Verapamil — uses, dosing, side effects & the brands that sell it · pharmaranks
Verapamil: uses, dosing, side effects & brands
Verapamil is a calcium channel blocker sold in the U.S. under 7 brand and generic names, for variant angina pectoris, atrial fibrillation and atrial flutter. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.
By the pharmaranks editorial team·Reviewed against the FDA (openFDA label, NDC Directory & Enforcement) sources·How we research
Key facts
Drug class
Calcium Channel Blocker
Treats
Variant Angina Pectoris, Atrial Fibrillation and Atrial Flutter
7 products — Verelan, Verelan Pm and Verapamil Hydrochloride, and others
Prescription?
Prescription only
Generic available?
Yes
Typical price
about $6 for a 30-count supply
How verapamil is dosed
From the FDA label for Verelan (application NDA019614). Other verapamil products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.
Essential Hypertension The dose of verapamil hydrochloride sustained-release capsules should be individualized by titration. The usual daily dose of sustained-release verapamil, verapamil hydrochloride sustained-release capsules, in clinical trials has been 240 mg given by mouth once daily in the morning. However, initial doses of 120 mg a day may be warranted in patients who may have an increased response to verapamil (e.g., elderly, small people, etc.). Upward titration should be based on therapeutic efficacy and safety evaluated approximately 24 hours after dosing. The antihypertensive effects of verapamil hydrochloride sustained-release capsules are evident within the first week of therapy. If adequate response is not obtained with 120 mg of verapamil hydrochloride sustained-release capsules, the dose may be titrated upward in the following manner: (a) 180 mg in the morning. (b) 240 mg in the morning. (c) 360 mg in the morning. (d) 480 mg in the morning. Verapamil hydrochloride sustained-release capsules are for once-a-day administration. When switching from immediate-release verapamil to verapamil hydrochloride sustained-release capsules, the same total daily dose of verapamil hydrochloride sustained-release capsules can be used. As with immediate-release verapamil, dosages of verapamil hydrochloride sustained-release capsules should be individualized and titration may be…
Verapamil side effects
Serious adverse reactions are uncommon when verapamil HCl therapy is initiated with upward dose titration within the recommended single and total daily dose. See WARNINGS for discussion of heart failure, hypotension, elevated liver enzymes, AV block, and rapid ventricular response. Reversible (upon discontinuation of verapamil) non-obstructive, paralytic ileus has been infrequently reported in association with the use of verapamil. In clinical trials involving 285 hypertensive patients on verapamil hydrochloride sustained-release capsules for greater than 1 week the following adverse reactions were reported in greater than 1.0% of the patients: Constipation 7.4% Headache 5.3% Dizziness 4.2% Lethargy 3.2% Dyspepsia 2.5% Rash 1.4% Ankle Edema 1.4% Sleep Disturbance 1.4% Myalgia 1.1% In clinical trials of other formulations of verapamil HCl (N=4,954) the following reactions have occurred at rates greater than 1.0%: Constipation 7.3% Dizziness 3.3% Nausea 2.7% Hypotension 2.5% Edema 1.9% Headache 2.2% Rash 1.2% CHF/Pulmonary Edema 1.8% Fatigue 1.7% Bradycardia (HR<50/min) 1.4% AV block-total 1°, 2°, 3° 1.2% 2° and 3° 0.8% Flushing 0.6% Elevated Liver Enzymes (See WARNINGS ) In clinical trials related to the control of ventricular response in digitalized patients who had atrial fibrillation or atrial flutter, ventricular rate below 50/min at rest occurred in 15% of patients and…
Every verapamil product we track (7)
Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.
