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DOSING: The usual oral dose is 180-480 mg/day. Verapamil may be given once, twice or three times daily depending on the formulation used. Verapamil can be taken with food.

DRUG INTERACTIONS: Concurrent use of verapamil with a beta blocker (another class of medications that slow heart rate) can occasionally cause profound and dangerous heart slowing.

Verapamil can raise the levels of some drugs in blood including digoxin (Lanoxin), theophylline (Slo-Bid), and carbamazepine (Tegretol). Therefore, monitoring of the levels of these drugs is important to avoid toxicity.

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verapamil (cont.)

Verapamil may reduce blood levels of lithium in some patients. For unclear reasons some patients who took both verapamil and lithium have noticed increased side effects of lithium without increases in their blood levels of lithium.

PREGNANCY: Safety during pregnancy has not been established. Verapamil crosses the placenta and enters the fetus.

NURSING MOTHERS: Safety in nursing mothers has not been established. Verapamil is excreted in human milk.

SIDE EFFECTS: Side effects from verapamil generally are mild and transient. It can cause dizziness, weakness or fainting because of a slow heart rate or low blood pressure. Other side effects include swelling of the lower extremities, rash, headache, and constipation. Verapamil also can cause mildly abnormal liver tests that usually return to normal with discontinuation of the medication.

Verapamil may reduce the heart rate. Verapamil also can cause excessive lowering of blood pressure in rare instances. Verapamil can aggravate heart failure, especially in patients with poor function of their heart muscle.

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