維拉帕米

用途

• Supraventricular tachycardia
• Supraventricular tachyarrhythmias
• Supraventricular tachyarrhythmias (Acute)
• To control ventricular rate in atrial fibrillation
• Cardiovascular disease
• Cardiovascular disease
• Supraventricular tachycardia
• Treatment of hypertension
• Emergency treatment for hemodynamically unstable and sustained (continuous) supraventricular tachycardia
• General arrhythmias
• Acute termination of supraventricular tachycardia
• Supraventricular tachyarrhythmias
• Supraventricular tachyarrhythmias (Acute)

給藥方式

可能的副作用

• Hypotension
• Bradycardia
• Tachycardia
• Exacerbation of congestive heart failure (CHF)
• Peripheral edema
• AV block
• Pulmonary edema
• Nausea
• Constipation
• Dizziness
• Headache
• Fatigue
• Precipitation or exacerbation of congestive heart failure

注意事項與禁忌

• Cardiogenic shock
• Severe CHF (unless secondary to a supraventricular tachycardia amenable to verapamil)
• Hypotension (<90 mmHg systolic)
• Sick sinus syndrome
• 2nd or 3rd degree AV block
• Digoxin intoxication
• Hypersensitivity to verapamil
• Recent use (within a few hours) of IV beta-adrenergic blockers
• Hypotension
• Left ventricular dysfunction
• Heart failure
• > **Critical Warning:** IV verapamil is contraindicated within a few hours of IV beta-adrenergic blocking agents (e.g., propranolol). The combination can severely depress myocardial contractility and AV node conduction, potentially causing rapid hemodynamic deterioration and ventricular fibrillation. * **Cardiac Disease:** Use with caution in patients with heart failure or hypertrophic cardiomyopathy (HCM) due to negative inotropic effects. * **Organ Impairment:** Toxicity may be potentiated in patients with hepatic or renal impairment. * **Arrhythmias:** Use very cautiously in patients with atrial fibrillation and Wolff-Parkinson-White (WPW) syndrome as fatal arrhythmias may result. * **Endocrine:** May increase blood glucose in dogs; use with caution in diabetic animals. * **Breed Sensitivities:** Verapamil is a neurotoxic substrate of P-glycoprotein. Use with extreme caution in herding breeds (e.g., Collies, Australian Shepherds) that may possess the MDR1 (ABCB1) gene mutation causing a nonfunctional P-gp protein.

藥物相互作用

• ACE Inhibitors: May cause additive hypotensive effects
• Alpha-Adrenergic Blockers (e.g., prazosin): May cause additive hypotensive effects
• Beta-Adrenergic Blockers (e.g., propranolol): May cause additive negative cardiac inotrope and chronotrope effects; IV combination is contraindicated
• Doxorubicin: Verapamil may increase doxorubicin concentrations
• COPP Chemotherapy: May decrease oral absorption of verapamil
• Cyclosporine: Verapamil may increase cyclosporine levels
• Dantrolene: Cardiovascular collapse reported in animals when used with verapamil
• Digoxin: Verapamil may increase blood levels of digoxin; monitoring recommended
• Disopyramide: May cause additive effects and impair left ventricular function; concurrent use within 24-48 hours not recommended
• Diuretics: May cause additive hypotensive effects
• Erythromycin, Clarithromycin: May increase verapamil levels
• Flecainide: Possible additive effects; concurrent use is to be avoided in humans
• Neuromuscular Blockers: Effects of nondepolarizing muscle relaxants may be enhanced by verapamil
• Phenobarbital: May reduce verapamil levels
• Quinidine: Additive alpha-adrenergic blocking activity; increased hypotensive effect; verapamil can block quinidine's AV conductive effects and increase quinidine levels
• Rifampin: May reduce verapamil levels
• Theophylline: Verapamil may increase serum levels of theophylline and lead to toxicity
• Vincristine: Calcium channel blockers may increase intracellular vincristine by inhibiting the drug's outflow from the cell
• Beta-blockers: Profound negative inotropic and chronotropic effect
• Sodium-channel blockers: May lead to cardiovascular depression and hypotension
• Vitamin D or Calcium salts: May adversely affect verapamil activity
• Cimetidine: May increase the effects of verapamil
• Digitoxin: May increase blood levels leading to potentially toxic effects
• Non-depolarizing muscle relaxants: Neuromuscular blocking effects may be enhanced

常見問題