Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM
Classifications: calcium channel blocker; antihypertensive; antiarrhythmic class iv; Therapeutic:antiarrhythmic; antihypertensive
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.
Decreases angina attacks by dilating coronary arteries and inhibiting coronary vasospasms. Decreases nodal conduction, resulting
in an antiarrhythmic effect. Dilates peripheral arterioles, causing decreased total peripheral vascular resistance with
reduction in BP.
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 manic depression.
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);
pregnancy (category C); children <18 y (extended release tablets).
Duchenne's muscular dystrophy; hepatic and renal impairment; MI followed by coronary occlusion, aortic stenosis; GI obstruction,
GERD, hiatal hernia, ileus; IV form in neonates or infants.
Route & Dosage
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 80 mg t.i.d. or 90240 mg sustained release 12 times/d up to 480 mg/d (Note: Covera-HS must be given once daily
Supraventricular Tachycardia, Atrial Fibrillation
Adult: IV 2.55 mg initial dose, then 510 mg after 1530 min (max total dose: 20 mg)
Child: IV <1 y, 0.10.2 mg/kg q30min prn; >1 y, 0.10.3 mg/kg (max dose: 5 mg)
Clcr <10 mL/min: give 5075% of dose
Hemodialysis: Supplemental dose not necessary
In cirrhosis, use 2050% of normal dose.
- 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.
INCOMPATIBILITIES Solution/additive: Albumin, aminophylline, amphotericin B, hydralazine, trimethoprim/sulfamethoxazole. Y-site: Albumin, amphotericin B cholesteryl complex, ampicillin, mezlocillin, nafcillin, oxacillin, propofol, sodium bicarbonate.
- Store at 15°30° C (59°86° F) and protect from light.
Adverse Effects (≥1%)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:
Diagnostic Test Interference
Verapamil may cause elevations of serum AST, ALT, alkaline phosphatase.
InteractionsDrug: beta blockers
increase risk of CHF, bradycardia, or heart block; significantly increased levels of digoxin
and toxicity; potentiates hypotensive effects of hypotensive agents
; levels of lithium
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. St. John's wort
may decrease efficacy.
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:
In liver (CYP3A4). Elimination:
70% in urine; 16% in feces. Half-Life:
Assessment & Drug Effects
- Monitor therapeutic effectiveness. Drug should decrease angina frequency, nitroglycerin consumption, and episodes of ST
- 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.