Verapamil

Верапамил Drug photo

The description is actual on 21.04.2016

  • Latin name: Verapamil
  • ATH code: C08DA01
  • Active ingredient: Verapamil (Verapamil)
  • Producer: Biosynthesis of joint stock company, Obolenskoye, STI-MED-SORB, Irbitsky himfarmzavod, AVVA-RUS (Russia), Hemofarm A.D concern. (Yugoslavia), Pharbita (Netherlands), BASF Generics (Germany), Alkaloid of the autonomous area (Republic of Macedonia)

Structure

In 1 tablet — verapamil of a hydrochloride of 40 mg or 80 mg.

Starch wheat, lactose, silicon dioxide, MKTs, povidone, magnesium stearate, talc — auxiliary components.

Form of production of Verapamil

  • tablets in a cover of 40 mg and 80 mg;
  • solution for intravenous administration of 2,5%;
  • tablets of the prolonged action of 240 mg;
  • dragee of 40 mg and 80 mg.

Pharmacological action

Antiarrhytmic, anti-anginal.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Pharmacological group of drugs to which Verapamil — blockers of calcium channels belongs. They possess antiarrhytmic, hypotensive and antiangialny action. The mechanism of action is connected with blockade of "slow" calcium channels which are located in cells of a myocardium, the carrying-out system of heart and smooth muscle cells of vessels. Besides, these channels are in unstriated muscles of urinary tract, bronchial tubes and a uterus. As a result of blockade the increased current of calcium ions in cells is normalized patholologically. Reducing a transmembrane entrance of Ca2 + in cardiomyocytes, drug reduces force of reductions of a myocardium and frequency of ChSS, and, therefore, the need of a myocardium for oxygen decreases.

Reduces a tone of muscles of a wall of vessels and causes dilatation mainly of arterioles that attracts decrease in resistance in a big circle and reduction of an afterload. Increases also coronary blood stream. Conductivity slows down AV, automatism of a sinus node oppresses that allows to apply it to treatment of supraventricular arrhythmias.

At Verapamil action on the carrying-out system (a sinus and atrioventricular node) is more expressed, and action on vessels is less expressed. Improves secretory function of kidneys. It is necessary to remember that drug aggravates heart failure, provokes the expressed bradycardia and atriventrikulyarny blockade.

Pharmacokinetics

It is almost completely soaked up from a gastrointestinal tract. The maximum concentration in blood is defined in 1-2 hours. For 90% contacts blood proteins. It is quickly metabolized in a liver. At course treatment action amplifies that is connected with accumulation of drug and its metabolites.

Elimination half-life at a single dose — 3-6 hours, at long till 12 o'clock. It is allocated through kidneys (about 74%).

Indications to Verapamil use

  • supraventricular tachycardia;
  • stable angina of exertion;
  • stenocardia with supraventricular disturbances of a rhythm;
  • sinus tachycardia;
  • supraventricular ekstrasistoliya;
  • ciliary tachyarrhythmia;
  • hypertensive crisis (in/in use);
  • arterial hypertension.

Contraindications

  • the expressed bradycardia;
  • the expressed LZh dysfunction;
  • AV blockade of the II-III Art.;
  • hypersensitivity;
  • arterial hypotension;
  • SSSU;
  • pregnancy, feeding by a breast.

With care it is appointed at bradycardia, AV to blockade of the I Art., sinuatrial blockade, HSN, at advanced age, at a liver and/or renal failure.

Side effects

The met side reactions are more often:

The met side reactions are more rare:

  • diarrhea;
  • hyperplasia of gums;
  • nervousness;
  • fatigue;
  • block;
  • skin itch, rash;
  • AV blockade of the III Art., at fast in introduction;
  • agranulocytosis, thrombocytopenia;
  • galactorrhoea, gynecomastia;
  • arthritis;
  • peripheral hypostases;
  • fluid lungs.

