Verapamil is a calcium channel blocker that is used in the elimination of cardiovascular diseases. The drug has antiarrhythmic and antihypertensive effects. What side effects and contraindications does Verapamil have for use?
The medication is produced in tablet form, in dosages of 40 and 80 milligrams. Another form is a solution for intravenous injection.
The main active ingredient is verapamil hydrochloride. Additional substances:
- orthophosphate;
- starch;
- magnesium salt of stearic acid;
- food supplement E464;
- additive E320;
- talc;
- gelatin;
- titanium oxide;
- nipagin;
- disodium salt of indigo-5.5-disulfonic acid.
Pharmacological properties
Verapamil reduces the oxygen demand of the heart muscles by reducing contractility and heart rate. Subsequently, the coronary vessels expand, blood flow increases. The tone of peripheral capillaries worsens.
The drug has a pharmacological effect in supraventricular arrhythmia by suppressing the automatism of the sinus node. So that the medication does not harm, it is necessary to eliminate contraindications before use.
Verapamil: indications for use
The instruction for the drug states that it is used in the presence of the following conditions:
- Chronic stable angina pectoris (a clinical syndrome characterized by the appearance of paroxysmal chest pain of compressive or oppressive nature in response to a certain level of load).
- Unstable angina pectoris (a period of coronary heart disease, which threatens the occurrence of a heart attack and related complications and an intermediate between a stable course and complication).
- Vasospastic angina pectoris (coronary insufficiency, which is a sharp as well as critical narrowing of the corresponding arteries by more than seventy percent).
- Paroxysmal supraventricular tachycardia (a disease that is characterized by a sharp attack of a rapid heartbeat and its sudden end, while there is no violation of the heart rhythm).
- Supraventricular extrasystole (a type of heartbeat in which ectopic arrhythmia forms in the myocardium of the atria or in the atrioventricular junction).
- Arterial hypertension (syndrome of increased systolic or diastolic blood pressure).
"Verapamil": contraindications to the use of the drug
Restrictions on the prescription of a medicine are:
- Acute and chronic heart diseases.
- Severe form of bradycardia (slowing down the functioning of the most important organ in our body, the heart).
- Atrioventricular block (heart block, which indicates a violation of the impulse from the two upper organs to the ventricles).
- Sinoatrial block (violation of the movement of an electrical impulse from the natural pacemaker to the underlying chambers of the heart).
- Fainting, which is provoked by a sharp decrease in cardiac output and cerebral ischemia as a result of an acute arrhythmia in the heart.
- Wolff-Parkinson-White syndrome (a disease of abnormal excitation of the ventricles of the heart along the extra duct between the ventricle and the atrium).
- Cardiogenic shock (left ventricular failure, which is characterized by a sudden deterioration in the contractility of the heart muscles).
- Syndrome of weakness of the sinus node (rhythm disturbance provoked by weakening or termination of the function of automatism of the sinus-atrial node).
- Age to eighteen.
- Increased sensitivity to the main or additional components.
How to take the drug?
According to reviews and instructions for use with the tablets, Verapamil is consumed during or after meals. Dosing is established individually based on the form, as well as the severity of the pathological process, the individual characteristics of the patient and the effectiveness of the therapy.
Adult patients are prescribed 40–80 milligrams of the drug four times a day to prevent arrhythmias, as well as attacks of suddenly developing chest pain and hypertension. It is possible to increase a single concentration of the drug to 120-160 milligrams. The maximum daily dosage of the drug is 480 mg.
Patients with severe hepatic impairment "Verapamil" is prescribed in minimum pharmacological dosages, and the maximum allowable daily concentration of the drug is 120 milligrams.
Is the drug prescribed for children?
The use of Verapamil is also prescribed for small patients with hypertensive and arrhythmic diseases. The drug is taken in two to three times a day. The daily concentration of the drug for children from 5 years of age is prescribed - up to 60 milligrams, for children from 6 to 14 years old - up to 80-360 mg. Infants and children up to 5 years of age are recommended intravenous administration of Verapamil. A single dosage in this situation will be for newborns - 0.75-2 milligrams, for children from 1 to 5 years old - 2-3 mg.
Annotation to the drug also separately provides for the use of prolonged forms. Adult patients for the treatment of hypertension are prescribed a single use of 240 milligrams, a gradual decrease can be achieved by consuming half the dosage in the morning - 120 mg per day.
How to use the solution
According to the instructions for use with ampoules, Verapamil is used to eliminate a hypertensive crisis intravenously from 5 to 10 milligrams. In case of a sudden violation of the heart rhythm, an intravenous jet medicine is also used in the same concentration.
Repeatedly in the same dosage after 20-30 minutes if there is no positive dynamics. For maintenance treatment, they switch to intravenous drip administration with a solution of dextrose and sodium chloride. A single concentration with this introduction for children from 1 to 5 years old is 2-3 milligrams.
According to the instructions for the ampoules, Verapamil is administered through a dropper, especially if an elderly person. In this case, 2 mg of the drug is diluted with 100 milliliters of 0.9% sodium chloride solution. To stop heart rhythm disturbances, it is necessary to use 2-4 milligrams of Verapamil.
What negative effects can a drug cause
When using Verapamil, certain undesirable reactions may occur:
- Atrioventricular block (a type of heart block that indicates problems in conducting an impulse from the atria to the ventricles).
- Bradycardia (decrease in heart rate).
- Facial hyperemia (overflow of blood vessels in the circulatory system).
- Arterial hypotension (lowering blood pressure by more than twenty percent of standard marks).
