Verapamil, 40 mg 50 pcs

Verapamil is a class I selective calcium channel blocker. The main pharmacological properties of the drug are due to its ability to prevent entry of calcium ions into cardiomyocytes and smooth muscle cells of the vascular wall through slow membrane calcium channels.

Verapamil has antiarrhythmic, antianginal and hypotensive activity. Reduces myocardial oxygen demand by reducing myocardial contractility and heart rate. Causes dilatation of coronary arteries and increased coronary blood flow.

The antihypertensive effect of Verapamil is associated with reduction of peripheral arterial smooth muscle tone and with the ability to reduce PPS. By slowing AV conduction, Verapamil has antiarrhythmic effect in supraventricular arrhythmias, normal HR remains unchanged or decreases insignificantly.

Verapamil also has some natriuretic and diuretic effects by reducing tubular reabsorption.

Indications

Prevention of angina attacks (including Prinzmetal angina); treatment and prevention of supraventricular arrhythmias (paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, extrasystole); arterial hypertension.

Intravenous is used in acute attacks of angina pectoris, episodes of supraventricular paroxysmal tachycardia and hypertensive crises.

Active ingredient

Composition

Active substance:

verapamil hydrochloride 40 mg.

Auxiliary substances:

Calcium phosphate displaced,

starch,
.

butyl hydroxyanisole,

purified talc,

magnesium stearate,

gelatin,

methylparaben,

hydroxypropyl methylcellulose,

titanium dioxide,

Indigo carmine.

How to take, the dosage

The dosing regimen is individual. Orally in adults – in the initial dose of 40-80 mg 3 times per day. For prolonged-acting dosage forms, the single dose should be increased and the frequency of administration decreased. For children aged 6-14 years, 80-360 mg/day, under 6 years, 40-60 mg/day; frequency of administration – 3-4 times/day.

If necessary, verapamil may be administered by IV stream (slowly, under control of BP, HR and ECG).

The single dose for adults is 5-10 mg; if there is no effect, the same dose may be administered again after 20 minutes. The 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 significant hepatic dysfunction, the daily dose of verapamil should not exceed 120 mg. Maximum dose: 480 mg/day in adults when taken orally.

Interaction

Increases plasma levels of digoxin, cyclosporine, theophylline, carbamazepine, decreases – lithium.

Weakens antibacterial activity of rifampicin, depressant effect of phenobarbital, decreases clearance of metoprolol and propranolol, increases the effects of muscle relaxants. Rifampicin, sulfinpyrazone, phenobarbital, calcium salts, vitamin D – weaken the effect.

Hypotensive effect is enhanced by antihypertensive drugs (diuretics, vasodilators), tricyclic and tetracyclic antidepressants and neuroleptics: antianginal – nitrates.

Beta-adrenoblockers, class IA antiarrhythmics, cardiac glycosides, inhaled anesthetics, X-ray contrast agents potentiate (mutually) inhibitory effect on sinoatrial node automatism, AV conduction and myocardial contractility. Simultaneous use of verapamil with acetylsalicylic acid increases existing bleeding. Cimetidine increases the plasma content of verapamil.

Special Instructions

Patients with hypertrophic cardiomyopathy complicated by left ventricular obstruction, high pulmonary capillary occlusion pressure, paroxysmal nocturnal dyspnea or orthopnea, sinus-atrial node dysfunction should be treated with caution.

Patients with significant impairment of liver function and neuromuscular transmission (Duchenne myopathy) require constant medical monitoring and possibly dose reduction.

Contraindications

Severe arterial hypotension, AV-blockade of II and III degree, sinoatrial block and CCSU (except patients with pacemaker), WPW syndrome or Laun-Hanong-Levin syndrome combined with atrial flutter or fibrillation (except patients with pacemaker), pregnancy, lactation, hypersensitivity to verapamil.

Side effects

Cardiovascular system: bradycardia (less than 50 bpm), marked BP decrease, development or worsening of heart failure, tachycardia; rarely – angina pectoris, up to and including myocardial infarction (especially in patients with severe obstructive coronary artery disease), arrhythmia (including ventricular fibrillation).including ventricular fibrillation and torsade de pointes); when rapidly injected intravenously – AV-blockade of degree III, asystole, collapse.

CNS and peripheral nervous system disorders: dizziness, headache, fainting, anxiety, lethargy, fatigue, asthenia, somnolence, depression, extrapyramidal disorders (ataxia, mask-like face, shuffling gait, stiff arms or legs, trembling hands and fingers, difficulty swallowing).

Digestive system disorders: nausea, constipation (rarely – diarrhea), gum hyperplasia (bleeding, soreness, swelling), increased appetite, increased liver transaminases and alkaline phosphatase activity.

Allergic reactions: skin itching, skin rash, facial hyperemia, erythema multiforme (including Stevens-Johnson syndrome).

Other: weight gain, very rarely – agranulocytosis, gynecomastia, hyperprolactinemia, galactorrhea, arthritis, transient vision loss with Cmax, pulmonary edema, asymptomatic thrombocytopenia, peripheral edema.

Overdose

Symptoms: arterial hypotension, bradycardia, AV block, cardiogenic shock, coma, asystole.

Treatment: as a specific antidote calcium gluconate is used (10-20 ml 10% solution IV); in bradycardia and AV blockade atropine, isoprenaline or orciprenaline are administered; in hypotension – plasma exchange solutions, dopamine, norepinephrine; dobutamine is used if signs of heart failure are observed.

Similarities