Verivas
Generic Name
Verapamil Hydrochloride
Manufacturer
Example Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| verivas 25 mg tablet | ৳ 30.00 | ৳ 300.00 |
Description
Overview of the medicine
Verivas 25 mg Tablet contains Verapamil Hydrochloride, a calcium channel blocker used to treat hypertension, angina pectoris, and certain cardiac arrhythmias. It works by relaxing blood vessels and slowing the heart rate, reducing the heart's workload.
Uses & Indications
Dosage
Adults
Typical starting dose for hypertension or angina for immediate-release formulation is 80 mg three times daily (TID). A 25 mg tablet may be used as a low starting dose, for dose titration, or in patients with specific cardiac arrhythmias. Doses may range from 40 mg three times daily to 120 mg three times daily, adjusted based on patient response and tolerance.
Elderly
Lower initial doses (e.g., 40 mg two or three times daily) may be appropriate due to increased sensitivity and reduced hepatic metabolism and renal clearance.
Renal_impairment
No dosage adjustment needed for mild to moderate renal impairment, but caution is advised in severe cases due to metabolite accumulation and potential for exaggerated hypotensive effects. Monitor carefully.
How to Take
Take the tablet orally, usually with food or milk to minimize gastric irritation. Do not crush or chew immediate-release tablets, swallow them whole. Extended-release forms should never be crushed or chewed.
Mechanism of Action
Verapamil is a phenylalkylamine calcium channel blocker. It inhibits the transmembrane influx of calcium ions into cardiac and vascular smooth muscle cells. This action leads to a reduction in myocardial contractility, arterial vasodilation, and decreased heart rate and AV nodal conduction.
Pharmacokinetics
Onset
Oral: 1-2 hours for antihypertensive effect; antiarrhythmic effect may be seen within 30 minutes to 2 hours.
Excretion
Approximately 70% renally excreted as metabolites, 16% in feces within 5 days. Only about 3-4% of a dose is excreted unchanged in urine.
Half life
2-8 hours (single dose), 4.5-12 hours (multiple doses), due to saturation of hepatic metabolism.
Absorption
Well absorbed orally (90%), but extensive first-pass metabolism leads to ~20-35% bioavailability. Peak plasma concentrations are reached in 1-2 hours for immediate-release formulations.
Metabolism
Extensively metabolized in the liver (primarily CYP3A4) to several inactive metabolites and one active metabolite (norverapamil), which has 10-20% of the activity of verapamil.
Side Effects
Contraindications
- Severe left ventricular dysfunction (e.g., ejection fraction < 30% or moderate to severe symptoms of heart failure)
- Hypotension (systolic BP < 90 mmHg) or cardiogenic shock
- Sick sinus syndrome (unless a functional pacemaker is in place)
- Second- or third-degree AV block (unless a functional pacemaker is in place)
- Atrial flutter or fibrillation with an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes)
Drug Interactions
Digoxin
Verapamil can increase serum digoxin levels by 50-75%. Reduce digoxin dose when initiating verapamil and monitor digoxin levels.
Clonidine
Increased risk of AV block and bradycardia. Avoid co-administration if possible.
Beta-blockers
Increased risk of bradycardia, AV block, profound hypotension, and myocardial depression. Use with extreme caution.
Carbamazepine
Verapamil can increase carbamazepine levels, potentially leading to toxicity. Monitor carbamazepine levels.
Statins (e.g., Simvastatin, Lovastatin)
Verapamil inhibits CYP3A4, leading to increased statin plasma concentrations and an increased risk of myopathy/rhabdomyolysis. Lower statin dose or switch to alternative.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children. Do not freeze.
Overdose
Symptoms include profound hypotension, bradycardia (including complete AV block and asystole), cardiac arrest, and impaired consciousness. Treatment is supportive, including intravenous calcium gluconate, vasopressors (e.g., norepinephrine), atropine for bradycardia, and cardiac pacing if necessary. Glucagon and high-dose insulin may also be considered in refractory cases.
