Names and pronunciation
(ver-ap′a-mill) Calan, Calan SR, Isoptin, Isoptin SR, Verelan, Verelan PM
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Drug reference
(ver-ap′a-mill) Calan, Calan SR, Isoptin, Isoptin SR, Verelan, Verelan PM
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Func. class.: Calcium channel blocker; antihypertensive; antianginal, antidysrhythmic (class IV)
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Chem. class.: Diphenylalkylamine
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ACTION: Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; dilates coronary arteries; decreases SA/AV node conduction; dilates peripheral arteries
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USES: Chronic stable, vasospastic, V unstable angina; dysrhythmias, hyperten sion, supraventricular tachycardia, atrial flutter or fibrillation.
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Unlabeled uses: acute MI, claudica tion, mania, atrial tachycardia, periph eral vascular disease
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CONTRAINDICATIONS: Sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90 mm Hg systolic, cardiogenic shock, severe HF, Lown-Ganong-Levine syndrome, Wolff- Parkinson-White syndrome Precautions: Pregnancy, breastfeeding, children, geriatric patients, HF, hypotension, hepatic injury, renal disease, concomitant β-blocker therapy
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SIDE EFFECTS CNS: Headache, drowsiness, dizziness, anxiety, depression, weakness, insomnia, confusion, light-headedness, asthenia, fatigue CV: Edema, HF, bradycardia, hypoten sion, palpitations, AV block, dysrhythmias GI: Nausea, diarrhea, gastric upset, con stipation, increased LFTs GU: Impotence, gynecomastia, nocturia, polyuria HEMA: Bruising, petechiae, bleeding EENT: Blurred vision, tinnitus, equilib rium change, epistaxis RESP: Cough INTEG: Rash, bruising MISC: Gingival hyperplasia SYST: Stevens-Johnson syndrome
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INTERACTIONS Increase: hypotension—prazosin, quiNI Dine, fentaNYL, other antihypertensives, nitrates Increase: effects of verapamil—β- blockers, cimetidine, clarithromycin, erythromycin, monitor for CV effects Increase: levels of digoxin, theophylline, cycloSPORINE, carBAMazepine, nonde polarizing muscle relaxants Decrease: effects of lithium Decrease: antihypertensive effects— NSAIDs Drug/Food Increase: hypotensive effects—grapefruit juice Drug/Herb Increase: verapamil effect—ginseng, ginkgo Increase: hypertension—ephedra (ma huang) Decrease: verapamil effect—St. John’s wort Drug/Lab Test Increase: AST, ALT, alk phos, BUN, creati nine, serum cholesterol
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TREATMENT OF OVERDOSE: Defibrillation, atropine for AV block, vasopressor for hypotension, IV calcium
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DOSAGE AND ROUTES Hypertension • Adult: PO IR 80 mg tid, may titrate up ward; EXT REL 120-240 mg/day as single dose, may increase to 240-480 mg/day Angina • Adult: PO 80-120 mg tid, increase weekly, max 480 mg/day Atrial fibrillation/flutter • Adult: PO IR 240-480 mg/day in 3-4 divided doses in digitalized patients • Adult: IV BOL 5-10 mg (0.075-0.15 mg/kg) over 2 min, may repeat 10 mg (0.15 mg/kg) 1⁄2 hr after 1st dose; mainte nance infusion 0.005 mg/kg/min infusion • Child 1-15 yr: IV BOL 0.1-0.3 mg/kg over ≥2 min, repeat in 30 min, max 5 mg in single dose • Child 0-1 yr: IV BOL 0.1-0.2 mg/kg over ≥2 min, may repeat after 30 min To prevent paroxysmal supraventricular tachycardia • Adult: PO IR 240-480 daily, divided in 3 or 4 doses, max 480 mg/day Hepatic disease/geriatric patients/ compromised ventricular function • Adult: PO 40 mg tid initially, increase as tolerated
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Available forms: Tabs 40, 80, 120 mg; ext rel tabs 120, 180, 240 mg; inj 2.5 mg/ mL in ampules, syringes, vials; ext rel caps 100, 120, 180, 200, 240, 300, 360 mg
