Buy Isoptin Online

Verapamil Injection (verapamil hydrochloride)

OTHER BRAND NAMES

Isoptin (Discontinued)

THERAPEUTIC CLASS

Calcium channel blocker (CCB) (nondihydropyridine)

DEA CLASS

RX

INDICATIONS

Rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardia, including those associated with accessory bypass tracts (Wolff-Parkinson-White and Lown-Ganong-Levine syndromes). Temporary control of rapid ventricular rate in atrial flutter/fibrillation (A-flutter/fib).

ADULT DOSAGE

Paroxysmal Supraventricular Tachycardia

Including those associated w/ accessory bypass tracts

Give as slow IV bolus over at least 2 min under continuous ECG and BP monitoring; individualize interval for subsequent doses
Initial: 5-10mg (0.075-0.15mg/kg)
Repeat: 10mg (0.15mg/kg) 30 min after 1st dose if initial response is inadequate

Atrial Fibrillation/Flutter

Temporary control of rapid ventricular rate except when associated w/ accessory bypass tracts

Give as slow IV bolus over at least 2 min under continuous ECG and BP monitoring; individualize interval for subsequent doses
Initial: 5-10mg (0.075-0.15mg/kg)
Repeat: 10mg (0.15mg/kg) 30 min after 1st dose if initial response is inadequate

PEDIATRIC DOSAGE

Paroxysmal Supraventricular Tachycardia

Including those associated w/ accessory bypass tracts

Give as slow IV bolus over at least 2 min under continuous ECG and BP monitoring; individualize interval for subsequent doses
0-1 Year:
Initial: 0.1-0.2mg/kg
Usual Range: 0.75-2mg
Repeat dose 30 min after 1st dose if initial response is inadequate

1-15 Years:
Initial: 0.1-0.3mg/kg
Max Initial: 5mg
Usual Range: 2-5mg
Repeat dose 30 min after 1st dose if initial response is inadequate
Max: 10mg as single dose

Atrial Fibrillation/Flutter

Temporary control of rapid ventricular rate except when associated w/ accessory bypass tracts

Give as slow IV bolus over at least 2 min under continuous ECG and BP monitoring; individualize interval for subsequent doses
0-1 Year:
Initial: 0.1-0.2mg/kg
Usual Range: 0.75-2mg
Repeat dose 30 min after 1st dose if initial response is inadequate

1-15 Years:
Initial: 0.1-0.3mg/kg
Max Initial: 5mg
Usual Range: 2-5mg
Repeat dose 30 min after 1st dose if initial response is inadequate
Max: 10mg as single dose

DOSING CONSIDERATIONS

Elderly
Give dose over at least 3 min

ADMINISTRATION

IV route

Give as a slow IV inj over at least a 2-min period under continuous ECG and BP monitoring
Do not dilute w/ sodium lactate inj in polyvinyl chloride bags
Avoid admixing verapamil HCl inj w/ albumin, amphotericin B, hydralazine HCl, or trimethoprim w/ sulfamethoxazole
Verapamil HCl inj will precipitate in any sol w/ a pH above 6.0

HOW SUPPLIED

Inj: 2.5mg/mL [2mL, 4mL]

CONTRAINDICATIONS

Severe hypotension or cardiogenic shock, 2nd/3rd-degree atrioventricular (AV) block or sick sinus syndrome (except with functioning ventricular pacemaker), severe congestive heart failure, IV β-blocker (eg, propranolol), A-flutter/fib with an accessory bypass tract, wide-complex ventricular tachycardia.

WARNINGS/PRECAUTIONS

Initiate in a treatment setting with monitoring and resuscitation facilities. May produce transient and asymptomatic decrease in BP below baseline levels which may result in dizziness. May rarely produce 2nd/3rd-degree AV block, bradycardia, and (extreme cases) asystole. Control non-severe or rate related heart failure with digitalis glycosides and diuretics, as appropriate, before therapy. Acute worsening of heart failure may be seen in patients with moderately severe to severe cardiac dysfunction. May require reduction in subsequent doses, or d/c of therapy and institution of appropriate therapy if 2nd/3rd-degree AV block or bundle branch block develops. Avoid multiple doses with significant hepatic/renal failure; if repeated inj are essential, closely monitor BP and PR interval and utilize smaller repeat doses. Cannot be removed by hemodialysis. Caution with Duchenne's muscular dystrophy; may precipitate respiratory muscle failure. Caution and monitor patients with supratentorial tumors during anesthesia induction; may increase intracranial pressure. Caution with neonates/infants; may cause severe hemodynamic side effects (rare).

ADVERSE REACTIONS

Hypotension, bradycardia, severe tachycardia, dizziness, headache.

DRUG INTERACTIONS

See Contraindications. Monitor for AV block or excessive bradycardia with digitalis preparations. May cause exaggerated hypotensive response with oral quinidine, β-blockers, and prazosin. Avoid disopyramide within 48 hrs before or 24 hrs after therapy. May have additive effects reducing myocardial contractility and prolonging AV conduction and repolarization with flecainide. May potentiate depolarizing/nondepolarizing neuromuscular blockers; may need to reduce dose of verapamil and/or dose of the neuromuscular blockers. Caution with highly protein-bound drugs. May increase sensitivity to effects of lithium, and decrease serum lithium levels in patients receiving chronic stable oral lithium; monitor carefully. May increase carbamazepine and cyclosporine levels. Phenobarbital may increase clearance. Rifampin may reduce oral bioavailability. Titrate carefully with inhalation anesthetics to avoid excessive cardiovascular (CV) depression. May cause CV collapse with dantrolene. Hyperkalemia and myocardial depression reported with coadministration of oral therapy and IV dantrolene.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Calcium channel blocker (nondihydropyridine); inhibits calcium ion (and possibly sodium ion) influx through slow channels into conductile and contractile myocardial cells and vascular smooth muscle cells.

PHARMACOKINETICS

Distribution: Crosses placenta, found in breast milk. Metabolism: (PO) Liver (extensive); various N- and O-dealkylated products of verapamil (major metabolites). Elimination: (PO) Urine (70%, 3-4% unchanged), feces (16%); (IV infusion) T1/2=2-5 hrs.

ASSESSMENT

Assess for moderately severe to severe cardiac dysfunction, Duchenne's muscular dystrophy, supratentorial tumors, significant hepatic/renal failure, pregnancy/nursing status, and possible drug interactions. Obtain baseline BP.

MONITORING

Monitor for AV block, bradycardia, asystole, acute worsening of heart failure, bundle branch block, precipitation of respiratory muscle failure, and hemodynamic side effects in neonates/infants. Monitor ECG and BP.

PATIENT COUNSELING

Inform of risks/benefits of therapy.

STORAGE

20-25°C (68-77°F). Protect from light by retaining in package until ready to use.

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