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베라파밀

Verapamil

Verapamil hydrochloride

칼슘 채널 차단제 / 제4형 항부정맥제POIVSC개고양이소형 포유류말

다른 이름: Calan · Isoptin · Verelan · Covera-HS · Securon · CP-16533-1 · D-365 · iproveratril hydrochloride · verapamili hydrochloridum

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

Initial dose of 0.05 mg/kg IV slowly, can repeat every 5 minutes up to a total dose of 0.15-0.2 mg/kg; Oral Dose: 0.5-2 mg/kg PO q8hIV/PO· q8h (for PO)
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
Supraventricular tachycardiaInitial dose of 0.05 mg/kg IV slowly, can repeat every 5 minutes up to a total dose of 0.15-0.2 mg/kg; Oral Dose: 0.5-2 mg/kg PO q8hIV/POq8h (for PO)—🌎 NA
Treatment of hypertension1-5 mg/kg PO q8hPOq8h—🌎 NA
Emergency treatment for hemodynamically unstable and sustained (continuous) supraventricular tachycardia0.05 mg/kg boluses IV (slowly) up to a total dose of 0.15 mg/kgIVSeries of boluses—🌎 NA
General arrhythmias1-5 mg/kg PO three times daily; 0.05-0.25 mg/kg IV slowlyPO/IVTID (for PO)—🌎 NA
Acute termination of supraventricular tachycardiaInitial dose of 0.05 mg/kg should be administered over 1-2 minutes while ECG is monitored; if not effective, may repeat in 5-10 minutes. If arrhythmia still not terminated, may give one last dose of 0.05 mg/kg (total = 0.15 mg/kg). For longer control, may give as a CRI at 2-10 micrograms/kg/minute.IVPRN / CRI—🌎 NA
Supraventricular tachyarrhythmias0.5-3 mg/kgPOq8h—🌍 EU
Supraventricular tachyarrhythmias (Acute)0.05 mg/kgIVonceover 5 minutes🌍 EU
  • Emergency treatment for hemodynamically unstable and sustained (continuous) supraventricular tachycardia: As an alternative to diltiazem
  • Acute termination of supraventricular tachycardia: Effect may persist for 30 minutes or less.
  • Supraventricular tachyarrhythmias (Acute): Administer slowly with ECG monitoring. Up to 4 repeat IV administrations at a reduced dose of 0.025 mg/kg q5min if necessary.

고양이

적응증용량경로빈도기간지역
Supraventricular tachycardiaInitial dose of 0.025 mg/kg IV slowly, can repeat every 5 minutes up to a total dose of 0.15-0.2 mg/kg; Oral Dose: 0.5-1 mg/kg PO q8hIV/POq8h (for PO)—🌎 NA
Supraventricular tachyarrhythmias0.5-1 mg/kgPOq8h—🌍 EU
Supraventricular tachyarrhythmias (Acute)0.025 mg/kgIVonceover 5 minutes🌍 EU
  • Supraventricular tachyarrhythmias (Acute): Administer slowly with ECG monitoring. Up to 3 repeat IV administrations q5min if necessary.

소형 포유류

적응증용량경로빈도기간지역
Cardiovascular disease0.25-0.5 mg (total dose per hamster) SCSC——🌎 NA
Cardiovascular disease8-16 mg/kg PO + 0.5-2 mg/kg SC once daily (q24h)PO/SCq24h—🌎 NA
  • Cardiovascular disease: Hamsters
  • Cardiovascular disease: Rabbits

말

적응증용량경로빈도기간지역
To control ventricular rate in atrial fibrillation0.025-0.05 mg/kg IV q 30 minutes; give less than 0.2 mg/kg total doseIVq 30 minutes—🌎 NA
  • To control ventricular rate in atrial fibrillation: ARCI UCGFS CLASS 4 DRUG

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

베라파밀은 ​비디히드로피리딘계 칼슘 채널 차단제​이자 ​제4형 항부정맥제​입니다.

주로 혈관 평활근에 작용하여 혈관 확장을 유발하는 디히드로피리딘계 칼슘 채널 차단제(예: 암로디핀)와 달리, 베라파밀은 심장 전도계, 특히 방실결절(AV node)에 깊은 영향을 미칩니다.

​주요 임상 용도:​

  • 수의학에서는 주로 개와 고양이의 ​상심실성 빈맥(SVT)​ 관리에 사용됩니다.
  • 심방조동 또는 심방세동에서 심실 박동수 조절에 사용될 수 있습니다.
  • ​임상 요점:​ 베라파밀은 알려진 ​P-당단백질(P-gp)​ 억제제입니다. 이러한 기전 때문에 항경련제가 중추신경계에서 배출되는 것을 막기 위해 약물 난치성 간질의 보조 치료제로 연구되고 있습니다.

작용 기전

Verapamil exerts its effects by blocking the transmembrane influx of extracellular calcium ions through L-type voltage-gated calcium channels in myocardial cells and vascular smooth muscle cells.

  • ​Cardiac Conduction (Primary Effect):​ Blocks calcium channels in the SA and AV nodes → decreases AV node conduction velocity and increases the effective refractory period → slows ventricular response rate in supraventricular arrhythmias.
  • ​Myocardial Contractility:​ Exhibits a negative inotropic effect (decreases heart muscle contractility).
  • ​Vascular Smooth Muscle:​ Inhibits contractile mechanisms → causes vasodilation and decreases peripheral vascular resistance (though less potently than amlodipine).
  • ​Neurological:​ Inhibits ​P-glycoprotein (MDR1/ABCB1)​ at the blood-brain barrier → reduces the efflux of certain substrate drugs back into the systemic circulation.

