Verapamil (Calan, Verelan, Calan SR, Isoptin) Considerations for Use*
US/FDA Approved Indication: Heart Rate Control for Atrial Fibrillation
|Black Box Warning*|
Mechanism of Action
Blocks calcium-dependent contractions in cardiac and peripheral smooth muscle leading to vasodilation; slows cardiac conduction through SA node
Acute setting: 0.075 to 0.15 mg/kg (average 5 to 10 mg) IV over 2 minutes; 2nd dose of 10 mg IV may be given 15-30 minutes later if needed
Non-acute setting or maintenance: 120 to 480 mg daily, slow-release/extended release available and preferred
Elderly: In general, use lower adult dosage and administer over at least 3 minutes; adjust dosage based on clinical response
Hepatic Impairment: Use with caution; if possible reduce initial dosage to about 33% of the usual starting dosage and adjust based on clinical goals
Renal Impairment: Use with caution; no dosage adjustment needed
|Major Side Effects||
hypotension, heart block, HF
|Dosage forms and Strengths||
IV: 2.5 mg/mL solution for injection
Many verapamil products are not equivalent on a mg:mg basis; monitor response and side effects when interchanging between products.
Covera-HS and Verelan PM are chronotherapeutic products; give at bedtime to blunt early morning surge in blood pressure
Take with food or milk to minimize gastric irritation
Sustained-release tablets may be broken and each piece swallowed whole; do not chew or crush
Extended-release table ts should be swallowed whole
Contents of sustained-release capsules may be sprinkled on food (eg, apple sauce); do not chew or crush capsule contents
Empty tablets that appear in stool are not significant
* Refer to prescribing information for more complete information.
†Dosages given in the table may differ from those recommended by the manufacturers.
- American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Washington, DC: American College of Cardiology.
- Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
- Tarascon Pocket Pharmacopoeia® 2012.