VERAPAMIL Bagian 3

POPULASI KHUSUS

KEHAMILAN

Kategori C.

LAKTASI

Didistribusikan ke dalam susu; menghentikan menyusui atau obat.

PEDIATRIK

Mungkin efek samping yang parah kardiovaskular (misalnya, hipotensi refrakter, serangan jantung) setelah pemberian IV dari verapamil pada neonatus dan infants. Jika digunakan pada anak-anak, sarankan hati-hati. Beberapa ahli menyatakan verapamil yang tidak boleh digunakan pada bayi.

Keamanan dan kemanjuran verapamil oral tidak didirikan pada anak-anak <18 tahun.

GERIATRI

Pertimbangkan frekuensi yang lebih besar dari penurunan fungsi hati, ginjal, dan / atau jantung dan penyakit penyerta dan terapi obat yang diamati dalam elderly.c Pilih dosis dengan hati-hati, titrasi dosis secara hati hati.

PENURUNAN HEPATIC

Gangguan hati berat memperpanjang eliminasi paruh verapamil. (Lihat Eliminasi:. Populasi khusus, di bawah Farmakokinetik) penyesuaian Dosis mungkin dibutuhkan>

Gunakan dengan hati-hati dan dengan pemantauan ketat untuk perpanjangan interval PR pada EKG, perubahan BP, atau tanda-tanda lain dari overdosis.

PENURUNAN GINJAL

Gunakan dengan hati-hati dan dengan pemantauan ketat untuk perpanjangan interval PR pada EKG, perubahan BP, atau tanda-tanda lain dari overdosis.

EFEK SAMPING YANG UMUM

Sembelit, pusing, mual, headache (sakit kepala)

INTERAKSI VERAPAMIL :

Dimetabolisme terutama oleh CYP3A4, 1A2, dan 2C.

Obat yang Enzim mikrosomal Hati Mempengaruhi

CYP3A4 induser: Kemungkinan penurunan verapamil konsentrasi plasma.

Inhibitor CYP3A4: Kemungkinan peningkatan Konsentrasi. Plasma verapamil

Obat protein-terikat

Potensi verapamil untuk mengungsi dari mengikat reseptor, atau untuk menggantikan dari reseptor obat mengikat protein lainya., Gunakan dengan hati hati.

