Description
Verapamil Pharmacological action
Verapamil is one of the main drugs in the group of calcium channel blockers. It has antiarrhythmic, antianginal and antihypertensive activity.
The drug reduces myocardial oxygen demand by reducing myocardial contractility and heart rate. Causes dilatation of coronary vessels of the heart and increases coronary blood flow; reduces smooth muscle tone of peripheral arteries and total peripheral vascular resistance.
Verapamil significantly slows down AV conductivity and inhibits sinus node automatism, which allows using the drug for treatment of supraventricular arrhythmias.
Verapamil is the drug of choice for treatment of angina of vasospastic genesis (Prinzmetal’s angina). It has an effect in tension angina and in treatment of angina with supraventricular arrhythmias.
Indications of Verapamil
Treatment and prevention of cardiac rhythm disorders: paroxysmal supraventricular tachycardia, atrial flutter and fibrillation (tachyarrhythmic version), supraventricular extrasystole;
treatment and prevention of chronic stable angina (angina pectoris), unstable angina (angina pectoris at rest); vasospastic angina (angina Prinzmetal, variant angina);
treatment of arterial hypertension.
Contraindications to use
Severe bradycardia;
Chronic heart failure stage IIB-III;
Cardiogenic shock (except that caused by arrhythmia);
sinotrial blockade;
AV blockade of II and III degree (excluding patients with an artificial pacemaker);
sinus node weakness syndrome;
Wolff-Parkinson-White syndrome;
Morgania-Adams-Stokes syndrome;
acute heart failure;
concomitant use of beta-adrenoblockers (IV);
children under 18 years of age;
Hypersensitivity to the components of the drug.
The drug should be administered with caution in patients with 1st degree AV-blockade, 1st and 2nd degree chronic heart failure, arterial hypotension (systolic pressure less than 100 mm Hg), bradycardia, severe liver dysfunction.
Dosing regimen
- Verapamil is taken orally with a small amount of water during or after meals.
- Regimen of dosage and duration of treatment are set individually depending on the patient’s condition, severity, peculiarities of the disease course and effectiveness of therapy.
- For prevention of angina and arrhythmia attacks and for treatment of arterial hypertension, the drug is prescribed to adults in the initial dose of 40-80 mg three to four times a day. If necessary, the single dose is increased to 120-160 mg. Maximum daily dose is 480 mg.
- In patients with significant liver dysfunction, verapamil elimination from the body is slow, so it is reasonable to start treatment with the minimum dose. The daily dose should not exceed 120 mg.
