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Non-DHP CCB·Cardiovascular - Antihypertensives
Hypertension, angina, SVT termination, AF rate control
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Max Dose
480 mg/day
Half-life
3–7 h
Caution: Constipation
HIGH
High risk: Heart Block
AVOID
Avoid / Cautions
Heart failure with reduced ejection fraction (HFrEF), 2nd/3rd degree AV block, WPW syndrome with AF, sick sinus syndrome. Pregnancy Category C.
Overview
Non-dihydropyridine CCB. Exerts potent negative inotropic and negative chronotropic effects. Acts heavily on the AV node.
Clinical Focus
NEVER co-administer with beta-blockers due to the risk of fatal complete heart block and asystole.
Bottom Line
Verapamil is the preferred CCB for rate control in AF/SVT, but must never be combined with beta-blockers due to risk of fatal bradycardia and AV block.
Brand Names
Isoptin, Isoptin SR, Veracaps SR
Oral Routes
Tablets (40 mg, 80 mg). SR Tablets (180 mg, 240 mg).
Parenteral
Ampoule (5 mg/2 mL) for IV use.
Primary
Hypertension, angina, SVT termination, AF rate control.
Off-Label
Cluster headache prophylaxis.
Clinical Place
Alternative to beta-blockers for rate control in AF, especially in asthmatic patients.
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