Verapamil (Calan, Verelan, Calan SR, Isoptin) Considerations for Use*

US/FDA Approved Indication: Heart Rate Control for Atrial Fibrillation

Click here to view a Print Quality PDF of this table

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

Dosing

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

Contraindications
  • severe LV dysfunction
  • hypotension (SBP < 90)
  • cardiogenic shock
  • sick sinus syndrome without pacemaker
  • 2nd or 3rd deg ree AV block without pacemaker
  • A-Fib/flutter conducted via accessory pathway (ie, Wolff -Parkinson-White)
  • Major Side Effects

    hypotension, heart block, HF

    Dosage forms and Strengths

    PO:
    40 mg, 80 mg, 120 mg immediate - release tablets (Calan®)
    120 mg, 180 mg, 240 mg sustained - release tablets (Isoptin® SR)
    120 mg, 180 mg, 240 mg, 360 mg sustained - release capsules (Verelan®) 100mg, 200 mg, 300 mg extended - release (Verelan® PM)
    180 mg, 240 mg extended - release tablets (Covera - HS®)

    IV: 2.5 mg/mL solution for injection

    Special Notes

    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

    Counseling

    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.


    Sources:

    1. 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.
    2. Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
    3. Tarascon Pocket Pharmacopoeia® 2012.