베라파밀

동물 종별 용량

투여 경로

금기

• 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

이상반응

• 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

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
• Digoxin · Verapamil may increase blood levels of digoxin; monitoring recommended · major
• 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

모니터링

• ECG
• 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)
• Blood pressure
• Heart rate and rhythm
• Liver function (in patients with hepatic disease)

과용량

**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.