VPL Injection
Verapamil Hydrochloride
5mg
Samarth Life Sciences Pvt Ltd
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Indications
VPL Injection is used for:
Essential hypertension, Angina pectoris and prevention of re-infarction, Supraventricular arrhythmias. Paroxysmal supraventricular tachycardias, Atrial fibrillation with rapid ventricular response (except WPWS) , Atrial flutter with rapid conduction, Extrasystoles, Acute hypertension, Acute coronary insufficiency, For the prophylaxis and / or therapy of ectopic arrhythmias (predominantly ventricular extrasystoles) in halothane anaesthesia and in the application of adrenaline in halothane anaesthesia respectively.
Adult Dose
Oral
Hypertension
Adult:
Immediate release
80 mg PO q8hr initially; maintenance: 80-320 mg PO q12hr
Extended release
180 mg/day PO (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day PO, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day
Angina
Immediate release
80 mg PO q8hr initially; usual range: 80-120 mg PO q8hr; not to exceed 480 mg/day
Extended release
180 mg/day PO at bedtime initially; maintenance: 180-480 mg/day PO at bedtime
Chronic Atrial Fibrillation & Paroxysmal Supraventricular Tachycardia
Treatment of chronic atrial fibrillation (rate control); prevention of paroxysmal supraventricular tachycardia
Immediate release: 240-480 mg/day PO divided q6-8hr
Tardive Dyskinesia
40 mg PO q8hr; may be titrated to 120 mg q8hr
Intravenous
2.5-5 mg IV over 2 minutes; 5-10 mg dose may be repeated after 15-30 minutes
Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose
Hepatic impairment: In cirrhosis, reduce dose by 20-50% of normal for oral and IV administration
Child Dose
Supraventricular Tachycardia
1-15 years old: 0.1-0.3 mg/kg (not to exceed 5 mg) IV over 2 minutes; second dose (not to exceed 10 mg) may be given after 30 minutes
Alternatively (not well established), 4-8 mg/kg/day PO divided q8hr
Renal Dose
Renal impairment: Use with caution; monitor ECG; for Verelan PM, manufacturer recommends 100 mg at bedtime initially; if CrCl <10 mL/min, reduce dose by 25-50%
Administration
Should be taken with food.
Contra Indications
Cardiogenic shock, hypotension (systolic pressure <90 mmHg), marked bradycardia, uncompensated heart failure, 2nd- or 3rd-degree AV block (unless pacemaker is fitted), sick-sinus syndrome, severe ventricular dysfunction, atrial flutter or atrial fibrillation and accessory bypass tract (e.g. Wolff-Parkinson-White, Lown-Ganong-Levine syndromes).
Precautions
Patient w/ bradycardia or 1st-degree AV block, attenuated neuromuscular transmission, hypertrophic cardiomyopathy. Avoid abrupt withdrawal. Renal and hepatic impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor BP, heart rate, ECG, LFTs (periodically).
Lactation: Distributed in milk; nursing infant doses range from <0.01% to 0.1% of mother’s dose; manufacturer suggests refraining from nursing (though American Academy of Pediatrics committee states that drug is compatible with nursing)
Pregnancy-Lactation
Interactions
Increased cardiac depressant effects with beta-blockers and flecainide. Increased risk of additive bradycardia, conduction disturbances and digoxin toxicity with digoxin. Increased risk of bradycardia and hypotension with remifentanil and sufentanil. Increased levels of both everolimus and verapamil on concurrent use. May increase doxorubicin, buspirone, carbamazepine, ciclosporin, epirubicin, eplerenone, quinidine, statins, sirolimus, tacrolimus, quinupristin/dalfopristin levels. Verapamil increase blood alcohol levels. Unpredictable interactions with lithium. Decreased verapamil concentrations with phenobarbital, sulfinpyrazone, rifampicin, rifabutin and rifapentine. Increased verapamil concentrations with protease inhibitors and cimetidine.
Potentially Fatal: Increased cardiac depressant effects with amiodarone. Increased risk of QT prolongation with dofetilide, ranolazine, sertindole. Additive bradycardia with ivabradine. Increased risk of heart block with clonidine. Increased risk of acute hyperkalaemia and CV collapse with dantrolene.
Adverse Effects
Side effects of Verapamil Hydrochloride :
>10%
Headache,Gingival hyperplasia
1-10%
Constipation (9%),Dizziness (4%),Hypotension (4%),Dyspepsia (3%),Nausea (3%),Edema (2%),Rash (2%),Increased liver enzymes (1%),Sleep disturbance (1%),Dyspnea
Mechanism of Action
Verapamil inhibits entry of calcium ions into arterial smooth muscle cells as well as the myocytes and conducting tissue. These actions lead to reversal and preventions of coronary artery spasm, reduction in afterload through peripheral vasodilatation and reduction in ventricular rate in patients with chronic atrial flutter or fibrillation and reduction in the occurrence of paroxysmal supraventricular tachycardia. Verapamil reduces BP, relieves angina and slows AV conduction.
Note
VPL 5mg Injection manufactured by Samarth Life Sciences Pvt Ltd. Its generic name is Verapamil Hydrochloride. VPL is availble in Nepal.
Farmaco Nepal drug index information on VPL Injection is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.