provides anticonvulsant, hypotensive and diuretic action, it includes Verapamil 80 mg per day and other drugs.

Therapeutic indications:

    Arrhythmias (in particular, supraventricular tachycardia).
    Arterial hypertension. This is one of the antihypertensive drugs used during pregnancy and can be used for a long time, but it is rarely used as a basic antihypertensive drug in pregnant women.
    Angina pectoris.
Reviews of verapamil in pregnancy indicate that the drug is effective, in therapeutic doses is tolerated well and does not have harmful effects on the fetus.
    "... With the reception of Ginipral, there was a tachycardia, so this medication was prescribed. Saw for a very long time, almost before delivery. The child was born healthy ";
    "... I drank from the 28th and up to 32 weeks with Ginipral, since I and the child had a tachycardia."
Analysis of pregnancy outcomes in women who received this drug in the first trimester did not reveal an increase in the frequency of congenital anomalies in the fetus due to its administration. In children of women who received the drug in the II and III trimesters, there were also no undesirable consequences.

Reviews about Verapamil

From what tablets Verapamil? Indications for use of verapamil include the treatment of stable angina pectoris, arterial hypertension, arrhythmias, especially in combination with obstructive pulmonary diseases. The drug is also effective for the prevention of repeated myocardial infarctions. It can be combined with nitrates.
Reviews of Verapamil at the forums indicate that the drug was most often prescribed with a combination of paroxysmal supraventricular tachycardia and atrial fibrillation with hypertension.
All the reviews boil down to the fact that the drug is inexpensive and effective:
    "... The drug is effective, so I can safely recommend it to everyone";
    "... I use more than one year, I accept together with Enap. Has got rid of extrasystoles, has achieved a normal blood pressure ";
    "... I take many years with arrhythmias 40 mg twice. Failures of course happen, but less often than before ";
    "... Verapamil is my" table "medicine. A strong palpitation worries (100 - 130). It helps well and is very cheap ";
    "... Due to the regular administration of Verapamil, there were attacks of angina pectoris."
In obstetric practice, this drug is also used for tachycardia, rhythm disturbances in pregnant women, in order to reduce the tone of the uterus.

Reviews about Verapamil during pregnancy are different:

    "... I did not feel any good - only a severe heartburn and headache";
    "... There is no use, weakness and dizziness";
    "... In the second trimester, there was a tachycardia, after the reception it became easier and the child became calmer."
Side effects, which most often caused this drug - bradycardia, constipation, flushes of blood to the face.
It is not recommended to appoint it in cases of renal insufficiency, since it is excreted more often by kidneys than other CCBs. With kidney damage, the risk of cumulation and overdose increases.