Veral

Symptomatic CHD: Chronic stable angina pectoris, unstable angina pectoris; vasospastic angina pectoris (Prinzmetal angina, variant angina); angina pectoris in conditions after MI in patients w/o cardiac insufficiency if β-adrenergic blocking agents are not indicated. Heart beat rate disorders: Paroxysmal supraventricular tachycardia, atrial fibrillation/atrial flutter w/ rapid AV conduction (except in case of WPW syndrome or Lown-Ganong-Levine syndrome). HTN.

240 & 360 mg/day. Max daily dose: 480 mg. Adult & adolescent >50 kg CHD 240-480 mg/day in 2 single doses (1 single dose in the morning at sufficient efficacy, 1 additional single dose in the evening). HTN 240-480 mg/day in 2 single doses. Paroxysmal, supraventricular tachycardia, atrial fibrillation/atrial flutter 240-480 mg/day in 2 single doses per day in 2 single doses. Hepatic dysfunction 80-120 mg/day.

Should be taken with food: Take w/ sufficient quantity of liqd (eg, a glass of water, no grapefruit juice). Do not take in lying position. Swallow whole, do not suck/chew/crush.

Hypersensitivity (allergy). CV shock; pronounced conduction disturbances (eg, SA or AV block degrees II & III; except in patients w/ an artificial pacemaker); sick sinus syndrome (except in patients w/ an artificial pacemaker); cardiac insufficiency w/ reduced ejection fraction of <35% &/or pulmonary wedge pressure >20 mmHg (unless secondary to a supraventricular tachycardia amenable to verapamil therapy); atrial fibrillation/flutter in the presence of an accessory bypass tract (eg, WPW or Lown-Ganong-Levine syndrome); combination w/ ivabradine. Do not use concurrently w/ β-blockers IV.

Acute MI w/ complications (bradycardia, hypotension, left ventricular dysfunction). Discontinue in the development of 2nd or 3rd degree AV block or unifascicular, bifascicular or trifascicular bundle branch block. Patients w/ sick sinus syndrome. Concomitant use w/ anti-arrhythmics (eg, flecainide, disopyramide), β-receptor blockers (eg, metoprolol, propranolol) & inhalation anaesth; timolol eye drops; digoxin; HMG-CoA reductase inhibitors. Cardiac insufficiency patients w/ ejection fraction higher than 35%. Presence of diseases in which neuromuscular transmission is affected (myasthenia gravis, Lambert-Eaton syndrome, advanced Duchenne muscular dystrophy). Hypotension (<90 mmHg systolic BP). Renal or severe liver impairment. Reactivity may be impaired to such an extent that the ability to drive to operate machinery or to work in an unsafe posture is impaired. Effects of alcohol may be exaggerated. Pregnancy & lactation.

Nervosity; dizziness or drowsiness, headache, neuropathy; bradycardia, development of cardiac insufficiency or exacerbation of preexisting cardiac insufficiency, excessive fall in BP &/or orthostatic dysregulation; flush, hypotension; constipation, nausea; erythromelalgia; peripheral edema.

Mutual potentiation of CV effects w/ anti-arrhythmic (eg, flecainide, disopyramide), β-receptor blockers (eg, metoprolol, propranolol) & inhalational anaesth. Additive hypotensive effect w/ prazosin & terazosin. Hypotension & pulmonary edema w/ quinidine. Increased plasma levels of amiodarone. Decreased oral & systemic clearance of theophylline. Increased AUC of carbamazepine (in refractory partial epilepsy patients), imipramine. Decreased plasma conc w/ phenytoin. Increased C_max & AUC of glyburide, colchicine, doxorubicin, buspirone, midazolam, almotriptan. Increased levels w/ clarithromycin, erythromycin, telithromycin. Decreased C_max & AUC w/ rifampicin. Increased plasma level w/ clotrimazole, ketoconazole, itraconazole. Increased clearance w/ phenobarb. Decreased total body & extrarenal clearance of digitoxin. Reduces clearance w/ cimetidine. Ciclosporin, everolimus, sirolimus. Increased tacrolimus levels. Increased AUC w/ atorvastatin. Increased C_max & AUC w/ lovastatin, simvastatin. Reduced BP lowering effect w/ sulfinpyrazone. Additional heart rate lowering effect to ivabradine. Grapefruit juice, St. John's wort.

Calcium Antagonists

C08DA01 - verapamil ; Belongs to the class of phenylalkylamine derivative selective calcium-channel blockers with direct cardiac effects. Used in the treatment of cardiovascular diseases.

Rx