VERAPAMIL SUMMARY
Verapamil HCl is a calcium antagonist or slow channel inhibitor.
Intravenous Verapamil HCI is indicated for the following:
- Rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-Parkinson-White [W-P-W] and Lown-Ganong-Levine [L-G-L] syndromes). When clinically advisable, appropriate vagal maneuvers (e.g., Valsalva maneuver) should be attempted prior to verapamil hydrochloride administration.
- Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation except when the atrial flutter and/or atrial fibrillation are associated with accessory bypass tracts (Wolff-Parkinson-White [W-P-W] and Lown-Ganong-Levine [L-G-L] syndromes).
In controlled studies in the United States, about 60% of patients with supraventricular tachycardia converted to normal sinus rhythm within 10 minutes after intravenous verapamil. Uncontrolled studies reported in the world literature describe a conversion rate of about 80%. About 70% of patients with atrial flutter and/or fibrillation with a fast ventricular rate respond with a decrease in ventricular rate of at least 20%. Conversion of atrial flutter or fibrillation to sinus rhythm is uncommon (about 10%) after verapamil and may reflect the spontaneous conversion rate, since the conversion rate after placebo was similar. Slowing of the ventricular rate in patients with atrial fibrillation/flutter lasts 30 to 60 minutes after a single injection.
Because a small fraction (<1%) of patients treated with verapamil respond with life-threatening adverse responses (rapid ventricular rate In atrial flutter/fibrillation and an accessory bypass tract, marked hypotension, or extreme bradycardia/asystole - see Contraindications and Warnings), the initial use of intravenous verapamil should, if possible, be in a treatment setting with monitoring and resuscitation facilities, including DC-cardioversion capability (see Suggested Treatment of Acute Cardiovascular Adverse Reactions). As familiarity with the patient's response is gained, use in an office setting may be acceptable.
Cardioversion has been used safely and effectively after intravenous verapamil.
|
NEWS HIGHLIGHTS
Published Studies Related to Verapamil
Effect of verapamil, trandolapril and their combination on vascular function and structure in essential hypertensive patients. [2009.07]
AIM: The aim of the present study is to evaluate the effect of treatment with verapamil, trandolapril and their combination on peripheral microcirculation vasoreactivity... CONCLUSION: The present study demonstrates that chronic treatment with verapamil ameliorates endothelial function in the forearm microcirculation of essential hypertensive patients, while trandolapril protects microcirculation from structural alterations. The combination of the two drugs is potentially a powerful tool to counteract hypertension-related microvascular dysfunction and damage.
Pulse pressure and risk of cardiovascular outcomes in patients with hypertension and coronary artery disease: an INternational VErapamil SR-trandolapril STudy (INVEST) analysis. [2009.06]
CONCLUSION: In CAD patients with hypertension, PP (on anti-hypertensive treatment) is a weaker predictor of cardiovascular outcomes than SBP, DBP, or MAP.
Enantioselective disposition of fexofenadine with the P-glycoprotein inhibitor verapamil. [2009.05]
AIMS: The aim was to compare possible effects of verapamil, as a P-glycoprotein (P-gp) inhibitor, on the pharmacokinetics of each fexofenadine enantiomer, as a P-gp substrate... CONCLUSION: This study indicates that P-gp plays a key role in the stereoselectivity of fexofenadine pharmacokinetics, since the pharmacokinetics of fexofenadine enantiomers were altered by the P-gp inhibitor verapamil, and this effect was greater for S-fexofenadine compared with R-fexofenadine.
Effect of intralesional verapamil for treatment of Peyronie's disease: a randomized single-blind, placebo-controlled study. [2009]
PURPOSE: We aimed to assess the effect of intralesional verapamil on the treatment of Peyronie's disease... CONCLUSION: Although in some studies verapamil has been found to be effective in the treatment of Peyronie's disease, we did not find any improvement in comparison with the control group. Furthermore, larger scale studies are warranted to assess the effect of this drug on the treatment of Peyronie's disease.
Verapamil augmentation of lithium treatment improves outcome in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms. [2008.12]
OBJECTIVES: Attenuation of protein kinase C (PKC) is a mechanism common to both established (lithium, valproate) and some novel (tamoxifen) antimanic agents. Verapamil, although primarily known as a calcium channel blocker, also has PKC inhibitory activity. Verapamil has shown antimanic activity in some but not all studies. Therefore, we investigated verapamil, used alone or as an adjunctive treatment, in manic patients who did not respond to an initial adequate trial of lithium... CONCLUSIONS: In this preliminary investigation, verapamil monotherapy did not demonstrate antimanic efficacy. By contrast, the combination of verapamil plus lithium was highly efficacious. Our findings thus suggest that verapamil may have potential utility as an adjunct to lithium. This effect may be mediated by additive actions on PKC inhibition, which may be an important mechanism for antimanic agents in general.
Clinical Trials Related to Verapamil
Food Study of Verapamil HCl Extended-Release Capsules 300 mg and Verelan® PM Extended-Release Capsules 300 mg [Completed]
The objective for this study was to investigate the bioequivalence of Mylan's verapamil HCl
extended-release 300 mg capsules to Schwarz's Verelan® PM extended-release 300 mg capsules
following a single, oral 300 mg (1 x 300 mg) dose administration under fed conditions.
Fasting Study of Verapamil HCl Extended-Release Capsules 300 mg and Verelan® PM Extended-Release Capsules 300 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan's verapamil HCl
extended-release 300 mg capsules to Schwarz's Verelan® PM extended-release 300 mg capsules
following evening administration of a single, oral 300 mg (1 x 300 mg) dose under fasting
conditions.
Fasting Study of Verapamil HCl Extended-Release Capsules 300 mg to Verelan® PM Extended-Release Capsules 300 mg [Completed]
The objective for this study was to investigate the bioequivalence of Mylan's verapamil HCl
extended-release 300 mg capsules to Schwarz's Verelan® PM extended-release 300 mg capsules
following evening administration of a single, oral 300 mg (1 x 300 mg) dose administration
under fasting conditions.
Fasting Applesauce Study of Verapamil HCl Extended-Release Capsules 300 mg and Verelan® PM Extended-Release Capsules 300 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan's verapamil HCl
extended-release 300 mg capsules to Schwarz's Verelan® PM extended-release 300 mg capsules
following by a single, oral 300 mg (1 x 300 mg) dose administration sprinkled on one
tablespoon of applesauce under fasting conditions.
The Effect of Concomitant Administration of Erythromycin and Diltiazem on CYP3A Activity in Healthy Volunteers [Completed]
We, the researchers at the Indiana University School of Medicine, are doing this study to
better understand how the effects of certain medications are altered when taken
simultaneously, or in combination with each other. We will also look at how each volunteer's
genes (DNA) may affect the way these medications are metabolized.
Hypothesis:
We will test the hypothesis that the extent of drug-drug interaction caused by the
combination of erythromycin and diltiazem is not predictable from the extent of interaction
produced by each inhibitor alone. Specifically we will test the hypothesis that the
combination of erythromycin and diltiazem will cause a greater decrease in midazolam
intravenous and oral clearance than the sum of the decreases caused by each inhibitor alone.
|
|
|
|
Page last updated: 2009-10-20
|
