Angimil

• Hypertension: Management of elevated blood pressure to reduce the risk of cardiovascular events.
• Angina Pectoris: Treatment of chronic stable angina and vasospastic (Prinzmetal’s) angina by decreasing myocardial oxygen demand.
• Supraventricular Arrhythmias: Management of paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation/flutter with rapid ventricular response, and arrhythmias associated with Wolff-Parkinson-White syndrome.
• Off-label Uses: Prevention of migraine headaches and treatment of hypertrophic cardiomyopathy symptoms.

• Route: Oral (immediate-release and extended-release tablets/capsules); intravenous administration for acute arrhythmias.
• Adult Oral Dosage:
• Hypertension and angina: Initial 80–120 mg three times daily (immediate release) or 180 mg once daily (extended release).
• Maintenance dose: 240–480 mg daily divided or once daily (extended release).
• IV Dosage: For acute arrhythmias, 2.5–5 mg IV over 2 minutes, repeated as necessary with careful monitoring.
• Pediatrics: Safety and efficacy not well established; use only if benefits outweigh risks.
• Elderly: Start at lower doses due to increased sensitivity; titrate cautiously.
• Renal Impairment: No dosage adjustment generally required.
• Hepatic Impairment: Use with caution; dose reduction may be needed.
• Administration: Take oral doses with food to improve absorption. Do not crush extended-release forms.

Verapamil is a non-dihydropyridine calcium channel blocker that inhibits L-type calcium channels in cardiac and vascular smooth muscle, decreasing intracellular calcium influx. This leads to negative inotropic, chronotropic, and dromotropic effects: it reduces myocardial contractility, slows sinoatrial and atrioventricular node conduction, and dilates coronary and peripheral arteries. These actions lower myocardial oxygen demand and control heart rate, effectively treating hypertension, angina, and certain arrhythmias.

• Absorption: Well absorbed orally; extensive first-pass metabolism reduces bioavailability to 20–35%.
• Distribution: Volume of distribution 3–5 L/kg; approximately 90% plasma protein binding.
• Metabolism: Extensively metabolized by hepatic CYP3A4 to inactive metabolites.
• Half-life: 3–7 hours (immediate release), up to 12 hours (extended release).
• Excretion: Mainly via feces (~70%) and urine (~20%) as metabolites.

• Pregnancy: Category C (FDA). Animal studies show adverse effects at high doses; use only if benefits justify risks.
• Lactation: Excreted in small amounts in breast milk; caution advised when administered to nursing mothers.

• Calcium channel blocker, non-dihydropyridine subclass.

• Hypersensitivity to verapamil or excipients.
• Severe left ventricular dysfunction without pacemaker.
• Hypotension (systolic BP <90 mmHg).
• Cardiogenic shock.
• Second- or third-degree AV block without pacemaker.
• Sick sinus syndrome without pacemaker.
• Concurrent IV beta-blocker use.

• Monitor for bradycardia, AV block, hypotension, and heart failure exacerbation.
• Use cautiously in hepatic impairment.
• Avoid abrupt discontinuation to prevent rebound hypertension or arrhythmias.
• Risk of gingival hyperplasia; maintain oral hygiene.

• Common: Constipation, dizziness, headache, flushing, peripheral edema, nausea.
• Serious: Bradycardia, AV block, heart failure exacerbation, hypotension, hepatotoxicity (rare).

• CYP3A4 inhibitors increase verapamil levels (e.g., ketoconazole).
• Additive cardiac depression with beta-blockers.
• Increases digoxin levels; monitor closely.
• Interacts with statins metabolized by CYP3A4, increasing toxicity risk.

• No major recent changes in dosing or indications.
• Continues to be recommended for hypertension, angina, and specific arrhythmias with attention to drug interactions.

• Store at 20°C–25°C (68°F–77°F).
• Protect from moisture and light.
• Keep in tightly closed container and out of reach of children.