- Migraine (a pathological condition characterized by the appearance of episodic or regular severe pain in any part of the head).
- Nausea.
- Dizziness.
- Inhibition.
- Constipation
- Nervous excitability.
- Fatigue.
- Vomiting.
- Itchy skin.
- Rashes.
- Peripheral edema (a condition of the limbs, characterized by the accumulation of fluid in the soft tissues).
To eliminate drug overdose, calcium, Norepinephrine, or Isoproterenolum are administered intravenously. Depending on the clinical symptoms of poisoning, medications are prescribed for symptomatic treatment.
Features
While taking Verapamil, mandatory monitoring of the functioning of the heart, as well as blood vessels and the respiratory system is necessary.
According to the indications and contraindications, Verapamil is used with extreme caution when:
- Severe functional disorders of the liver.
- Arterial hypotension.
- The initial stages of heart disease.
- Atrioventricular blockade of the first degree.
- Bradycardia.
Drug interaction
The simultaneous use of Verapamil with antiarrhythmic drugs, inhaled painkillers provokes an increase in cardiotoxic effects, which is manifested by atrioventricular blockade, as well as a sharp decrease in blood pressure and heart failure.
The combination of Verapamil with Carbamazepine and drugs that contain lithium provokes an increase in neurotoxic effects. With simultaneous use with acetylsalicylic acid, the likelihood of bleeding increases. When taken with muscle relaxants, it enhances their effect.
Joint use with diuretics and antihypertensive agents provokes an increase in the hypotensive effect of Verapamil. In combination with Digoxin, its plasma concentration increases and excretion by the kidneys decreases. Simultaneous use with Quinidine increases its plasma concentration, and, accordingly, the likelihood of sharp hypotension increases.
Can I take medication during pregnancy and breastfeeding?
Women in the Verapamil position are prescribed only in cases where the probable benefit to the mother exceeds the probable threat to the unborn baby. The drug is excreted in breast milk, so it is best to transfer to a mixture during the period of therapy.
There is currently no evidence of the toxicity of this medicine. Using it with the "interesting position" of a woman is possible if the possible benefit to the mother is higher than the risk to the unborn baby. However, Verapamil is often used during pregnancy. There are certain indications for its purpose, for example:
- Placental insufficiency (a set of changes in the placenta, which leads to a disruption in the interaction of the mother and child).
- The threat of premature birth.
- Nephropathy (a pathological condition characterized by damage to the parenchyma and glomerular apparatus of the kidneys).
With the threat of premature birth, Verapamil is prescribed simultaneously with Ginipral. Judging by the responses, “Ginipral” does not provoke a rapid heartbeat in all women, so future mothers can safely do without “Verapamil”.
Since the medication affects calcium metabolism, it is often used to prevent preterm labor. It has been confirmed that tocolytic treatment can only be carried out by calcium channel antagonists. When taken orally, it greatly worsens the amplitude of uterine contractions, up to the complete cessation of its activity.
With mild nephropathy, Verapamil monotherapy can be used, with preeclampsia, complex therapy is carried out, in addition to magnesium sulfate (it has anticonvulsant, as well as antihypertensive and diuretic effects), Verapamil is included.
Indications:
- Arrhythmia (a pathological disease in which there is a violation of the frequency, as well as the rhythm and sequence of the process of excitation and contraction of the heart).
- Arterial hypertension (a pathological condition in which there is a steady increase in blood pressure).
- Angina pectoris (a condition in which there is a sharp pain in the chest that occurs as a result of an acute deficit in the microcirculation of the blood of the myocardium of the heart muscle).
Opinions about “Verapamil” in the “interesting position” tell us that the drug is effectively and tolerated in pharmacological concentrations, as a rule, well and does not have a detrimental effect on the fetus.
Analysis of pregnancy outcomes in women who received this medication in the first three months did not reveal an increase in the incidence of congenital abnormalities in the fetus, which are caused by its use.
What substitute drugs does the drug have?
The verapamil generics include:
- Gallopamil.
- "Caveril."
- Finoptin.
- Amlodipine.
- Lecoptin.
- Isoptin.
- Nicardipine.
- Verogalid.
- "Riodipine."
Before replacing Verapamil with another drug, you should consult your doctor.
How to store the medicine
According to the instructions, the medicine "Verapamil" should be kept away from children, protected from moisture and the sun, at a temperature of up to plus twenty-five degrees. Shelf life is 36 months. The cost of the drug varies from 40 to 200 rubles.
Reviews
According to the responses, Verapamil is effective in preventing repeated signs of myocardial infarction. The medication can be combined with nitrates.
Reviews of the drug on the forums confirm that Verapamil was prescribed in most situations with a combination of arrhythmia, which appears and disappears suddenly with high blood pressure.
All responses come down to the fact that the drug is inexpensive and effective. In medical practice, this drug is also used for heart palpitations, as well as heart rhythm failures in pregnant women, to lower the tone of the uterus.
Reviews about "Verapamil" during the "interesting position" are different. The adverse reactions that this medicine provoked in most situations are bradycardia, intestinal obstruction, flushing of the face.
You can not prescribe it for kidney diseases, since it is stronger than other calcium channel blockers, excreted by the kidneys. With violations of the kidneys, the likelihood of its accumulation and poisoning increases.
Doctors' reviews on the effectiveness of Verapamil include its main advantages:
- Severe antihypertensive, as well as antianginal and antiarrhythmic effects.
- A wide range of pharmacological and preventive effects.
- Variability of drug forms.
One of the main advantages of Verapamil is its affordable cost.