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| Interactions: | Acenocoumarol
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Verapamil and Acenocoumarol should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Amiodarone
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Verapamil should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Aspirin
Adverse Effect: An increased risk of bleeding Clinical Management: Monitor patient for signs or symptoms of excessive bleeding. Verapamil is also reported to potentiate the platelet inhibitory effects of aspirin.
Atenolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Atenolol Comb
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Betaxolol
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Bisoprolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Bupivacaine
Adverse Effect: an increased risk of heart block Clinical Management: Clinicians should be aware of a potential interaction between verapamil and bupivacaine. If bupivacaine is to be given concurrently with verapamil, cardiac function should be closely monitored.
Buspirone
Adverse Effect: an increased risk of enhanced buspirone effects Clinical Management: Monitor patients who are receiving verapamil and buspirone for enhanced sedative effects of buspirone.
Carbamazepine
Adverse Effect: Carbamazepine toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma) Clinical Management: Monitor for clinical signs of carbamazepine toxicity along with carbamazepine serum levels. Adjust dose accordingly. Verapamil does not appear to interact with carbamazepine and may be considered as an alternative to verapamil.
Carvedilol
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Celecoxib
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Celiprolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Cimetidine
Adverse Effect: Increased verapamil concentrations and possible cardiovascular toxicity Clinical Management: Monitor the cardiovascular response (blood pressure, heart rate) of the calcium channel blocker if cimetidine is added to the regimen.
Clarithromycin
Adverse Effect: Increased verapamil plasma concentrations and an increased risk of hypotension and/or bradycardia Clinical Management: Monitor patient for hypotension and adjust doses of verapamil accordingly.
Cyclosporin
Adverse Effect: Increases Cyclosporine concentrations #Clinical Management: Monitor Cyclosporine concentrations and adjust the dosage accordingly.
Digoxin
Adverse Effect: Increased serum digoxin concentrations and toxicity (nausea, vomiting, arrhythmias) Clinical Management: Monitor patient for signs or symptoms of digitalis glycoside toxicity (nausea, vomiting, cardiac rhythm disturbance) and laboratory evidence of unacceptable increases in serum digoxin concentrations. Adjust dose as required.
Disopyramide
Adverse Effect: Congestive heart failure Clinical Management: The manufacturer suggests that disopyramide not be given 48 hours before or for 24 hours after verapamil therapy.
Esmolol
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Fentanyl
Adverse Effect: Severe hypotension Clinical Management: Concurrent use of a calcium channel blocker and a beta-adrenergic blocker during fentanyl anesthesia has been reported to result in severe hypotension.
Flurbiprofen
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Halothane
Adverse Effect: depressed cardiovascular activity Clinical Management: When used concomitantly, verapamil and halothane should each be carefully titrated to avoid excessive cardiovascular depression.
Ibuprofen
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Ibuprofen Comb
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Imipramine
Adverse Effect: Imipramine toxicity (dry mouth, sedation, urinary retention) Clinical Management: Monitor for anticholinergic side effects of imipramine if verapamil is added to therapy; lower doses of imipramine may be appropriate. Conversely, if verapamil is discontinued, monitor continued clinical efficacy of imipramine and adjust dosage accordingly.
Indinavir
Adverse Effect: increase in the Plasma concentration of Calcium Channel Blockers like Verapamil due to inhibition of cytochrome P450 3A4 # Clinical Management: Monitor for the adverse effect and administer the drugs with caution.
Indomethacin
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Itraconazole
Adverse Effect: Increased verapamil serum concentrations and toxicity (dizziness, hypotension, flushing, headache, peripheral edema) Clinical Management: Observe the patient for development of toxicity associated with verapamil (peripheral edema, dizziness, hypotension, flushing, headache). Consider reducing the dose of verapamil or withdrawing one of the agents.
Ketoprofen
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Ketorolac
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Labetalol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Levobunolol
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Lithium
Adverse Effect: Loss of mania control, neurotoxicity, bradycardia Clinical Management: Serum lithium levels should be monitored periodically. Patients should be followed closely for signs of mania or psychosis, as well as any symptoms of neurotoxicity such as ataxia, tremors, tinnitus, nausea, vomiting or diarrhea.