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit justifies potential risk to the fetus. Verapamil is excreted in breast milk; caution should be exercised when administered to a nursing woman, and close monitoring of the infant for adverse effects is recommended.
Side Effects
Contraindications
- Severe left ventricular dysfunction (e.g., ejection fraction < 30% or moderate to severe symptoms of heart failure)
- Hypotension (systolic BP < 90 mmHg) or cardiogenic shock
- Sick sinus syndrome (unless a functional pacemaker is in place)
- Second- or third-degree AV block (unless a functional pacemaker is in place)
- Atrial flutter or fibrillation with an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes)
Drug Interactions
Digoxin
Verapamil can increase serum digoxin levels by 50-75%. Reduce digoxin dose when initiating verapamil and monitor digoxin levels.
Clonidine
Increased risk of AV block and bradycardia. Avoid co-administration if possible.
Beta-blockers
Increased risk of bradycardia, AV block, profound hypotension, and myocardial depression. Use with extreme caution.
Carbamazepine
Verapamil can increase carbamazepine levels, potentially leading to toxicity. Monitor carbamazepine levels.
Statins (e.g., Simvastatin, Lovastatin)
Verapamil inhibits CYP3A4, leading to increased statin plasma concentrations and an increased risk of myopathy/rhabdomyolysis. Lower statin dose or switch to alternative.
Storage
Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children. Do not freeze.
Overdose
Symptoms include profound hypotension, bradycardia (including complete AV block and asystole), cardiac arrest, and impaired consciousness. Treatment is supportive, including intravenous calcium gluconate, vasopressors (e.g., norepinephrine), atropine for bradycardia, and cardiac pacing if necessary. Glucagon and high-dose insulin may also be considered in refractory cases.
Pregnancy & Lactation
Pregnancy Category C. Use only if potential benefit justifies potential risk to the fetus. Verapamil is excreted in breast milk; caution should be exercised when administered to a nursing woman, and close monitoring of the infant for adverse effects is recommended.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from the date of manufacture, specific details on packaging.
Availability
Pharmacies, Hospitals
Approval Status
Approved by regulatory authorities
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established verapamil's efficacy and safety in the management of hypertension, angina pectoris, and supraventricular tachyarrhythmias. Ongoing research continues to evaluate its role in various cardiovascular conditions and compare it with newer therapeutic agents.
Lab Monitoring
- Blood pressure monitoring
- Heart rate and ECG monitoring (especially at initiation, dose adjustments, and with concurrent use of other cardiac medications)
- Liver function tests (periodically with long-term therapy)
- Renal function tests (in patients with severe renal impairment)
Doctor Notes
- Monitor heart rate and blood pressure closely, especially at initiation and dose titration. Bradycardia or hypotension may necessitate dose reduction or discontinuation.
- Caution in patients with impaired left ventricular function or pre-existing AV conduction abnormalities. Avoid in severe cases.
- Be aware of significant drug interactions, particularly with beta-blockers, digoxin, and CYP3A4 substrates (e.g., statins, carbamazepine). Dose adjustments may be required.
- Advise patients about potential for constipation and recommend strategies for management.
Patient Guidelines
- Take this medicine exactly as prescribed by your doctor. Do not stop taking it suddenly without consulting your doctor.
- Avoid grapefruit and grapefruit juice while on this medication.
- Report any signs of dizziness, lightheadedness, slow heartbeat, or swelling in your ankles or feet to your doctor.
- Regularly monitor your blood pressure and heart rate as advised by your doctor.
- Inform your doctor and pharmacist about all other medications and supplements you are taking.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Verapamil may cause dizziness, lightheadedness, or fatigue, especially at the start of treatment or when the dose is changed. Exercise caution when driving or operating machinery until you know how this medicine affects you.
Lifestyle Advice
- Adopt a heart-healthy diet, low in sodium and saturated fats.
- Engage in regular, moderate physical activity as approved by your doctor.
- Maintain a healthy weight to reduce strain on your heart.
- Limit or avoid alcohol consumption.
- Quit smoking, as it significantly increases cardiovascular risk.
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Global Brand Names
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