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Verapamil Bagian 3

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 effectsb
Usually used to therapeutic advantage; monitor BPb
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 patientsb
Use with caution for oral management of hypertension; monitor closelyb
Concomitant use of IV verapamil and an IV β-adrenergic blocking agent within a few hours of each other is contraindicatedb
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 depressionb
Titrate dosages carefullyb
Aspirin
Increased bleeding timesc
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 animalsb
Clinical relevance to humans unknownb
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 toxicityb
Disopyramide
Possible additive effects and impairment of left ventricular functionb
Discontinue disopyramide 48 hours prior to initiating verapamil; do not reinstitute until 24 hours after verapamil has been discontinuedb
Diuretics
Additive hypotensive effectsb
Usually used to therapeutic advantage; monitor BPb
Erythromycin
Increased plasma verapamil concentrationsc
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 concentrationsc
Not considered clinically importantc
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 contraindicatedb
Neuromuscular blocking agents
Potentiation of neuromuscular blockadeb
Monitor neuromuscular function; decrease dosage of verapamil and/or neuromuscular blocking agent as necessaryb
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 MIb
Use with caution for oral management of hypertension; monitor closelyb
Concomitant use of IV verapamil and IV propranolol within a few hours of each other is contraindicatedb
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 cardiomyopathyb
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 concentrationsc
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 effectsb
Usually used to therapeutic advantage; monitor BPb
(AHFS, 2011)


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