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Verapamil

Antiarrhythmic/Antianginal/Antihypertensive Drug - Intern Revision

QuestionAnswer
List the drug classes that verapamil belongs to Antiarrhythmic Class IV, antianginal, antihypertensive, non-dihydropyridine CCB
What are the recommendations for using verapamil in pregnancy? Specialist referral is recommended
Is verapamil safe to use in breastfeeding? Data shows safe to use, but specialist referral is recommended
List the indications verapamil is used for Supraventricular tachycardia, Atrial fibrillation, atrial flutter, angina, hypertension, prevention of cluster headache
What dose of verapamil is used for SVT/AF/Flutter? Oral adult dose 40-80mg 2-3 x d, maintenance 160mg 2-3 x d. Oral adult CR tablet 120-180mg 1 d, maintenance 240mg 1 d.
What dose of verapamil is used for angina? Oral adult initial dose 80mg 2-3 x daily, maintenance dose 160mg 2-3x daily. Oral adult CR tablet initially 180-240mg 1 d, increasing to a max of 240mg bd.
Explain verapamil's MOA Blocks L type Ca channels in cardiac smooth muscle, myocardium and conducting system. This slows the firing of the SA node (HR), contractility (force) and conduction of AV node. Result=vasodilation and relaxation of coronary arteries/arterioles.
Compared to diltiazem, verapamil has greater what? Selectivity for cardiac tissue
What are the contra-indications for verapamil? severe bradycardia, sick sinus syndrome, 2nd or 3rd degree AV block, severe hypotension, HF, Afib/flutter that complicated WPW syndrome.
What are the precautions to consider before using verapamil? Combinations with other medications that can decrease cardiac output i.e. other antiarrhythmics, beta-blockers Renal and hepatic impairment (increase risk of ADR's and toxicity)
List the ADR's that are associated with verapamil Common: constipation, bradycardia Infrequent: AV block, onset or worsening of HF Rare: ileus
How does verapamil cause constipation? Slows gastric transit time
What are the referral points for verapamil? Ileus, bronchospasm, AV block, severe bradycardia, visual disturbances
What monitoring is associated with verapamil? Alcohol consumption (increases CNS effects of alcohol) Onset of ADR's BP, HR, ECG Improvement/worsening of condition Signs and symptoms of toxicity
What are the key interactions to watch out for with verapamil? Digoxin, carbamazepine, phenobarbitone, phenytoin, rifampicin, antiarrhythmics
What happens if verapamil and digoxin are used concurrently? Increased concentration of digoxin resulting in a synergistic effect that will decrease cardiac output
What happens if verapamil and another antiarrhythmic are used concurrently? Increased risk of heart failure?
An increased risk of nephrotoxicity is associated with using verapamil and which drug at the same time? Ciclosporin
Verapamils efficacy can be reduced if it is given conucrrently with which drugs? Hepatic enzyme inducers such carbamazepin, rifampicin, phenytoin, phenobarbitone
What are the key counselling points with verapamil? Reduce alcolhol consumption Check with Dr/Pharm before starting any new meds (RX or OTC) Do not stop taking abruptly Can cause dizzyness Avoid grapefruit juice Can affect mental altertness/coordination CR tabs: swallow whole and take with food
Created by: LDM
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