Verapamil hydrochloride tablet adverse reactions: Difference between revisions
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{{CMG}}; {{AE}} {{AK}} | {{CMG}}; {{AE}} {{AK}} | ||
==ADVERSE REACTIONS== | |||
<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = CALAN (VERAPAMIL HYDROCHLORIDE) TABLET, FILM COATED [G.D. SEARLE LLC DIVISION OF PFIZER INC] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=55d5f933-42ff-4c80-a102-0ccb7f76b082#nlm34090-1 | publisher = | date = | accessdate = }}</ref> | Serious adverse reactions are uncommon when CALAN therapy is initiated with upward dose titration within the recommended single and total daily dose. See [[Verapamil hydrochloride tablet warnings and precautions|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. The following reactions to orally administered verapamil occurred at rates greater than 1.0% or occurred at lower rates but appeared clearly drug-related in clinical trials in 4,954 patients: | ||
[[image:vera2.png]] | |||
In clinical trials related to the control of ventricular response in digitalized patients who had [[atrial fibrillation]] or [[flutter]], ventricular rates below 50 at rest occurred in 15% of patients and asymptomatic [[hypotension ]]occurred in 5% of patients. | |||
The following reactions, reported in 1.0% or less of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are listed to alert the physician to a possible relationship: | |||
'''Cardiovascular:''' [[angina pectoris]], [[atrioventricular dissociation]], [[chest pain]], [[claudication]], [[myocardial infarction]], [[palpitations]], [[purpura]]([[vasculitis]]), [[syncope]]. | |||
'''Digestive system:''' [[diarrhea]], dry mouth, gastrointestinal distress, [[gingival hyperplasia]]. | |||
'''Hemic and lymphatic''': [[ecchymosis ]]or [[bruising]]. | |||
'''Nervous system:''' [[cerebrovascular accident]], [[confusion]], equilibrium disorders, [[insomnia]], [[muscle cramps]], [[paresthesia]], [[psychotic ]]symptoms, [[shakiness]], [[somnolence]], [[extrapyramidal symptoms]]. | |||
'''Skin:''' [[arthralgia ]]and [[rash]], [[exanthema]], hair loss, [[hyperkeratosis]], [[macules]], [[sweating]], [[urticaria]], [[Stevens-Johnson syndrome]],[[ erythema multiforme]]. | |||
'''Special senses:''' [[blurred vision]], [[tinnitus]]. | |||
'''Urogenital:''' [[gynecomastia]], [[galactorrhea]]/[[hyperprolactinemia]], increased urination, spotty [[menstruation]], [[impotence]]. | |||
===Treatment of acute cardiovascular adverse reactions=== | |||
The frequency of cardiovascular adverse reactions that require therapy is rare; hence, experience with their treatment is limited. Whenever severe hypotension or complete AV block occurs following oral administration of verapamil, the appropriate emergency measures should be applied immediately; eg, intravenously administered [[norepinephrine ]]bitartrate, [[atropine ]]sulfate, [[isoproterenol ]]HCl (all in the usual doses), or [[calcium gluconate]] (10% solution). In patients with [[hypertrophic cardiomyopathy]] (IHSS), alpha-adrenergic agents ([[phenylephrine ]]HCl, [[metaraminol ]]bitartrate, or [[methoxamine ]]HCl) should be used to maintain blood pressure, and [[isoproterenol ]]and [[norepinephrine ]]should be avoided. If further support is necessary, [[dopamine]] HCl or [[dobutamine ]]HCl may be administered. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = CALAN (VERAPAMIL HYDROCHLORIDE) TABLET, FILM COATED [G.D. SEARLE LLC DIVISION OF PFIZER INC] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=55d5f933-42ff-4c80-a102-0ccb7f76b082#nlm34090-1 | publisher = | date = | accessdate = }}</ref> | |||
==References== | ==References== | ||
Revision as of 19:05, 4 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
ADVERSE REACTIONS
Serious adverse reactions are uncommon when CALAN 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. The following reactions to orally administered verapamil occurred at rates greater than 1.0% or occurred at lower rates but appeared clearly drug-related in clinical trials in 4,954 patients:
In clinical trials related to the control of ventricular response in digitalized patients who had atrial fibrillation or flutter, ventricular rates below 50 at rest occurred in 15% of patients and asymptomatic hypotension occurred in 5% of patients.
The following reactions, reported in 1.0% or less of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are listed to alert the physician to a possible relationship:
Cardiovascular: angina pectoris, atrioventricular dissociation, chest pain, claudication, myocardial infarction, palpitations, purpura(vasculitis), syncope.
Digestive system: diarrhea, dry mouth, gastrointestinal distress, gingival hyperplasia.
Hemic and lymphatic: ecchymosis or bruising.
Nervous system: cerebrovascular accident, confusion, equilibrium disorders, insomnia, muscle cramps, paresthesia, psychotic symptoms, shakiness, somnolence, extrapyramidal symptoms.
Skin: arthralgia and rash, exanthema, hair loss, hyperkeratosis, macules, sweating, urticaria, Stevens-Johnson syndrome,erythema multiforme.
Special senses: blurred vision, tinnitus.
Urogenital: gynecomastia, galactorrhea/hyperprolactinemia, increased urination, spotty menstruation, impotence.
Treatment of acute cardiovascular adverse reactions
The frequency of cardiovascular adverse reactions that require therapy is rare; hence, experience with their treatment is limited. Whenever severe hypotension or complete AV block occurs following oral administration of verapamil, the appropriate emergency measures should be applied immediately; eg, intravenously administered norepinephrine bitartrate, atropine sulfate, isoproterenol HCl (all in the usual doses), or calcium gluconate (10% solution). In patients with hypertrophic cardiomyopathy (IHSS), alpha-adrenergic agents (phenylephrine HCl, metaraminol bitartrate, or methoxamine HCl) should be used to maintain blood pressure, and isoproterenol and norepinephrine should be avoided. If further support is necessary, dopamine HCl or dobutamine HCl may be administered. Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician.[1]