Verapamil hydrochloride injection precautions: Difference between revisions
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==PRECAUTIONS== | |||
===Drug Interactions:=== | |||
(See [[Verapamil hydrochloride injection warnings|WARNINGS]]: Concomitant [[Antiarrhythmic ]]Therapy.) Verapamil hydrochloride injection has been used concomitantly with other cardioactive drugs (especially [[digitalis]]) without evidence of serious negative drug interactions. In rare instances, including when patients with severe [[cardiomyopathy]], [[congestive heart failure]], or recent[[ myocardial infarction]] were given intravenous[[ beta blockers|beta-adrenergic blocking]] agents or [[disopyramide ]]concomitantly with intravenous verapamil, serious adverse effects have occurred. Concomitant use of verapamil hydrochloride with [[beta blockers|β-adrenergic]] blockers may result in an exaggerated [[hypotensive ]]response. Such an effect was observed in one study, following the concomitant administration of verapamil and prazosin. It may be necessary to decrease the dose of verapamil and/or dose of the neuromuscular blocking agent when the drugs are used concomitantly. As verapamil is highly bound to plasma proteins, it should be administered with caution to patients receiving other highly protein-bound drugs. | |||
===Other=== | |||
'''Cimetidine:''' The interaction between [[cimetidine ]]and chronically administered verapamil has not been studied. In acute studies of healthy volunteers, clearance of verapamil was either reduced or unchanged. | |||
'''Lithium:''' Increased sensitivity to the effects of [[lithium ]](neurotoxicity) has been reported during concomitant verapamil-lithium therapy with either no change or an increase in serum [[lithium ]]levels. The addition of verapamil, however, has also resulted in the lowering of serum [[lithium ]]levels in patients receiving chronic stable oral lithium. Patients receiving both drugs must be monitored carefully. | |||
'''Carbamazepine:''' Verapamil therapy may increase [[carbamazepine ]]concentrations during combined therapy. This may produce [[carbamazepine ]]side effects such as [[diplopia]], [[headache]], [[ataxia]], or [[dizziness]]. | |||
'''Rifampin:''' Therapy with [[rifampin ]]may markedly reduce oral verapamil [[bioavailability]]. | |||
'''Phenobarbital:''' [[Phenobarbital ]]therapy may increase verapamil clearance. | |||
'''Cyclosporin:''' Verapamil therapy may increase serum levels of [[cyclosporin]]. | |||
'''Inhalation Anesthetics:''' Animal experiments have shown that inhalation [[anesthetics ]]depress cardiovascular activity by decreasing the inward movement of calcium ions. When used concomitantly, inhalation anesthetics and [[calcium antagonists]] (such as verapamil) should be titrated carefully to avoid excessive cardiovascular depression. | |||
'''Neuromuscular Blocking Agents:''' Clinical data and animal studies suggest that verapamil may potentiate the activity of depolarizing and nondepolarizing neuromuscular blocking agents. It may be necessary to decrease the dose of verapamil and/or the dose of the neuromuscular blocking agent when the drugs are used concomitantly. | |||
'''Dantrolene:''' Two animal studies suggest concomitant intravenous use of verapamil and [[dantrolene ]]sodium may result in cardiovascular collapse. There has been one report of [[hyperkalemia ]]and myocardial depression following the coadministration of oral verapamil and intravenous [[dantrolene]].<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = VERAPAMIL HYDROCHLORIDE INJECTION, SOLUTION [CARDINAL HEALTH] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=0c27c868-7eae-4b3e-babf-e89404ea27b7#nlm34090-1 | publisher = | date = | accessdate = }}</ref> | |||
Revision as of 23:12, 4 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
PRECAUTIONS
Drug Interactions:
(See WARNINGS: Concomitant Antiarrhythmic Therapy.) Verapamil hydrochloride injection has been used concomitantly with other cardioactive drugs (especially digitalis) without evidence of serious negative drug interactions. In rare instances, including when patients with severe cardiomyopathy, congestive heart failure, or recentmyocardial infarction were given intravenousbeta-adrenergic blocking agents or disopyramide concomitantly with intravenous verapamil, serious adverse effects have occurred. Concomitant use of verapamil hydrochloride with β-adrenergic blockers may result in an exaggerated hypotensive response. Such an effect was observed in one study, following the concomitant administration of verapamil and prazosin. It may be necessary to decrease the dose of verapamil and/or dose of the neuromuscular blocking agent when the drugs are used concomitantly. As verapamil is highly bound to plasma proteins, it should be administered with caution to patients receiving other highly protein-bound drugs.
Other
Cimetidine: The interaction between cimetidine and chronically administered verapamil has not been studied. In acute studies of healthy volunteers, clearance of verapamil was either reduced or unchanged.
Lithium: Increased sensitivity to the effects of lithium (neurotoxicity) has been reported during concomitant verapamil-lithium therapy with either no change or an increase in serum lithium levels. The addition of verapamil, however, has also resulted in the lowering of serum lithium levels in patients receiving chronic stable oral lithium. Patients receiving both drugs must be monitored carefully.
Carbamazepine: Verapamil therapy may increase carbamazepine concentrations during combined therapy. This may produce carbamazepine side effects such as diplopia, headache, ataxia, or dizziness.
Rifampin: Therapy with rifampin may markedly reduce oral verapamil bioavailability.
Phenobarbital: Phenobarbital therapy may increase verapamil clearance.
Cyclosporin: Verapamil therapy may increase serum levels of cyclosporin.
Inhalation Anesthetics: Animal experiments have shown that inhalation anesthetics depress cardiovascular activity by decreasing the inward movement of calcium ions. When used concomitantly, inhalation anesthetics and calcium antagonists (such as verapamil) should be titrated carefully to avoid excessive cardiovascular depression.
Neuromuscular Blocking Agents: Clinical data and animal studies suggest that verapamil may potentiate the activity of depolarizing and nondepolarizing neuromuscular blocking agents. It may be necessary to decrease the dose of verapamil and/or the dose of the neuromuscular blocking agent when the drugs are used concomitantly.
Dantrolene: Two animal studies suggest concomitant intravenous use of verapamil and dantrolene sodium may result in cardiovascular collapse. There has been one report of hyperkalemia and myocardial depression following the coadministration of oral verapamil and intravenous dantrolene.[1]