VerapamilVerapamil Hydrochloride

About Verapamil

Verapamil slows the movement of calcium into heart and blood vessel muscle, which relaxes arteries and slows conduction through the heart. The immediate-release tablet is labeled for angina (from artery spasm, unstable or chronic stable), for controlling the heart rate in chronic atrial fibrillation or flutter together with digitalis, for preventing repeated paroxysmal supraventricular tachycardia, and for high blood pressure; it is taken three or four times a day, to at most 480 mg a day. Extended-release tablets, generic versions of Calan SR, usually start at 180 mg each morning with food; Verelan capsules are usually taken as 240 mg each morning; Verelan PM capsules as 200 mg at bedtime, built to start releasing the drug four to five hours later. Older or smaller adults may start lower; safety and effectiveness in children are not established.

There is no boxed warning. Verapamil must not be taken with severe weakness of the left ventricle, low blood pressure or cardiogenic shock, sick sinus syndrome or second- or third-degree heart block without a working pacemaker, or atrial flutter or fibrillation with an accessory pathway, as in Wolff-Parkinson-White syndrome. The warnings cover worsening heart failure, blood pressure falling too low, raised liver enzymes, heart block and a slow pulse, and serious reactions in people with hypertrophic cardiomyopathy. Constipation is the most common side effect; dizziness, nausea, headache, swelling and tiredness also occur.

Verapamil slows CYP3A4, the liver enzyme that clears many drugs, so the label limits simvastatin to 10 mg a day and lovastatin to 40 mg a day; it also raises digoxin levels, and with a beta blocker it can slow the heart too much. The label says extended-release tablets keep their slow release when divided in half, and the 180 and 240 mg tablets are scored, but ask the pharmacist before splitting one. Verelan and Verelan PM capsules are swallowed whole or opened onto applesauce, never crushed or chewed; both are still listed as brands.

Taking Verapamil

How to take it

Immediate-release tablets are usually taken three or four times a day. Extended-release tablets are taken with food, usually in the morning, and swallowed whole; ask the pharmacist whether yours can be split. Verelan capsules are usually taken in the morning and Verelan PM capsules at bedtime; either can be swallowed whole or opened and sprinkled on a spoonful of soft applesauce that is not hot, swallowed at once without chewing, followed by a glass of cool water.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

At room temperature in the original container, tightly closed, protected from light and moisture, out of reach of children; an applesauce mixture is taken at once, not stored. Use a take-back program rather than flushing.

Interactions to know about

It raises levels of digoxin and of drugs cleared by CYP3A4, such as simvastatin, lovastatin, atorvastatin and carbamazepine; erythromycin and ritonavir raise verapamil levels and rifampin lowers them. With a beta blocker it can slow the heart too much. It raises blood alcohol levels and prolongs the effect of alcohol, and grapefruit juice can raise verapamil levels, so ask the prescriber about both.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Verapamil differs from pharmacy to pharmacy

Generic tablets are old generics that cost pharmacies little, so they are priced mostly on the dispensing fee and markup, but immediate-release doses come three or four times a day, which adds up where a pharmacy prices per tablet. The capsules come from few generic sources (Verelan-type generics are rated equivalent in three strengths), and a prescription for either brand that blocks substitution is filled at a brand price.

Because each form releases the drug differently, a pharmacy can fill only the form written or a generic rated equivalent to it; moving between tablets, daytime capsules and bedtime capsules needs a new prescription, and a pharmacy that does not stock your form may have to order it.

Ways to pay less for Verapamil without insurance

• Ask for generic substitution, and make sure the prescription does not block it.
• If you take immediate-release tablets for blood pressure, ask the prescriber whether a once-daily extended-release tablet would suit you.
• If a bedtime capsule is prescribed and quotes are high, ask the prescriber whether an extended-release tablet or a Verelan-type capsule would work instead.
• Once your dose is stable, ask for a ninety-day supply, and compare more than one pharmacy.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Verapamil

1. 1.Is this the exact extended-release form on my prescription?
2. 2.Can my tablet be split, or my capsule opened onto applesauce?
3. 3.Does it interact with my statin, digoxin or beta blocker?
4. 4.What pulse rate or symptoms mean I should call?

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