Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM
Classifications: cardiovascular agent; calcium channel blocker; antiarrhythmic, miscellaneous
Pregnancy Category: C
40 mg, 80 mg, 120 mg tablets; 120 mg, 180 mg, 240 mg sustained-release tablets; 100 mg, 120 mg, 180 mg, 200 mg, 240 mg, 300 mg sustained-release capsules; 5 mg/2 mL injection
Inhibits calcium ion influx through slow channels into cells of myocardial and arterial smooth muscle. Dilates coronary arteries
and arterioles and inhibits coronary artery spasm. Decreases and slows SA and AV node conduction without affecting normal
arterial action potential or intraventricular conduction. Associated vasodilation of arterioles decreases total peripheral
vascular resistance and reduces arterial BP at rest. May slightly decrease heart rate.
Dilates coronary arteries and inhibits coronary artery spasm, which increases myocardial oxygen delivery and produces an antianginal
effect. Also decreases nodal conduction, which results in an antiarrhythmic effect.
Supraventricular tachyarrhythmias; Prinzmetal's (variant) angina, chronic stable angina; unstable, crescendo or preinfarctive
angina and essential hypertension.
Paroxysmal supraventricular tachycardia, atrial fibrillation; prophylaxis of migraine headache; and as alternate therapy in
Severe hypotension (systolic <90 mm Hg), cardiogenic shock, cardiomegaly, digitalis toxicity, second- or third-degree AV block;
Wolff-Parkinson-White syndrome including atrial flutter and fibrillation; accessory AV pathway, left ventricular dysfunction,
severe CHF, sinus node disease, sick sinus syndrome (except in patients with functioning ventricular pacemaker). Safe use
during pregnancy (category C), lactation, or in children (oral) is not established.
Duchenne's muscular dystrophy; hepatic and renal impairment; MI followed by coronary occlusion, aortic stenosis.
Adult: PO 80 mg q68h, may increase up to 320480 mg/d in divided doses (Note: Covera-HS must be given once daily h.s.)
Adult: PO 4080 mg t.i.d. or 90240 mg sustained-release 12 times/d up to 480 mg/d (Note: Covera-HS must be given once
Supraventricular Tachycardia, Atrial Fibrillation
Adult: PO 240480 mg/d in divided doses IV 510 mg IV direct, may repeat in 1530 min if needed
<1 y, 0.10.2 mg/kg; 115 y, 0.10.3 mg/kg (25 mg)
- Give with food to reduce gastric irritation.
- Capsules can be opened and contents sprinkled on food. Do NOT dissolve or chew capsule contents.
- Give Covera-HS once a day in the evening.
- Do not withdraw abruptly; may increase and extend duration of pain in the angina patient.
PREPARE: IV Direct: Given undiluted or diluted in 5 mL of sterile water for injection. Inspect parenteral drug preparation before administration.
Make sure solution is clear and colorless.
ADMINISTER: Direct: Give a single dose over 23 min.
amphotericin B cholesteryl complex,
CNS: Dizziness, vertigo, headache, fatigue, sleep disturbances, depression, syncope. CV:
Hypotension, congestive heart failure, bradycardia, severe tachycardia, peripheral edema, AV block. GI: Nausea, abdominal discomfort, constipation, elevated liver enzymes. Body as a Whole: Flushing, pulmonary edema, muscle fatigue, diaphoresis. Skin: Pruritus.
- Store at 15°30° C (59°86° F) and protect from light.
Verapamil may cause elevations of serum AST,
beta blockers increase risk of CHF, bradycardia, or heart block; significantly increased levels of digoxin and carbamazepine and toxicity; potentiates hypotensive effects of hypotensive agents; levels of lithium and cyclosporine may be increased, increasing their toxicity; calcium salts (IV) may antagonize verapamil effects. Food:
Grapefruit juice may increase verapamil levels. Herbal:
Hawthorne may have additive hypotensive effects.
Absorption: 90% absorbed, but only 2530% reaches systemic circulation (first pass metabolism). Peak: 12 h PO; 48 h sustained release; 5 min IV. Distribution: Widely distributed, including CNS; crosses placenta; present in breast milk. Metabolism: Metabolized in liver. Elimination: 70% excreted in urine; 16% in feces. Half-Life: 28 h.
Assessment & Drug Effects
- Monitor therapeutic effectiveness. Drug should decrease angina frequency, nitroglycerin consumption, and episodes of ST segment
- Establish baseline data and periodically monitor: BP and pulse.
- Lab tests: Baseline and periodic liver and kidney functions.
- Instruct patient to remain in recumbent position for at least 1 h after dose is given to diminish subjective effects of transient
asymptomatic hypotension that may accompany infusion.
- Monitor for AV block or excessive bradycardia when infusion is given concurrently with digitalis.
- Monitor I&O ratio during IV and early oral maintenance therapy. Renal impairment prolongs duration of action, increasing potential
for toxicity and incidence of adverse effects. Advise patient to report gradual weight gain and evidence of edema.
- Monitor ECG continuously during IV administration. Essential because drug action may be prolonged and incidence of adverse
reactions is highest during IV administration in older adults, patients with impaired kidney function, and patients of small
- Check BP shortly before administration of next dose to evaluate degree of control during early treatment for hypertension.
Patient & Family Education
- Monitor radial pulse before each dose, notify physician of an irregular pulse or one slower than established guideline.
- Adhere to established guidelines for exercise program.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Decrease intake of caffeine-containing beverage (i.e., coffee, tea, chocolate).
- Change positions slowly from lying down to standing to prevent falls because of drug-related vertigo until tolerance to reduced
BP is established.
- Notify physician of easy bruising, petechiae, unexplained bleeding.
- Do not use OTC drugs, especially aspirin, unless they are specifically prescribed by physician.
- Do not breast feed while taking this drug without consulting physician.