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Administer: PO route • IR: Give without regard to food, give with meals or milk to prevent gastric upset Ext rel route • Do not crush or chew ext rel products; Verelan caps may be opened and contents sprinkled on food; do not dissolve chew cap contents • Before meals, at bedtime; give ext rel product with food Direct IV route • Undiluted through Y-tube or 3-way stopcock of compatible sol; give over 2 min or 3 min for geriatric patients, with continuous ECG and B/P monitoring, dis card unused solution • Do not use IV with IV β-blockers; may cause AV nodal blockade Y-site compatibilities: Alfentanil, amika cin, argatroban, ascorbic acid, atracu rium, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorpha nol, calcium chloride/gluconate, CARBO platin, caspofungin, ceFAZolin, cefonicid, cefotaxime, cefoTEtan, cefOXitin, ceftizox ime, cefTRIAXone, cefuroxime, chlor proMAZINE, cimetidine, ciprofloxacin, clindamycin, cyanocobalamin, cyclophos phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexameth asone, dexmedetomidine, digoxin, diltia zem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin hydrochloride, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epi rubicin, epoetin alfa, eptifibatide, erythro mycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fen taNYL, fluconazole, fludarabine, gem citabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, ifos famide, imipenem/cilastatin, inamrinone, insulin, isoproterenol, ketorolac, labet alol, levoFLOXacin, lidocaine, linezolid, LORazepam, magnesium sulfate, manni tol, mechlorethamine, meperidine, meta raminol, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDA ZOLE, miconazole, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nalbuphine, naloxone, nesiritide, nitro glycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxy tocin, PACLitaxel, palonosetron, papaver ine, PEMEtrexed, penicillin G, pentami dine, pentazocine, phentolamine, phenylephrine, phytonadione, piperacil lin/tazobactam, potassium chloride, pro cainamide, prochlorperazine, prometha zine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, rocu ronium, sodium acetate, succinylcholine, SUFentanil, tacrolimus, teniposide, the ophylline, thiamine, ticarcillin/clavula nate, tirofiban, tobramycin, tolazoline, trimethaphan, urokinase, vancomycin, vasopressin, vecuronium, vinCRIStine, vinorelbine, voriconazole
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Assess: • Cardiac status: B/P, pulse, respiration, ECG intervals (PR, QRS, QT); notify pre scriber if pulse <50 bpm, systolic B/P <90 mm Hg • HF: I&O ratios, weight daily; crackles, weight gain, dyspnea, jugular venous distention • Renal, hepatic studies during long-term treatment, serum potassium periodically • Stevens-Johnson syndrome: rash with fever, fatigue, joint pain, lesions; discontinue immediately • Pregnancy/breastfeeding: use only if benefit outweighs fetal risk; avoid breast feeding • Beers: avoid use in older adults; may cause fluid retention or exacerbate heart failure
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Evaluate: • Therapeutic response: decreased angi nal pain, decreased B/P, dysrhythmias
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To increase fluids, fiber to counteract constipation • How to take pulse, B/P before taking product; to keep record or graph • To avoid hazardous activities until sta bilized on product, dizziness no longer a V problem • To limit caffeine consumption; to avoid alcohol products • To avoid OTC or grapefruit products unless directed by prescriber • To comply with all areas of medical regimen: diet, exercise, stress reduction, product therapy • To change positions slowly to prevent syncope • Not to discontinue abruptly; chest pain may occur • To report chest pain, palpitations, irregu- lar heartbeats, swelling of extremities, skin irritation, rash, tremors, weakness • To notify prescriber if pregnancy is planned; to avoid breastfeeding
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PHARMACOKINETICS Metabolized by liver by CYP3A4, excreted in urine (70% as metabolites), protein binding 90% PO: Onset variable; peak 3-4 hr; duration 17-24 hr; half-life 4 min, 3-12 hr IV: Onset 3 min, peak 3-5 min, duration 10-20 min
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• Adult: PO IR 80 mg tid, may titrate up ward; EXT REL 120-240 mg/day as single dose, may increase to 240-480 mg/day Angina
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• Adult: PO 80-120 mg tid, increase weekly, max 480 mg/day Atrial fibrillation/flutter
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• Adult: PO IR 240-480 mg/day in 3-4 divided doses in digitalized patients
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• Adult: IV BOL 5-10 mg (0.075-0.15 mg/kg) over 2 min, may repeat 10 mg (0.15 mg/kg) 1⁄2 hr after 1st dose; mainte nance infusion 0.005 mg/kg/min infusion
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• Adult: PO IR 240-480 daily, divided in 3 or 4 doses, max 480 mg/day Hepatic disease/geriatric patients/ compromised ventricular function
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• Adult: PO 40 mg tid initially, increase as tolerated
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