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維拉帕米

Verapamil

Verapamil hydrochloride

鈣離子通道阻斷劑 / 第四類抗心律不整藥POIVSC狗貓小型哺乳類馬

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

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

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)
— 🐕

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

各物種劑量

🌎 NA — North America🌍 EU — Europe

狗

適應症劑量途徑頻次療程地區
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.

貓

適應症劑量途徑頻次療程地區
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.

小型哺乳類

適應症劑量途徑頻次療程地區
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

馬

適應症劑量途徑頻次療程地區
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

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概覽

維拉帕米（Verapamil）是一種​非二氫吡啶類鈣離子通道阻斷劑​及​第四類抗心律不整藥物​。

與主要作用於血管平滑肌引起血管擴張的二氫吡啶類鈣離子通道阻斷劑（如氨氯地平 Amlodipine）不同，維拉帕米對心臟傳導系統（特別是房室結 AV node）具有顯著影響。

​主要臨床用途：​

  • 在獸醫學中，主要用於控制犬貓的​上心室心搏過速 (SVT)​。
  • 可用於控制心房撲動或心房顫動的心室率。
  • ​臨床要點：​ 維拉帕米是已知的 ​P-醣蛋白 (P-gp)​ 抑制劑。基於此機制，目前正被研究作為難治性癲癇的輔助治療，以防止抗癲癇藥物從中樞神經系統被排出。

作用機制

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.

安全性與警告

禁忌症

  • 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

不良反應

  • 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

​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

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

監測

  • 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)

藥物動力學

半衰期

狗0.8 - 2.5 hours

吸收

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.

分佈

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.

代謝

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

排除

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

過量

​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.

可用產品

劑型

  • 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

獸醫用

  • None

人用標示

  • 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)

各地核准狀態

European Union✓ 已核准處方藥EMA

Human authorized products used under the cascade.

United Kingdom✓ 已核准處方藥 · POMVMD

POM (Prescription Only Medicine)

暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

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.

飼主須知

維拉帕米是一種主要用於矯正異常快速心律的心臟藥物。

  • ​按時服藥至關重要：​ 為了達到療效，您的寵物必須完全按照獸醫的處方服用所有劑量。請勿隨意漏服或突然停藥。
  • ​注意事項：​ 如果您的寵物出現異常嗜睡、運動不耐、開始喘息、呼吸急促或咳嗽，或行為及態度發生突然改變，請立即聯繫您的獸醫。
  • ​飲食建議：​ 請遵循獸醫關於是否隨餐給藥的指示，因為食物可能會影響某些劑型的吸收。

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