Application instruction of Verapamil (Way and dosage)

Tablets Verapamil, application instruction

Pill of usual duration of action is taken inside before meal on 40-80 mg three times a day at stenocardia and tachycardia. With the increased arterial pressure — in 2 receptions, at the same time the daily dose can reach 480 mg. The daily dose for children till 5 flyings makes 40-60 mg.

The prolonged forms at arterial hypertension are appointed on 240 mg in the morning. It is desirable to begin treatment with more smaller dose — 120 mg of 1 times a day. In the subsequent in 2 weeks increase of a dose is carried out. Its increase up to 480 mg a day in two steps in 12 hours is possible. A dose it is impossible to exceed more than 480 mg a day if there is a question of long therapy.

Apply Verapamil to stopping of hypertensive crisis in/in struyno on 5–10 mg. At paroxysmal disturbances of a rhythm it is also entered in/in struyno in a dose of 5-10 mg. Repeatedly in the same dose in 20-30 min. if the effect is absent. For a maintenance therapy turn on into drop maintaining on solution of a dextrose, chloride sodium. A single dose at in introduction for children from 1 to 5 flyings — 2-3 mg.

Overdose

Overdose is shown by bradycardia, AV blockade and SA blockade, decrease in the ABP, an asystolia.

Treatment is begun with a gastric lavage, reception of sorbents. At disturbance of conductivity are entered intravenously izoprenalin, Atropine, 10% gluconate Calcium solution, plasma substituting solutions. The artificial pacemaker is recommended. For increase of the ABP appoint alpha adrenostimulyatory.

Interaction

CYP3A4 inhibitors reduce concentration of verapamil, and increase of its concentration in plasma causes grapefruit juice. Drug increases concentration in plasma of carbamazepine, cyclosporine, theophylline, quinidine, cardiac glycosides and ethanol. Increases risk of neurotoxic effect of the drugs Li+.

Cimetidinum increases bioavailability of verapamil therefore sometimes there is a need of reduction of a dose by 50%.

Rifampicin considerably reduces its bioavailability.

At combined use with inhalation anesthetics there is a risk of bradycardia, heart failure and AV of blockade.

The combination with beta adrenoblockers even more reduces contractility of a myocardium, increases risk of bradycardia and disturbances of AV of conductivity. Alpha adrenoblockers strengthen hypotensive action.

The negative inotropic effect is summed up at purpose of Disopyramidum and flekainid which it is impossible to appoint even within 2 days to or 1 days after Verapamil use.

Strengthens effect of peripheral muscle relaxants.

Terms of sale

It is released according to the recipe of the doctor.

Storage conditions

Temperature of storage is up to 25 °C.

Period of validity

5 years.

Verapamil at pregnancy

Now there are no data about emrio-and fetotoksichnost of this drug. Its use at pregnancy is possible if the expected advantage for mother is higher than potential risk for a fruit. Nevertheless, drug during pregnancy is used quite often. There are obstetric and therapeutic indications to its appointment.

Obstetric indications:

  • threat of premature births (as a part of complex therapy);
  • placental insufficiency;
  • nephropathy of pregnant women.

At threat of premature births this drug is appointed together with Ginipral, at the same time Verapamil is accepted in 20-30 minutes. Judging by responses Ginipral not causes tachycardia in all and then pregnant women do without Verapamil. But most often it should be accepted.

  • "… I have a tachycardia and hands shiver after Ginipral's reception, the child has a cardiopalmus too. It is necessary to accept also the second drug";
  • "… I drink Verapamil as necessary if pulse more than 100. Usually it only happens in the morning";
  • "… From 26th week Ginipral drank and Verapamil — it well helped at tachycardia".

As drug influences a calcium exchange, it is widely used in therapy of the menacing premature births. It is proved that tokolitichesky therapy can be carried out only by blockers of calcium channels. At oral administration considerably reduces amplitude of reductions of a uterus, up to complete cessation of activity. However, if to consider power of the inhibiting effect on a uterus, then from this group Nitrendipin and Nifedipine exceed Verapamil and Diltiazem.