안전성·주의사항

금기사항

  • 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
  • Left ventricular dysfunction
  • Heart failure

부작용

  • 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

주의

​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.

약물 상호작용

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

DigoxinMajor

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

TheophyllineMajor

Verapamil may increase serum levels of theophylline and lead to toxicity

VincristineModerate

Calcium channel blockers may increase intracellular vincristine by inhibiting the drug's outflow from the cell

Beta-blockersMajor

Profound negative inotropic and chronotropic effect

Sodium-channel blockersMajor

May lead to cardiovascular depression and hypotension

Vitamin D or Calcium saltsModerate

May adversely affect verapamil activity

CimetidineModerate

May increase the effects of verapamil

DigitoxinMajor

May increase blood levels leading to potentially toxic effects

Non-depolarizing muscle relaxantsModerate

Neuromuscular blocking effects may be enhanced

모니터링

  • Clinical signs of toxicity (hypotension, bradycardia, edema)
  • Blood pressure (especially during acute IV therapy)
  • Serum concentration (if efficacy or toxicity warrant; 100-300 ng/mL is considered therapeutic)
  • ECG (especially during IV administration)
  • Heart rate and rhythm
  • Liver function (in patients with hepatic disease)

약동학

반감기

개0.8 - 2.5 hours

흡수

Rapidly absorbed after oral administration (~90%), but undergoes a high first-pass effect in the liver, resulting in systemic bioavailability of only 20-30%. Hepatic dysfunction can significantly increase bioavailability. Food decreases the rate and extent of absorption of sustained-release tablets.

분포

Volume of distribution is approximately 4.5 L/kg in dogs. Highly protein-bound (~90% in humans). Crosses the placenta and enters milk at levels approaching plasma concentrations.

대사

Extensively metabolized in the liver to at least 12 separate metabolites, with norverapamil being the predominant active metabolite.

배설

The majority of metabolites are excreted in the urine. Only 3-4% is excreted unchanged in the urine.

과다투여

​Clinical Signs of Overdose:​ Bradycardia, hypotension, hyperglycemia, junctional rhythms, and 2nd or 3rd degree AV block.

​Treatment:​

  • ​Decontamination:​ If secondary to recent oral ingestion, consider gut emptying and activated charcoal administration.
  • ​Supportive Care:​ Vigorously monitor cardiac and respiratory function.
  • ​Negative Inotropy:​ Intravenous calcium salts (1 mL of 10% solution per 10 kg of body weight) may treat negative inotropic signs, but may not adequately resolve heart block.
  • ​Hypotension:​ Fluid therapy and pressor agents (e.g., dopamine, norepinephrine) may be utilized.
  • ​AV Block / Bradycardia:​ Treat with isoproterenol, norepinephrine, atropine, or cardiac pacing.
  • ​Rapid Ventricular Rate:​ Patients developing rapid ventricular rate due to antegrade conduction in flutter/fibrillation with WPW syndrome have been treated with D.C. cardioversion, lidocaine, or procainamide.

제품

제형

  • Sustained/Extended-Release Tablets
  • Sustained/Extended-Release Capsules
  • Injection
  • Injectable: 2.5 mg/ml solution
  • Oral: 40 mg, 80 mg, 120 mg, 160 mg tablets
  • Oral: 40 mg/5 ml oral solution

동물용의약품

  • None

인용의약품

  • Verapamil HCl Tablets: 40 mg, 80 mg & 120 mg (Calan®, generic)
  • Verapamil HCl Sustained/Extended-Release Tablets/Capsules: 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg & 360 mg (Calan® SR, Covera-HS®, Isoptin® SR, Verelan®, Verelan® PM, generic)
  • Verapamil HCl for Injection: 2.5 mg/mL in 2 mL & 4 mL vials, amps and syringes (generic)
  • Securon (2.5 mg/ml injectable)
  • Verapamil (40 mg, 80 mg, 120 mg, 160 mg tablets; 40 mg/5 ml oral solution)

규제 현황

European Union✓ 승인됨처방전의약품EMA

Human authorized products used under the cascade.

United Kingdom✓ 승인됨처방전의약품 · POMVMD

POM (Prescription Only Medicine)

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Verapamil HCl tablets should be stored at room temperature (15-30°C). The injectable product should be stored at room temperature (15-30°C) and protected from light and freezing.

보호자 정보

베라파밀은 주로 비정상적으로 빠른 심장 박동을 교정하는 데 사용되는 심장 약물입니다.

  • ​투약 준수:​ 효과를 보려면 수의사가 처방한 대로 반려동물에게 모든 용량을 정확히 투여해야 합니다. 임의로 투약을 건너뛰거나 갑자기 중단하지 마십시오.
  • ​주의 깊게 관찰할 사항:​ 반려동물이 평소보다 무기력해지거나, 운동을 힘들어하거나, 쌕쌕거리거나, 숨가쁨 또는 기침을 하거나, 행동이나 태도에 갑작스러운 변화가 생기면 즉시 수의사에게 연락하십시오.
  • ​식이 주의사항:​ 음식물이 특정 제형의 흡수에 영향을 미칠 수 있으므로, 약을 먹일 때 음식과 함께 줄지 여부에 대해서는 수의사의 지시를 따르십시오.

VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.