Mefenamic Acid
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Meloxicam
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Metoprolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Metoprolol Comb
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Midazolam
Adverse Effect: Increased/prolonged sedation Clinical Management: Midazolam dosage reductions of up to 50% have been suggested when the drug is used concurrently with either diltiazem or verapamil. Monitor for signs of midazolam toxicity (eg, sedation, somnolence, confusion, impaired coordination, diminished reflexes, coma) and adjust midazolam dose accordingly.
Nabumetone
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Naproxen
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Nimesulide
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Oxcarbazepine
Adverse Effect: Decrease in the plasma levels of Oxcarbazepine # Clinical Management: Monitor for therapeutic effects and adjust the dose accordingly.
Oxprenolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Oxyphenbutazone
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Pancuronium
Adverse Effect: enhanced neuromuscular blockade Clinical Management: Concurrent administration of verapamil and pancuronium is not recommended. If concurrent use cannot be avoided, carefully titrate the dose of the neuromuscular blocking agent and monitor for increased or prolonged respiratory depression or paralysis (apnea).
Paracetamol
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Paracetamol Comb
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Phenacetin
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Phenindione
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Verapamil and Phenindione should be monitored for excessive bleeding, especially from the gastrointestinal tract.
Phenobarbitone
Adverse Effect: Decreased verapamil effectiveness Clinical Management: Monitor patient for loss of calcium channel blocker effects, including clinical signs or symptoms of hypertension or angina. Dose increases may be required.
Phenylbutazone
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Phenytoin
Adverse Effect: Decreased verapamil effectiveness Clinical Management: Monitor for continuing clinical effectiveness of verapamil. Larger than expected doses may be required. Other calcium channel blockers may be tried cautiously since some of these agents have been shown to interact with phenytoin to produce symptomatic, toxic elevations in serum phenytoin levels. Use of an alternative therapeutic class of drug (ACE inhibitors, for example) may be required to minimize the possibility for a phenytoin interaction.
Pindolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Piroxicam
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Prazosin
Adverse Effect: hypotension Clinical Management: Caution patient against orthostatic hypotension. Monitor blood pressure response carefully during initiation of combination therapy or after dose adjustments.
Propranolol
Adverse Effect: hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Propranolol Comb
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Quinidine
Adverse Effect: Hypotension, counteraction by verapamil of quinidines effect on AV conduction, and possible quinidine toxicity (ventricular arrhythmias, hypotension, exacerbation of heart failure) Clinical Management: Monitor blood pressure closely for hypotension, and also monitor for quinidine toxicity, including laboratory confirmation of alterations in serum quinidine levels. Avoid use of this combination in patients with hypertrophic cardiomyopathy.
Simvastatin
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis
Sotalol
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Succinyl Choline
Adverse Effect: Enhanced neuromuscular blockade Clinical Management: When using verapamil and succinylcholine concurrently, it may be necessary to reduce the dosage of one or both of the drugs. Prolonged neuromuscular blockade may be clinically insignificant in patients on a ventilator; however, continued monitoring is especially important post-operatively if theres a possibility of incomplete reversal of neuromuscular blockade.
Tenoxicam
Adverse Effect: An increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent NSAID and calcium channel blocker therapy should be monitored for signs of gastrointestinal hemorrhage, such as weakness, nausea, and blood in the stool.
Terazosin
Adverse Effect: hypotension Clinical Management: Caution patient about orthostatic hypotension. Monitor blood pressure response carefully during initiation of combination therapy or after dose adjustments.
Theophylline
Adverse Effect: Theophylline toxicity (nausea, vomiting, palpitations, seizures) Clinical Management: Theophylline serum concentrations should be closely monitored when verapamil is added, discontinued, or when dosing changes occur. Dosing adjustments of theophylline may be necessary.
Timolol
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Tretinoin
Adverse Effect: an increased risk of tretinoin toxicity Clinical Management: Monitor patients for signs and symptoms of tretinoin toxicity (headache, fever, weakness, and fatigue).
Vecuronium
Adverse Effect: Enhanced neuromuscular blockade Clinical Management: Concurrent administration of verapamil and vecuronium is not recommended. If concurrent use cannot be avoided, carefully titrate the dose of the neuromuscular blocking agent and monitor for increased or prolonged respiratory depression or paralysis (apnea).
Warfarin
Adverse Effect: an increased risk of gastrointestinal hemorrhage Clinical Management: Patients who are receiving concurrent Verapamil and Warfarin should be monitored for excessive bleeding, especially from the gastrointestinal tract |
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