Adult Dosing
Rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts
- 5-10 mg (0.075-0.15 mg/kg) IV over 2 min; if no initial response, give 10 mg (0.15 mg/kg) after 30 min
Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation excluding when associated with accessory bypass tracts
- 5-10 mg (0.075-0.15 mg/kg) IV over 2 min; if no initial response, give 10 mg (0.15 mg/kg) after 30 min
Notes:- Administer therapy as a slow IV inj. over at least a two minutes under continuous ECG and BP monitoring
- Administer the dose over at least 3 mins. in older patients to minimize the risk of untoward drug effects
Pediatric Dosing
Rapid conversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts
- <1 yrs: 0.1-0.2 mg/kg (0.75-2 mg) IV over 2 min; if no initial response, repeat dose in 30 min
- 1-15 yrs: 0.1-0.3 mg/kg (2-5 mg) IV over 2 min; if no initial response, repeat dose in 30 min [MAX: 10 mg]
Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation excluding when associated with accessory bypass tracts
- <1 yrs: 0.1-0.2 mg/kg (0.75-2 mg) IV over 2 min; if no initial response, repeat dose in 30 min
- 1-15 yrs: 0.1-0.3 mg/kg (2-5 mg) IV over 2 min; if no initial response, repeat dose in 30 min [MAX: 10 mg]
Note:- Administer therapy as a slow IV inj. over at least a two minutes under continuous ECG and BP monitoring
[Outline]
- Verapamil should be given as a slow intravenous injection over at least a 2 minute period of time under continuous ECG and BP monitoring
- Transient and asymptomatic hypotension may occur due to IV verapamil which may result in dizziness
- Monitor for extreme bradycardia or asystole as verapamil can affect AV and SA nodes
- If heart failure is not severe or rate related, manage it with digitalis glycosides and diuretics before verapamil is used. Monitor for acute worsening of heart failure in patients with moderately severe to severe cardiac dysfunction
- Intravenous verapamil has been used concomitantly with digitalis preparations without the occurrence of serious adverse effects
- Cardioversion has been used safely and effectively after intravenous verapamil
- Reduce dosage or suspend therapy if 2nd or 3rd degree AV block or fascicular bundle branch block occur
- Avoid repeated injections of verapamil in hepatic or renal failure or if needed then closely monitor for BP and PR interval
- Use with caution in Duchenne's muscular dystrophy as therapy may precipitate respiratory muscle failure in these patients
- Appropriate monitoring and caution should be exercised while using in patients with supratentorial tumors as it may increase intracranial pressure
- Administer the dose over at least 3 mins. in older patients to minimize the risk of untoward drug effects
Cautions: Use cautiously in
Pregnancy Category:C
Breastfeeding: Safe. Poorly excreted in breast milk; would not be expected to cause any adverse effects in breastfed infants, especially if the infant is >2 months. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). Maternal medication usually compatible with breastfeeding; no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 24 December 2010 ).According to manufacturer's data, verapamil is excreted in human milk; due to the potential for adverse reactions in nursing infants, nursing should be discontinued while verapamil is administered.
