Introduction
Veramil Tablet 80 mg is a calcium channel blocker primarily used to treat high blood pressure, angina (chest pain), and certain heart rhythm disorders. It works by relaxing blood vessels and reducing the heart rate, which helps improve blood flow and reduce the workload on the heart.
Uses
Veramil Tablet 80 mg is used for:
- Treatment of hypertension (high blood pressure).
- Management of angina pectoris (chronic stable, unstable, or vasospastic angina).
- Controlling heart rate in conditions such as atrial fibrillation or flutter.
- Prophylaxis and treatment of paroxysmal supraventricular tachycardia (PSVT).
| Brand Name | Veramil |
|---|---|
| Type | Tablet |
| Weight | 80 mg |
| Generic | Verapamil Hydrochloride |
| Manufacturer | Rangs Pharmaceuticals Ltd. |
| Available in | English বাংলা |
Mechanism of Action
Verapamil blocks L-type calcium channels in vascular smooth muscle and the myocardium, reducing intracellular calcium levels. This results in vasodilation, decreased heart contractility, and slower conduction through the atrioventricular (AV) node, which helps in reducing blood pressure, heart rate, and the occurrence of angina.
How Long Does It Take to Work?
The onset of action for Verapamil depends on the formulation used:
- Immediate-release tablets: Effects begin within 1-2 hours.
- Extended-release tablets: Effects may take 4-6 hours, but the medication works more steadily over time.
Absorption
Verapamil is well absorbed after oral administration, with bioavailability ranging from 20-35% due to first-pass metabolism in the liver. Peak plasma concentrations are typically reached within 1-2 hours for immediate-release formulations.
Route of Elimination
Verapamil is primarily metabolized in the liver, with about 70% of the dose excreted in urine as metabolites. A small percentage of the drug is excreted unchanged in the urine and feces.
Dosage
Verapamil Tablet:
- The dose of Verapamil should be individualized by titration and the drug should be administered with food.
- For essential hypertension the initial dose should be given 180 mg in the morning. If adequate response is not obtained with 180 mg of Verapamil then the dose may be titrated by following manner: 240 mg each morning. 180 mg each morning plus 180 mg each evening. 240 mg every 12 hourly.
- For angina the usual dose is 80 mg to 120 mg three times a day.
- For arrythmias in digitalized patients, Verapamil should be given 240 mg to 360 mg in divided doses, depending on the severity of the condition. Divided doses up to 180 mg/day may occasionally be needed.
Verapamil Injection:
Adults: 5 mg slowly intravenously, in tachycardias and hypertensive crises, if necessary repeat after 5 to 10 minutes. Drip infusion to maintain the therapeutic effect: 5-10 mg/hour in physiological saline, glucose, laevulose or similar solutions, on average up to a total dose of 100 mg/day.Children:
- Newborn: 0.75-1 mg (0.3-0.4 ml)
- Infants: 0.75-2 mg (0.3-0.8 ml)
- Children age 1-5 years: 2-3 mg (0.8-1.2 ml)
- Age 6-14 years: 2.5-5 mg (1-2 ml)
The dosage of Verapamil varies depending on the condition being treated:
- Hypertension: Initial dose of 80-120 mg three times a day (immediate-release) or 180 mg once daily (extended-release). Dosage can be titrated based on patient response.
- Angina: 80-120 mg three times a day (immediate-release) or 180 mg once daily (extended-release), with dose adjustments based on efficacy and tolerance.
- Arrhythmias: 240-480 mg/day in divided doses for controlling heart rate.
Administration
Verapamil is available in various formulations, including immediate-release tablets, extended-release tablets, and intravenous (IV) solutions. Oral formulations should be taken with food to minimize gastrointestinal discomfort, and extended-release tablets should not be crushed or chewed.
Side Effects
Common side effects of Verapamil include:
- Constipation
- Dizziness
- Headache
- Nausea
- Edema (swelling in the legs and feet)
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Heart failure
- Liver dysfunction
Toxicity
Verapamil overdose can cause severe hypotension, bradycardia, heart block, and cardiogenic shock. Treatment includes supportive measures such as fluid resuscitation, calcium gluconate, vasopressors, and in severe cases, temporary pacing or hemodialysis.
Precautions
- Use with caution in patients with liver impairment, as Verapamil is extensively metabolized in the liver.
- Avoid use in patients with severe heart failure or significant bradycardia.
- Adjust the dose for elderly patients or those with renal impairment.
Interaction
Verapamil can interact with several drugs, including:
- Beta-blockers: Increased risk of bradycardia or heart block.
- Digoxin: Verapamil increases digoxin levels, leading to potential toxicity.
- CYP3A4 inhibitors: Drugs like erythromycin and ketoconazole can increase Verapamil levels.
- Statins: Increased risk of muscle toxicity (rhabdomyolysis) when used with certain statins like simvastatin.
Disease Interaction
- Heart failure: Verapamil may worsen symptoms of heart failure in susceptible patients.
- Bradycardia: Use with caution in patients with low heart rates.
- Hepatic impairment: Dose adjustments may be required due to the liver’s role in drug metabolism.
Drug Interaction
Verapamil has significant drug interactions, particularly with medications affecting heart rate, blood pressure, or those metabolized by the liver (CYP3A4 substrates, inducers, or inhibitors). It should be used cautiously with drugs such as:
- Amiodarone
- Beta-blockers
- Statins (e.g., simvastatin)
- Antihypertensives
- Antiarrhythmic drugs
Food Interactions
Grapefruit juice can increase the blood levels of Verapamil, leading to a greater risk of side effects, particularly hypotension and bradycardia. Patients should be advised to avoid grapefruit juice while on Verapamil.
Pregnancy Use
Verapamil should only be used during pregnancy if the potential benefits outweigh the risks. There is limited data on its safety in pregnancy, and it is classified as pregnancy category C.
Lactation Use
Verapamil is excreted in breast milk in small amounts. Caution should be exercised when administering Verapamil to nursing mothers, as its effects on the nursing infant are not well established.
Acute Overdose
Symptoms of acute overdose include severe hypotension, bradycardia, and cardiac arrest. Management involves supportive care with intravenous fluids, vasopressors, calcium, and, if necessary, pacing for heart block.
Contraindication
Verapamil is contraindicated in:
- Severe hypotension
- Second- or third-degree atrioventricular (AV) block
- Sick sinus syndrome (unless a functioning pacemaker is present)
- Severe left ventricular dysfunction
- Hypersensitivity to Verapamil or any of its components
Use Direction
Verapamil should be taken with food to reduce gastrointestinal discomfort. Extended-release tablets should not be crushed or chewed, and dosing should follow a physician’s instructions based on the specific medical condition.
Storage Conditions
Store Verapamil at room temperature, away from moisture, heat, and direct light. Keep it out of reach of children.
Volume of Distribution
The volume of distribution of Verapamil is approximately 3.1 L/kg, indicating extensive distribution into tissues, including cardiac and smooth muscle.
Half Life
The elimination half-life of Verapamil is about 3-7 hours for immediate-release formulations and up to 12 hours for extended-release formulations. It may be prolonged in patients with hepatic impairment.
Clearance
Verapamil is primarily cleared by the liver, with a clearance rate of around 0.7 L/h/kg in healthy adults. Clearance may be significantly reduced in patients with hepatic impairment.
See in details version Veramil Tablet 80 mg also Veramil Tablet 80 mg in bangla
Some Frequently Asked Questions About Veramil Tablet 80 mg
