ভেরাপামিল হাইড্রোক্লোরাইড (Verapamil) এ আছে Verapamil (ভেরাপামিল হাইড্রোক্লোরাইড)। ভেরাপামিল হাইড্রোক্লোরাইড (Verapamil) এর কাজ, খাওয়ার নিয়ম, পার্শ্বপ্রতিক্রিয়া, মাত্রা ও সেবনবিধি, সতর্কতা, মিথষ্ক্রিয়া, গর্ভাবস্থায় ও স্তন্যদানকালে ব্যবহার, মাত্রাধিক্যতাঃ
Verapamil inhibits entry of Ca ions into the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarisation. It relaxes coronary vascular smooth muscle and coronary vasodilation, increases myocardial oxygen delivery, and slows automaticity and AV node conduction.
কাজ
ভেরাপামিল ট্যাবলেট: অপরিহার্য উচ্চ রক্তচাপ এনজিনা পেক্টেরিস এবং পুনঃ-সংক্রমণ ,সুপারভেন্ট্রিকুলার অ্যারিথমিয়াস প্রতিরোধ করে।
ভেরাপামিল ইনজেকশন: টাকাইকার্ডিস যেমন: পেরোক্সিসমাল সুপ্রেভেন্ট্রিকুলার টাকাইকার্ডিস দ্রুত ভেন্ট্রিকুলার প্রতিক্রিয়া (ডাব্লুপিডাব্লুএস বাদে) সহ অ্যাট্রিয়াল ফাইব্রিলেশন দ্রুত চালনা সহ অ্যাট্রিয়াল বিড়ম্বনা Extrasystoles তীব্র উচ্চ রক্তচাপ তীব্র করোনারি অপ্রতুলতা হ্যালোথেন অ্যানাস্থেসিয়াতে এবং যথাক্রমে হ্যালোথন অ্যানাস্থেসিয়াতে অ্যাড্রেনালিন প্রয়োগের প্রফিল্যাক্সিস এবং / বা অ্যাক্টোপিক অ্যারিথমিয়াসের (প্রধানত ভেন্ট্রিকুলার এক্সট্রাস্টিস্টোলস) থেরাপির জন্য নির্দেশিত ।
থেরাপিউটিক ক্লাস
Calcium-channel blockersমাত্রা ও সেবনবিধি
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)
of Verapamil, given intravenously, depending on age and action. The injection should be made slowly under electrocardiographic control and only until onset of the effect. Intravenous infusion in hypertensive crises: initially 0.05-0.1 mg/kg/hour; if the effect proves to be insufficient, the dose is increased at 30-60 minute intervals until twice the dose or more is reached. Average total dose up to 1.5 mg/kg/day.
পার্শ্ব প্রতিক্রিয়া
Verapamil is generally well tolerated. The following reaction to orally administered Verapamil appeared clearly drug related or occurred at rates greater than 1% in clinical trials with approximately 5000 patients.
- Digestive system: Constipation, nausea;
- Cardiovascular system: Hypotension, edema, CHF, pulmonary edema, bradycardia, AV block;
- Respiratory system: Upper respiratory tract infections;
- Nervous system: Dizziness, headache, fatigue;
- Skin: Rash, flashing;
- Hepatic: Elevated liver enzyme.
সতর্কতা
Care should be taken in 1st degree AV block, bradycardia <50 beats/minutes, hypotension <90 mm Hg systolic pressure, atrial fibrillation/flutter and simultaneous pre-excitation syndrome e.g. WPW syndrome, heart failure (previous compensation with cardiac glycosides/diuretics required).Verapamil may impair ability to drive or operate machinery, particularly in the initial stages of treatment and with concomitant consumption of alcohol. Verapamil markedly slows down the elimination of alcohol and prolongs the duration of the effects of alcohol.Verapamil should be given as a slow intravenous injection over at least 2 minutes under continuous ECG and blood pressure monitoring. Intravenous injection should only be given by the physician. In atrial fibrillation and simultaneous WPW syndrome there is a risk of inducing ventricular fibrillation
ঔষধের মিথষ্ক্রিয়া
May increase plasma level with CYP3A4 inhibitors (e.g. erythromycin, ritonavir), cimetidine. May decrease plasma level with CYP3A4 inducers (e.g. rifampicin), phenobarbital, sulfinpyrazone. Increased risk of bleeding with aspirin. May increase bradycardic and hypotensive effect with telithromycin. Increased AV blocking effect with clonidine. May increase plasma level of cardiac glycosides (e.g. digoxin, digitoxin), β-blockers (e.g. propranolol, metoprolol), α-blockers (e.g. terazosin, prazosin), immunosuppressants (e.g. sirolimus, ciclosporin, tacrolimus, everolimus), lipid lowering agents (e.g. lovastatin, simvastatin, atorvastatin), colchicines, quinidine, carbamazepine, imipramine, glibenclamide, doxorubicin, midazolam, buspirone, almotriptan, theophylline. May potentiate hypotensive effect with diuretics, antihypertensives, vasodilators. May increase neurotoxic effect of lithium.
গর্ভাবস্থায় ও স্তন্যদানকালে ব্যবহার
Verapamil carries the potential to produce fetal hypoxia associated with maternal hypotension. Verapamil should not be administered intravenously during the first six months of pregnancy. There are no data on use in the first and second trimester. Verapamil should not be used in the final trimester unless the benefits clearly outweigh the risks. Verapamil should not be administered intravenously during lactation. If a nursing mother requires intravenous Verapamil, breast feeding should be discontinued for the duration of treatment.
মাত্রাধিক্যতা
Treatment of overdose should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solution may increase calcium ion flux across the slow channel and have been used in the treatment of overdose with Verapamil. Verapamil cannot be removed by haemodialysis.
প্রতিলক্ষণ
- Severe left ventricular dysfunction
- Hypotension or cardiogenic shock
- Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)
- Second or third-degree atrioventricular (AV) block (except in patients with a functioning artificial pacemaker)
- Patients with atrial flutter or atrial fibrillation and an accessory by pass tract (eg. Wolff-Parkinson-White, Lown-Ganong-Levine syndrome)
- Patients with known hypersensitivity to verapamil hydrochloride
- Verapamil injection should not be administered intravenously to patients on beta-blockers (except in an intensive care setting) and known hypersensitivity to Verapamil hydrochloride.