At a nephropathy of easy severity monotherapy can be used by Verapamil, at a preeclampsia — complex therapy which in addition to the Magnesium sulfate having anticonvulsant, hypotensive and diuretic effect includes Verapamil on 80 mg a day and other HP.

Therapeutic indications:

  • Arrhythmias (in particular supraventricular tachycardia).
  • Arterial hypertension. It is one of the anti-hypertensive means applied during pregnancy and can it is long to be used, but as basic hypotensive drug at pregnant women is used seldom.
  • Stenocardia.

About Verapamil at pregnancy demonstrate that drug is effective, in therapeutic doses it is transferred well and does not exert an adverse effect on a fruit.

  • "… At Ginipral's reception there was tachycardia therefore appointed also this drug. A saw very long, almost before childbirth. The child was born healthy";
  • "… I drank with the 28th and to 32 weeks together with Ginipral as I and at the child had a tachycardia".

The analysis of result of pregnancy at the women receiving this drug in the I trimester did not reveal increase of frequency of the congenital anomalies at a fruit caused by its reception. At children of women who received drug in II and III trimesters undesirable effects are not revealed too.

Analogs of Verapamil

Coincidence on the ATH code of the 4th level:

The synonyms of this drug having the same active ingredient: Isoptinum, Kaveril, Finoptinum, Lekoptin.

Analogs of Verapamil — the blockers of calcium channels having similar effect: Gallopamil, Nifedipine, Nifedipine Retard, Amlodipin, Nikardipin, Riodipin, Nimodipin.

Zdravzona

  • Verapamil 80 of mg No. 50 of Tablet/Valenta/Valent Farmatsevtik of joint stock company
  • Verapamil solution for injections 2,5mg/ml 2 ml No. 10 ampulyalkaloid
  • Verapamil 40 of mg No. 50 tablet/double /
  • Verapamil 80 of mg No. 50 tablet/ozone/ozone of Ltd company
  • Verapamil 80 of mg No. 20 tabletkiakrikhin HFK of joint stock company

Drugstore of IFC

  • Verapamil tbl p / about 40 mg No. 30, Alkaloidmakedoniya
  • Verapamil tbl p / about 80 mg No. 30, Alkaloidmakedoniya
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Apteka24

  • Verapamiloz GNTSLS (Ukraine, Kharkiv)
  • Verapamildarnitsa (Ukraine, Kiev)
  • Tablet verapamil coated 0.08g No. 50darnitsa (Ukraine, Kiev)
  • Verapamil tablet hydrochloride coated 0.08g No. 50borshchagovsky HFZ (Ukraine, Kiev)
  • Verapamil No. 20darnitsa tablet 0.04g hydrochloride (Ukraine, Kiev)

Paniapteka

  • Tab. verapamil p / about 0.08g No. 50darnitsa
  • Tab. verapamil p / about 0.08g No. 50darnitsa
  • Tab. verapamil p / about 0.08g No. 50darnitsa
  • Tab. verapamil p / about 0.08g No. 50darnitsa
  • Tab. verapamil p / about 0.08g No. 50darnitsa

BIOSPHERE

  • Verapamil of 80 mg No. 50 tabl.p.o.
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Section: Cardiovascular
in more detail

Education: Graduated from Sverdlovsk medical school (1968 - 1971) as "Paramedic". Graduated from the Donetsk medical institute (1975 - 1981) as "An epidemiologist, a hygienist". Passed postgraduate study in the Central scientific research institute of epidemiology Moscow (1986 - 1989). An academic degree – the candidate of medical sciences (degree is awarded in 1989, protection – the Central scientific research institute of epidemiology Moscow). Numerous advanced training courses are studied in epidemiology and infectious diseases.

Experience: Work as the manager of department of disinfection and sterilization of 1981 - 1992. Work as the manager of department of especially dangerous infections of 1992 - 2010. Teaching activity at Medical institute 2010 - 2013.

PAY ATTENTION! Information on drugs on the website is help generalizing, collected from public sources and can form the basis for making decision on use of medicines it is not aware of treatment. Before medicine use Verapamil surely consult with the attending physician.