Verapamil hydrochloride sustained-release capsules are calcium ion influx inhibitors (slow channel blockers or calcium ion antagonists). Verapamil hydrochloride sustained-release capsules are available for oral administration as a 360 mg hard gelatin capsule (lavender cap/yellow body), a 240 mg hard gelatin capsule (dark blue cap/yellow body), a 180 mg hard gelatin capsule (light grey cap/yellow body), and a 120 mg hard gelatin capsule (yellow cap/yellow body). These pellet-filled capsules provide a sustained-release of the drug in the gastrointestinal tract. The structural formula of verapamil HCl is given below: C 27 H 38 N 2 O 4 •HCl M.W. 491.07 Chemical name: Benzeneacetonitrile, α-[3-[[2-(3,4-dimethoxyphenyl)-ethyl]methylamino]propyl]-3,4-dimethoxy-α-(1-methylethyl) monohydrochloride. Verapamil HCl is an almost white, crystalline powder, practically free of odor, with a bitter taste. It is soluble in water, chloroform and methanol. Verapamil HCl is not structurally related to other cardioactive drugs. In addition to verapamil HCl the verapamil hydrochloride sustained-release capsules contain the following inactive ingredients: fumaric acid, talc, sugar spheres, povidone, shellac, gelatin, FD&C red #40, yellow iron oxide, titanium dioxide, silicon dioxide, and sodium lauryl sulfate. In addition, the verapamil hydrochloride sustained-release capsules 240 mg and 360 mg…
What kind of drug is verapamil?
The FDA classifies verapamil as a calcium channel blocker. Calcium channel blockers slow the flow of calcium into the muscle cells of the heart and blood vessels. With less calcium, blood vessels relax and widen and the heart pumps with less force, which lowers blood pressure and eases chest pain. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.
Can you take verapamil with other medicines?
It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run verapamil against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.
What brand names is verapamil sold under?
Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.
Who shouldn’t take verapamil
Verapamil HCl is contraindicated in: Severe left ventricular dysfunction. (See WARNINGS . ) Hypotension (less than 90 mm Hg systolic pressure) or cardiogenic shock. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker). Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker). Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes). (See WARNINGS . ) Patients with known hypersensitivity to verapamil hydrochloride.
Verapamil drug interactions
Effects of other drugs on verapamil pharmacokinetics: In vitro metabolic studies indicate that verapamil is metabolized by cytochrome P450, CYP3A4, CYP1A2, and CYP2C. Clinically significant interactions have been reported with inhibitors of CYP3A4 (e.g., erythromycin, ritonavir) causing elevation of plasma levels of verapamil while inducers of CYP3A4 (e.g., rifampin) have caused a lowering of plasma levels of verapamil. Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients receiving concurrent telithromycin, an antibiotic in the ketolide class of antibiotics. Ivabradine Concurrent use of verapamil increases exposure to ivabradine and may exacerbate bradycardia and conduction disturbances. Avoid concomitant use of ivabradine and verapamil. HMG-CoA Reductase Inhibitors The use of HMG-CoA reductase inhibitors that are CYP3A4 substrates in combination with verapamil has been associated with reports of myopathy/rhabdomyolysis. Co-administration of multiple doses of 10 mg of verapamil with 80 mg simvastatin resulted in exposure to simvastatin 2.5-fold that following simvastatin alone. Limit the dose of simvastatin in patients on verapamil to 10 mg daily. Limit the daily dose of lovastatin to 40 mg. Lower starting and maintenance doses of other CYP3A4 substrates (e.g., atorvastatin) may be required as verapamil may increase the plasma…
We track 7 verapamil-containing products in the U.S.: Verelan, Verelan Pm, Verapamil Hydrochloride, Calan SR, Covera-Hs, Calan and Isoptin. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.
What forms does verapamil come in?
Across the brands we track, verapamil is currently marketed as capsule, delayed release, capsule, oral pellets, capsule, extended release, injectable, solution, tablet and tablet, extended release, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.
Is there a generic verapamil?
Yes. Our catalog lists 1 generic verapamil product alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.
Has verapamil been recalled?
The FDA's Enforcement database lists 2 recall records whose product description mentions verapamil. The most recent: Verapamil Hydrochloride Injection (Jul 2, 2024). A recall applies to specific lots, not to the drug as a whole — check the record for the affected lot numbers.