Tablets, film coated (on 10 pieces in blisters, on 1 or 5 blisters in a cardboard pack);
Solution for intravenous administration: colourless, transparent (in colourless glass ampoules on 2 ml, on 5 ampoules in blister strip packagings, on 2 or 10 packagings in a cardboard pack).

Is a part of 1 tablet:

Active ingredient: a verapamil hydrochloride – 40 or 80 mg;
Auxiliary components: disubstituted calcium phosphate, starch, butylhydroxyanisole, the purified talc, magnesium stearate, gelatin, methylparaben, a gidroksipropilmetiltsellyuloz, titanium dioxide, indigo carmine.

Is a part of 1 ampoule of injection solution:

Active ingredient: a verapamil hydrochloride – 5 mg;
Auxiliary components: sodium chloride – 17 mg, sodium hydroxide – 16,8 mg, monohydrate of citric acid – 42 mg, the concentrated Acidum hydrochloricum – 0,0054 ml, water for injections – to 2 ml.

Indications to use

Tablets

Disturbances of a cordial rhythm, including Bouveret's supraventricular disease, blinking and an atrial flutter (takhiaritmichesky option), supraventricular premature ventricular contraction – for treatment and prevention;
Unstable stenocardia (rest stenocardia), chronic stable stenocardia (angina of exertion), vasospastic stenocardia (alternative stenocardia, Printsmetal's stenocardia) – for treatment and prevention;
Arterial hypertension – for treatment.

Injection solution

Verapamil in the form of injection solution is applied to stopping of attacks of a supraventricular Bouveret's disease, atrial premature ventricular contraction, paroxysms of trembling and atrial fibrillation.

Contraindications

Absolute:

Chronic heart failure of IIB-III of a stage;
Morganyi-Adams-Stokes's syndrome;
Sinuatrial blockade;
Sick sinus syndrome;
Cardiogenic shock (except caused by arrhythmia) (for tablets);
The expressed bradycardia (for tablets);
WPW-syndrome (for tablets);
Acute heart failure (for tablets);
Atrioventricular block of II and III degrees (except patients with an artificial pacemaker) (for tablets);
Arterial hypotension (for injection solution);
Acute myocardial infarction (for injection solution);
Stenosis of the mouth of an aorta (for injection solution);
Digitalis intoxication (for injection solution);
Ventricular tachycardia (for injection solution);
Syndrome of Launa-Ganonga-Levina or WPW-syndrome in combination with trembling or fibrillation of auricles (excepting patients with a pacemaker) (for injection solution);
Porphyria (for injection solution);
Simultaneous therapy with intravenous administration of beta adrenoblockers;
Age up to 18 years;
Pregnancy and the period of a lactation (for injection solution);
Hypersensitivity to drug components.

Relative (Verapamil should be applied with care in the presence of the following states / diseases):

Atrioventricular block of the I degree;
Bradycardia;
The expressed functional disturbances of kidneys and a liver;
Arterial hypotension with a systolic pressure below 100 mm hg (for tablets);
Chronic heart failure of I and II degrees (for tablets) and I and IIA of degree (for injection solution);
Concomitant use with beta adrenoblockers (for injection solution);
Myocardial infarction with a left ventricular failure (for injection solution);
Advanced age (for injection solution).

Route of administration and dosage

Tablets

Verapamil is accepted inside, washing down with a small amount of water, it is more preferable – in time or after meal.

The doctor establishes the mode of dosing and duration of therapy individually depending on a condition of the patient, severity and features of disease, and also efficiency of drug.

The initial adult single dose at treatment of arterial hypertension and for prevention of attacks of stenocardia, arrhythmia makes 40-80 mg, frequency rate of reception – 3-4 times a day. The single dose is increased in case of need to 120-160 mg (as much as possible – 480 mg a day).

At the expressed functional disturbances of a liver it is reasonable to begin therapy with the smallest doses (as much as possible – 120 mg a day).

