Indications
- Angina (see Coronary Artery Disease)
- Cluster Headache Prophylaxis
- Hypertension (see Hypertension)
- Migraine Prophylaxis (see Migraines)
- Rate Control of AV Nodal-Mediated Arrhythmias
- Atrial Fibrillation with Rapid Ventricular Response (see Atrial Fibrillation)
- Supraventricular Tachycardia (SVT) with Rapid Ventricular Response (see Supraventricular Tachycardia)
Contraindications
Atrioventricular Heart Blocks
- First Degree Atrioventricular Block (First Degree Heart Block) (see First Degree Atrioventricular Block): with P-R interval ≥0.24 sec
- Second Degree Atrioventricular Block-Mobitz Type I (Wenckebach) (see Second Degree Atrioventricular Block-Mobitz Type I)
- Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II)
- Third Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block)
Hypotension (see Hypotension)
- Verapamil May Exacerbate Hypotension
Sinus Bradycardia (see Sinus Bradycardia)
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Pharmacology
- Non-Dihydropyridines (Phenylalkylamine) Calcium Channel Blocker (see Calcium Channel Blockers)
Physiologic Effects
- Atrioventricular Nodal Blockade: since calcium channels are especially concentrated in the sinoatrial and atrioventricular nodes within the heart
- Class IV Anti-Arrhythmic
- Coronary Vasodilation: via calcium channels located within vascular smooth muscle
- Decreased Myocardial Oxygen Consumption
- Minimal Systemic Vasodilation: via calcium channels located within vascular smooth muscle
- Verapamil is relatively selective for the myocardium (compared to the dihydropyridine calcium channel blockers) and it therefore, causes less reflex tachycardia than the dihydropyridine calcium channel blockers
- Negative Inotropy
Metabolism
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Administration
- PO:
- IV:
Dose Adjustment
- Hepatic
- Renal
Use During Pregnancy (see Pregnancy)
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Use During Breast Feeding
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Adverse Effects
Cardiovascular Adverse Effects
Atrioventricular Heart Blocks
- First Degree Atrioventricular Block (First Degree Heart Block) (see First Degree Atrioventricular Block)
- Second Degree Atrioventricular Block-Mobitz Type I (Wenckebach) (see Second Degree Atrioventricular Block-Mobitz Type I)
- Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II)
- Third Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block)
Sinus Bradycardia (see Sinus Bradycardia)
- May Occur
Hypotension (see Hypotension)
- Physiology: class effect (common to all calcium channel blockers)
Dermatologic Adverse Effects
- Facial Flushing (see Flushing)
Endocrinologic Adverse Effects
- Galactorrhea (see Galactorrhea)
Gastrointestinal Adverse Effects
- Constipation/Ileus (see Constipation and Ileus)
- Nausea (see Nausea and Vomiting)
Hematologic Adverse Effects
- Ecchymosis
Neurologic Adverse Effects
Otolaryngologic Adverse Effects
Gingival Hypertrophy (see Gingival Hypertrophy)
- Physiology: class effect (observed with other calcium channel blockers, as well)
Renal Adverse Effects
- Increased Urination
Rheumatologic Adverse Effects
- Peripheral Edema (see Peripheral Edema)
Other Adverse Effects
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Calcium Channel Blocker Intoxication
References
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