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Verapamil HCl
Verapamil HCl is a calcium channel blocker used to treat high blood pressure (hypertension), angina (chest pain), and certain types of arrhythmias such as supraventricular tachycardia and atrial fibrillation. It works by relaxing the muscles of the heart and blood vessels, which reduces the workload on the heart and helps control the heart rate. Verapamil is available in immediate-release (IR) and extended-release (ER) forms.
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Frequently Asked Questions
How long does it take for verapamil HCl to start working?
Verapamil starts working within 1 to 2 hours of taking an immediate-release tablet. Extended-release formulations provide longer-lasting effects throughout the day.
Can verapamil cause weight gain?
Verapamil does not typically cause weight gain, but some patients may experience swelling in the ankles or feet, which can mimic weight gain. Contact your healthcare provider if you notice significant swelling.
Can I take verapamil with other heart medications?
Yes, verapamil can be taken with other heart medications like ACE inhibitors or diuretics, but careful monitoring is needed if used with beta-blockers or digoxin due to the risk of heart rate slowing or heart block.
What should I do if I miss a dose of verapamil HCl?
If you miss a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not double up on doses to make up for a missed dose.
Is verapamil safe for long-term use?
Yes, verapamil is safe for long-term use in managing hypertension, angina, and arrhythmias. Regular check-ups with your healthcare provider are important to monitor its effectiveness and manage any potential side effects.
Comprehensive Drug Guide
How Does Verapamil HCl Work?
Verapamil works by blocking calcium channels in the heart and blood vessels. This reduces the force of heart contractions and dilates blood vessels, leading to lower blood pressure and reduced oxygen demand by the heart. Verapamil also slows down the conduction of electrical signals in the heart, which helps to control abnormal heart rhythms.
What is Verapamil HCl Used For?
Common Dosages
- Immediate-release tablets: 40 mg, 80 mg, 120 mg
- Extended-release tablets or capsules: 120 mg, 180 mg, 240 mg, 360 mg
Typical Dosing
- For hypertension: The typical starting dose of verapamil HCl immediate-release is 80 mg to 120 mg taken three times daily. Extended-release formulations are taken once daily, usually starting at 180 mg to 240 mg.
- For angina: Immediate-release doses of 80 mg to 120 mg three times daily may be used.
- For arrhythmias: Verapamil is often started at 120 mg to 240 mg daily, and the dose can be adjusted based on the patient’s heart rate and response.
Typical Dosing
FDA Approved Indications
- Hypertension (high blood pressure)
- Angina (chronic stable and vasospastic angina)
- Supraventricular tachycardia (SVT)
- Atrial fibrillation and atrial flutter with rapid ventricular response
Off-Label Uses
Pediatric Dosing
Who Shouldn't Take Verapamil HCl?
- Severe hypotension (low blood pressure)
- Sick sinus syndrome or AV block (without a pacemaker)
- Severe heart failure
- Known hypersensitivity to verapamil or any component of the formulation
- Cardiogenic shock
Advice From The Pharmacist
- Take verapamil HCl at the same time each day to maintain consistent levels in your bloodstream. For immediate-release formulations, doses are typically spread throughout the day.
- Do not crush or chew extended-release forms of verapamil, as doing so can release the drug all at once, increasing the risk of side effects.
- Verapamil may interact with grapefruit and grapefruit juice, which can raise the levels of the medication in your blood and lead to increased side effects.
- Monitor your blood pressure regularly while taking verapamil to ensure the medication is effectively controlling your blood pressure.
Side Effects of Verapamil HCl
Common Side Effects
- Constipation
- Dizziness
- Fatigue
- Headache
- Swelling of the ankles or feet
Uncommon/Severe Side Effects
- Bradycardia (slow heart rate)
- Severe hypotension (low blood pressure)
- Heart failure (worsening symptoms)
- Severe allergic reactions (rash, swelling, difficulty breathing)
Risks and Warnings of Verapamil HCl
- Bradycardia and Hypotension: Verapamil can cause a significant slowing of the heart rate and a drop in blood pressure, especially in patients with existing heart conditions or those taking other heart medications.
- Worsening Heart Failure: Verapamil can worsen symptoms of heart failure, particularly in patients with preexisting conditions. It should be used cautiously in patients with heart failure.
- Constipation: This is a common side effect of verapamil, and drinking plenty of fluids and consuming a fiber-rich diet can help alleviate it.
Interactions with Verapamil HCl
Common Drug Interactions
- Grapefruit juice: Grapefruit juice can increase the levels of verapamil in the blood, leading to potential toxicity. It is advised to avoid grapefruit products while on verapamil.
- Beta-blockers (e.g., metoprolol, atenolol): Using verapamil with beta-blockers can increase the risk of excessively slow heart rate (bradycardia) and heart block.
- Digoxin: Verapamil can increase blood levels of digoxin, leading to toxicity. Monitoring is recommended if both drugs are used together.
- Statins (e.g., simvastatin, atorvastatin): Verapamil can increase the risk of muscle pain or weakness when taken with statins.
Alternatives to Verapamil HCl
- Amlodipine (Norvasc): A dihydropyridine calcium channel blocker used for hypertension and angina, with fewer effects on heart rate.
- Diltiazem (Cardizem): A non-dihydropyridine calcium channel blocker like verapamil, used for hypertension, angina, and arrhythmias.
- Beta-blockers (e.g., metoprolol, propranolol): Used for treating hypertension, angina, and certain types of arrhythmias but with different mechanisms of action.
