Indications for VERELAN PM:
Give once daily at bedtime. May sprinkle contents on applesauce; do not crush or chew contents. Initially 200mg; may titrate upwards in steps to 300mg, then 400mg if necessary. May start at 100mg in impaired renal or hepatic function, elderly or small patients.
Severe left ventricular (LV) dysfunction (eg, ejection fraction <30%, moderate to severe heart failure). LV dysfunction treated with β-blockers. Hypotension. Cardiogenic shock. Sick sinus syndrome, 2nd- or 3rd-degree AV block, unless paced. Atrial flutter or fibrillation. Accessory bypass tract (eg, Wolff-Parkinson-White, Lown-Ganong-Levine syndromes).
Control mild ventricular dysfunction (eg, with digitalis, diuretics) prior to initiation. AV conduction or neuromuscular transmission disorders. Hepatic or renal impairment. Monitor liver function periodically. Hypertrophic cardiomyopathy. Pregnancy (Cat.C). Nursing mothers: not recommended.
Calcium channel blocker (CCB) (diphenylalkylamine).
Avoid ivabradine; disopyramide (within 48hrs before or 24hrs after verapamil); quinidine in cardiomyopathy. Limit simvastatin dose to 10mg/day or lovastatin to 40mg/day; may need to reduce initial and maintenance dose for other CYP3A4 substrates (eg, atorvastatin). Potentiates alcohol, β-blockers (monitor closely), other antihypertensives (monitor), theophylline, neuromuscular blockers, flecainide, carbamazepine, cyclosporine, doxorubicin. Consider reducing concomitant digoxin dose; monitor periodically; discontinue if toxicity suspected. Potentiated by CYP3A4 inhibitors (eg, erythromycin, ritonavir), grapefruit juice. Antagonized by CYP3A4 inducers (eg, rifampin, phenobarbital). Inhalation anesthetics may potentiate cardiac depression. May increase bleeding with aspirin. Monitor lithium levels. Monitor heart rate when concomitant clonidine. Concomitant mTOR inhibitors (eg, sirolimus, temsirolimus, everolimus): consider dose reductions of both drugs.
Headache, infection, constipation, flu syndrome, peripheral edema, dizziness, pharyngitis, sinusitis, lethargy, dyspepsia; CHF, hypotension, AV block, elevated liver enzymes; rare: paralytic ileus.