Adult Dosing
Angina
- Immediate release form
- Usual dose: 80-120 mg PO tid
- Start 40 mg PO tid if increased response to verapamil, decreased hepatic function or if elderly
- Max: 480 mg/day
- Extended Release Form
- Start 180 mg PO qhs
- May increase to 480 mg PO qhs
- Max: 480 mg/day
Hypertension
- Immediate release form
- Start 80 mg PO tid
- 40 mg PO tid in elderly or if small stature
- Usual range: 80-120 mg PO tid. Max: 480 mg/day
- Extended release tabs (12 hrs dosing form)
- Start 180 mg PO qam
- Start 120 mg PO qam in elderly or of small stature
- Usual dose: 120-480 mg/day divided daily-bid. Divide doses > 240 mg/day bid
- Max: 480 mg/day
- Covera HS
- Start 180 mg PO qhs
- May increase to 480 mg PO qhs
- Max: 480 mg/day
- Extended release (24 hrs AM dosing form), Verelan
- Start 240 mg PO qam
- Start 120 mg PO qam in elderly or if short stature
- Titrate upward based on therapeutic efficacy and safety
- Max: 480 mg/day
- Extended release (24 hrs PM dosing form), Verelan PM
- Start 200 mg PO qhs
- Start 100 mg PO qhs in elderly or if short stature
- Max: 400 mg/day
PSVT prophylaxis
- Immediate release form
- 80-120 mg PO tid-qid
- Max: 480 mg/day
Arrhythmias
- Immediate release form
- Digitalized patients with chronic AF: 240-320 mg/day divided tid-qid
- Max: 480 mg/day
Acute Coronary Syndromes [Non-FDA Approved]
- 120 – 480mg Sustained Release PO daily
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <10 mL/min: Decrease dose 50-75%
Hepatic Dose Adjustment
- Hepatic impairment: Decrease dose 50-80%
- Transient and asymptomatic hypotension may occur due to verapamil which may result in dizziness
- Pulmonary edema has been reported
- 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
- 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 dosage 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
- Use with caution in older patients to minimize the risk of untoward drug effects
- Events of elevated transaminases with and without concomitant elevations in alkaline phosphatase and bilirubin have also been reported with the therapy, monitoring recommended
- Therapy may decrease neuromuscular transmission in patients with Duchenne’s muscular dystrophy, and prolongs recovery from the neuromuscular blocking agent vecuronium
- Concomitant use with beta blocker in patients with any degree of ventricular dysfunction should be avoided
- Concomitant use with quinidine in patients with hypertrophic cardiomyopathy should be avoided
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- History of serious ventricular arrhythmias or CHF
- Bradycardia
- GERD
- Myasthenia gravis
- Muscular dystrophy
- Elderly patients
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)This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 10 June 2011). 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.
US Trade Name(s)
- Calan
- Calan SR
- Covera-HS
- Isoptin SR
- Veralan
- Verelan PM
US Availability
verapamil (generic)
- TABS: 40, 80, 120 mg
- Extended Release TABS: 120, 180, 240 mg (12 hrs dosing)
- Extended Release CAPS: 120, 180, 240 mg (24 hrs AM dosing)
- Extended Release CAPS: 100, 200, 300 mg (24 hrs PM dosing)
Calan
Calan SR
- Extended Release TABS: 120, 180, 240 mg
Covera-HS
- Extended Release TABS: 180, 240 mg
Isoptin SR
- Extended Release TABS: 120, 180, 240 mg
Veralan
- Extended Release CAPS: 120, 180, 240, 360 mg
Verelan PM
- Extended Release CAPS: 100, 200, 300 mg
Canadian Trade Name(s)
- Apo-Verap SR
- Covera-HS
- Isoptin SR
- Nu-Verap
- Nu-Verap SR
- Verelan
Canadian Availability
verapamil (generic)
- TABS: 80, 120 mg
- ETABS: 120, 180, 240 mg
Apo-Verap SR
- TABS: 80, 120 mg
- ETABS: 120, 180, 240 mg
Covera-HS
Isoptin SR, Nu-Verap SR
Nu-Verap
Verelan
UK Trade Name(s)
- Cordilox
- Half-securon SR
- Securon SR
- Univer
- Verapress MR
- Vertab SR 240
UK Availability
verapamil (generic)
- TABS: 40, 80, 120, 160 mg
- SOLN: 40 mg/5 mL (150 mL)
Cordilox
Half-securon SR
Securon SR
Univer
Verapress MR, Vertab SR 240
Australian Trade Name(s)
- Anpec
- Anpec SR
- Cordilox SR
- Isoptin
- Isoptin SR
- Veracaps SR
Australian Availability
Anpec
Anpec SR
Cordilox SR, Isoptin SR
Isoptin
- TABS: 40, 80, 120, 160 mg
Veracaps SR
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Covera-HS 240 MG TB24 [Bottle] (PFIZER U.S.)
30 mg = $102.89
90 mg = $283.45 - Verelan 240 MG CP24 [Bottle] (SCHWARZ PHARMA)
30 mg = $136
90 mg = $407.99 - Calan 80 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $46.86
60 mg = $85 - Calan SR 180 MG TBCR [Bottle] (PFIZER U.S.)
30 mg = $94.48
90 mg = $251.96 - Verelan PM 100 MG CP24 [Bottle] (SCHWARZ PHARMA)
30 mg = $123.99
90 mg = $345.96 - Verelan 180 MG CP24 [Bottle] (SCHWARZ PHARMA)
30 mg = $115.99
90 mg = $317.97 - Verelan PM 200 MG CP24 [Bottle] (SCHWARZ PHARMA)
30 mg = $139.98
90 mg = $399.99 - Calan SR 120 MG TBCR [Bottle] (PFIZER U.S.)
30 mg = $75.59
90 mg = $199.47 - Calan SR 240 MG TBCR [Bottle] (PFIZER U.S.)
30 mg = $112
90 mg = $314.97 - Verelan 360 MG CP24 [Bottle] (SCHWARZ PHARMA)
30 mg = $237.98
90 mg = $669.97 - Covera-HS 180 MG TB24 [Bottle] (PFIZER U.S.)
30 mg = $72.99
90 mg = $209.96 - Calan 40 MG TABS [Bottle] (PFIZER U.S.)
90 mg = $69.29
270 mg = $188.95 - Verapamil HCl 40 MG TABS [Bottle] (WATSON LABS)
90 mg = $24.99
180 mg = $39.97 - Calan 120 MG TABS [Bottle] (PFIZER U.S.)
90 mg = $156.94
180 mg = $300.39 - Verelan PM 300 MG CP24 [Bottle] (SCHWARZ PHARMA)
30 mg = $207.99
90 mg = $609.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