Obat tertentu dan Makanan

Obat atau makanan	Interaksi	Comment
ACE inhibitors	Additive hypotensive effects^b	Usually used to therapeutic advantage; monitor BP^b
α-Adrenergic blocking agents (e.g., prazosin)	Increased hypotensive effect, possibly excessive in some patients¹¹⁸
β-Adrenergic blocking agents (see entries for atenolol, metoprolol, and propranolol)	Additive negative effects on myocardial contractility, heart rate, and AV conduction³⁵⁶^, ³⁵⁷ Excessive bradycardia and AV block, including complete heart block, reported in hypertensive patients^b	Use with caution for oral management of hypertension; monitor closely^b Concomitant use of IV verapamil and an IV β-adrenergic blocking agent within a few hours of each other is contraindicated^b
Alcohol	Inhibition of ethanol elimination, resulting in increased blood ethanol concentrations and prolonged intoxicating effects³⁶²^, ³⁸⁵^, ^c
Antineoplastic agents	Increased serum concentrations and efficacy of doxorubicin³⁷⁶ Decreased verapamil absorption when used with COPP (cyclophosphamide, vincristine, procarbazine, prednisone) or VAC (vindesine, doxorubicin, cisplatin) regimen³⁷⁶ Decreased paclitaxel clearance (interaction with R-verapamil)³⁷⁶
Anesthetics, inhalation	Potentiation of cardiovascular depression^b	Titrate dosages carefully^b
Aspirin	Increased bleeding times^c
Atenolol (see entry for β-Adrenergic blocking agents)	Pharmacokinetic interaction unlikely¹⁴¹^, ¹⁴²
Carbamazepine	Increased plasma carbamazepine concentrations and subsequent toxicity¹⁰⁴^, ¹⁰⁵^, ¹⁰⁶	Reduce carbamazepine dosage by 40-50% after initiating verapamil therapy¹⁰⁴^, ¹⁰⁵ Monitor for carbamazepine toxicity (e.g., diplopia, headache, ataxia, dizziness)¹⁰⁴^, ¹⁰⁵^, ³⁶²
Cimetidine	Variable effects on verapamil clearance and oral bioavailability reported¹⁰⁹^, ¹¹⁰^, ¹¹¹^, ¹¹²^, ¹¹³^, ¹¹⁴^, ¹¹⁷^, ¹¹⁸^, ²⁰⁷^, ³⁶²	Monitor for changes in verapamil's therapeutic and toxic effects if cimetidine is added to or eliminated from regimen¹⁰⁹^, ¹¹⁰^, ³⁶²
Cyclosporine	Increased blood cyclosporine concentrations¹¹⁷^, ¹¹⁸^, ²⁹⁴^, ²⁹⁵^, ²⁹⁶	Monitor for cyclosporine toxicity²⁹⁴^, ²⁹⁶
Dantrolene	Cardiovascular collapse following concomitant use of IV verapamil and IV dantrolene in animals^b	Clinical relevance to humans unknown^b
Digoxin	Increased serum digoxin concentrations and digoxin toxicity²⁰⁷^, ²⁴⁴^, ^b	Monitor serum digoxin concentrations carefully and reduce digoxin dosage as necessary;^b observe closely for digoxin toxicity^b
Disopyramide	Possible additive effects and impairment of left ventricular function^b	Discontinue disopyramide 48 hours prior to initiating verapamil; do not reinstitute until 24 hours after verapamil has been discontinued^b
Diuretics	Additive hypotensive effects^b	Usually used to therapeutic advantage; monitor BP^b
Erythromycin	Increased plasma verapamil concentrations^c
Flecainide	Possible additive effects on myocardial contractility, AV conduction, and repolarization;¹¹⁷^, ¹¹⁸^, ²⁴¹ possible additive negative inotropic effect and prolongation of AV conduction³⁶²	Avoid concomitant use unless potential benefits outweigh risks²⁹²^, ²⁹³
Grapefruit juice	Increased plasma verapamil concentrations^c	Not considered clinically important^c
Lithium	Possible increased, decreased, or unchanged serum lithium concentrations;¹¹⁷^, ¹¹⁸^, ¹³²^, ¹³³^, ²⁰⁷^, ²⁴¹^, ³⁶² possible increased sensitivity to lithium's neurotoxic effects²⁰⁷	Monitor for lithium toxicity;²⁰⁷ monitor serum lithium concentrations; adjust dosage as necessary¹¹⁷^, ¹¹⁸^, ¹³²^, ¹³³^, ²⁰⁷^, ²⁴¹^, ³⁶²
Metoprolol (see entry for β-Adrenergic blocking agents)	Increased oral bioavailability of metoprolol¹¹⁷^, ¹¹⁸^, ¹⁴¹^, ¹⁴²^, ¹⁴³^, ²⁰⁷	Avoid concomitant use, if possible;¹⁴¹^, ¹⁴² if used concomitantly, adjust metoprolol dosage and monitor patient closely¹⁴² Concomitant use of IV verapamil and IV metoprolol within a few hours of each other is contraindicated^b
Neuromuscular blocking agents	Potentiation of neuromuscular blockade^b	Monitor neuromuscular function; decrease dosage of verapamil and/or neuromuscular blocking agent as necessary^b
Nitrates	Possible additive beneficial effects; undesirable interactions unlikely³⁷⁶
Phenobarbital	Increased clearance of total and unbound verapamil,²⁰⁷^, ³⁰²^, ³⁰³^, ³⁰⁵ possibly via induction of hepatic metabolism³⁰³^, ³⁰⁴	Adjust verapamil dosage as necessary³⁰⁵
Propranolol (see entry for β-Adrenergic blocking agents)	Increased incidence of CHF, arrhythmia, and severe hypotension, particularly if IV route or high propranolol dosages are used or if patient has moderately severe or severe CHF, severe cardiomyopathy, or recent MI^b	Use with caution for oral management of hypertension; monitor closely^b Concomitant use of IV verapamil and IV propranolol within a few hours of each other is contraindicated^b
Quinidine	Additive adrenergic blocking activity at α₁- and α₂-receptors¹⁵⁴ Hypotensive effect in patients with hypertrophic cardiomyopathy¹¹⁷^, ¹¹⁸^, ¹⁵³^, ²⁰⁷ Verapamil counteracts the effects of quinidine on AV conduction³⁶² Possible increased plasma quinidine concentrations¹¹⁷^, ¹¹⁸^, ¹⁵⁵^, ²⁰⁷	Avoid concomitant use in patients with hypertrophic cardiomyopathy^b
Rifampin	Decreased oral bioavailability of verapamil	Monitor closely if rifampin is added to or eliminated from regimen; adjust verapamil dosage as necessary¹³⁴^, ¹³⁵^, ¹³⁶^, ¹³⁷^, ¹³⁸
Ritonavir	Increased plasma verapamil concentrations^c
Theophylline	Decreased clearance, elevated serum concentrations, and prolonged serum half-life of theophylline	Monitor for theophylline toxicity
Timolol, ophthalmic	Severe bradycardia ²⁰⁷^, ²⁴²^, ²⁴³ (associated with wandering atrial pacemaker ²⁰⁷^, ²⁴² and transient asystole) reported²⁴³	Use with caution²⁴³
Vasodilators	Additive hypotensive effects^b	Usually used to therapeutic advantage; monitor BP^b

(AHFS, 2011)

Obat-Drug Information | Informasi Obat

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