Injection solution

Verapamil should be entered intravenously, slowly, for not less than 2 minutes, continuously controlling the electrocardiogram, heart rate and arterial pressure. At elderly patients for the purpose of decrease in risk of development of undesirable actions administration of solution needs to be carried out within, at least, 3 minutes.

When stopping paroxysmal disturbances of a cordial rhythm Verapamil is entered intravenously struyno on 2-4 ml of 0,25% of solution (5-10 mg), controlling the electrocardiogram and arterial pressure. In cases of lack of effect perhaps repeated introduction of the same dose of drug in 30 minutes. For cultivation of 2 ml of 0,25% of solution of Verapamil use 100-150 ml of 0,9% of solution of sodium chloride.

Side effects

Tablets

Central nervous system: headache, dizziness; in rare instances – block, the increased nervous irritability, increased fatigue;
Alimentary system: vomiting, nausea, locks; in some cases – tranzitorny increase in activity of hepatic transaminases in a blood plasma;
Cardiovascular system: face reddening, AV blockade, the expressed bradycardia, arterial hypotension, emergence of symptoms of heart failure (at use of high doses of drug, in particular at predisposed patients);
Allergic reactions: itch, skin rash;
Others: peripheral hypostases.

Injection solution

Alimentary system: nausea, increase in activity of hepatic transaminases and alkaline phosphatase;
Central nervous system: increased fatigue, uneasiness, headache, dizziness, syncope, extrapyramidal disturbances, block, adynamy, depression, drowsiness;
Cardiovascular system: the expressed bradycardia (it is not less than 50 beats per minute), the expressed lowering of arterial pressure, aggravation or development of heart failure, tachycardia; perhaps – development of stenocardia, up to a myocardial infarction (in particular at patients with crushing obstructive defeats of coronary arteries), arrhythmias (including trembling and ventricular fibrillation); at bystry administration of solution – an asystolia, an atrioventricular block of the III degree, a collapse;
Allergic reactions: a dermahemia of the person, rash, a skin itch, a multiformny exudative erythema (including Stephens-Johnson's syndrome);
Others: a fluid lungs, tranzitorny loss of sight against the background of the maximum concentration, asymptomatic thrombocytopenia, peripheral hypostases (including puffiness of anklebones, shins and feet).

Special instructions

During therapy it is necessary to control function of respiratory and cardiovascular system, level of electrolytes and glucose in blood, amount of the emitted urine and volume of the circulating blood.

At intravenous administration of Verapamil lengthening of an interval of PQ at concentration in a blood plasma is possible higher than 30 mg/ml.

It is not recommended to stop therapy suddenly.

Verapamil should be applied with care to drivers of vehicles and people whose profession is connected with the increased concentration of attention (because of reduction in the rate of reaction).

Medicinal interaction

At simultaneous use of Verapamil with some medicines there can be following effects:

Antiarrhytmic means, beta adrenoblockers and inhalation anesthetics: strengthening of cardiotoxic effect (danger of development of an atrioventricular block, sharp reduction in the frequency of cordial reductions, development of heart failure, a sharp lowering of arterial pressure increases);
Anti-hypertensive means and diuretics: strengthening of hypotensive effect of Verapamil;
Digoxin: increase in level of concentration of digoxin in a blood plasma (for identification of an optimum dosage of drug and prevention of intoxication it is necessary to control its level in a blood plasma);
Cimetidinum and ranitidine: increase in level of concentration of Verapamil in a blood plasma;
Theophylline, Prazozinum, cyclosporine: increase in their concentration in a blood plasma;
Muscle relaxants: strengthening of myorelaxation action;
Rifampicin, phenobarbital: reduction of concentration of Verapamil in a blood plasma and weakening of its action;
Acetylsalicylic acid: increase in probability of developing of bleedings;
Quinidine: increase in level of concentration of quinidine in a blood plasma, strengthening of risk of lowering of arterial pressure, at a hypertrophic cardiomyopathy – development of the expressed arterial hypotension;
Carbamazepine, lithium: increase in danger of development of neurotoxic effects.