What is the most important information I should know about Verapamil?

• Do not stop taking this medication without first talking to your doctor. If you stop taking the medication, your condition could become worse.
• Do not crush, chew, or break extended-release forms of Verapamil such as generic Covera-HS and Verelan PM. Swallow them whole. Generic Verapamil SR, Isoptin SR, and Calan SR may be divided in half but should not be crushed or chewed.

What is Verapamil?

• Verapamil is in a class of drugs called calcium channel blockers. Verapamil relaxes (widens) blood vessels (veins and arteries), which makes it easier for the heart to pump and reduces its workload.
• Verapamil is used to treat hypertension (high blood pressure), to treat angina (chest pain), and to control some types of irregular heartbeats.
• Verapamil may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Verapamil?

• Before taking this medication, tell your doctor if you have
  • kidney or liver disease;
  • other diseases of the heart or blood vessels such as sick sinus syndrome, aortic stenosis, heart failure, heart block, Wolff-Parkinson-White syndrome, coronary artery disease, or low blood pressure; or
  • muscular dystrophy.
• You may not be able to take Verapamil, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
• Verapamil is in the FDA pregnancy category C. This means that it is not known whether Verapamil will be harmful to an unborn baby. Do not take Verapamil without first talking to your doctor if you are pregnant or could become pregnant during treatment.
• Verapamil passes into breast milk and may harm a nursing infant. Do not take Verapamil without first talking to your doctor if you are breast-feeding a baby.

How should I take Verapamil?

• Take Verapamil exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
• Take each dose with a full glass of water.
• Verelan, Verelan PM, Calan, Isoptin, Covera-HS, and generic forms of regular-release Verapamil can be taken with or without food. Taking the medication with food may reduce stomach upset if it occurs.
• Calan SR, Isoptin SR, and generic sustained-release Verapamil (Verapamil SR) may be more likely to cause stomach upset and should be taken with food to reduce this side effect.
• Take Covera-HS and Verelan PM at bedtime.
• If you have trouble swallowing the Verelan pellet-filled capsules, they can be opened and the contents can be sprinkled onto cold, soft food such as applesauce. This mixture must be swallowed without chewing. Use the mixture immediately. Do not save it for later use. (Do not use this procedure for the Verelan PM capsules.)
• Do not crush, chew, or break extended-release forms of Verapamil such as Covera-HS and Verelan PM. Swallow them whole. Generic Verapamil SR, Isoptin SR, and Calan SR may be divided in half if the tablets are scored, but should not be crushed or chewed.
• If you are taking Covera-HS, do not be concerned if you find what looks like an undissolved tablet in your stool. This medication is formulated with an outer shell that does not dissolve. This shell allows the medicine to be released slowly into your body before it is passed out in the stool.
• It is important to take Verapamil regularly to get the most benefit.
• Do not stop taking this medication without first talking to your doctor. If you stop taking the medication, your condition could become worse.
• Grapefruit and grapefruit juice may interact with Verapamil. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
• Your doctor may want you to have blood tests, blood pressure monitoring, or other medical evaluations during treatment with Verapamil to monitor progress and side effects.
• Store Verapamil at room temperature away from moisture and heat.

What happens if I miss a dose?

• Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

What happens if I overdose?

• Seek emergency medical attention.
• Symptoms of a Verapamil overdose include dizziness, weakness, chest pain, shortness of breath, fainting, an unusually fast or slow heartbeat, coma, slurred speech, and confusion.

What should I avoid while taking Verapamil?

• Grapefruit and grapefruit juice may interact with Verapamil. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
• Avoid the use alcohol. Alcohol may further lower blood pressure and increase drowsiness and dizziness while taking Verapamil.
• Follow any recommendations your doctor makes about diet or exercise.

What are the possible side effects of Verapamil?

• If you experience any of the following serious side effects, stop taking Verapamil and contact your doctor immediately or seek emergency medical treatment:
  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
  • an unusually fast or slow heartbeat;
  • shortness of breath (heart failure);
  • fainting;
  • abnormal behavior or psychosis;
  • jaundice (yellowing of the skin or eyes); or
  • swelling of the legs or ankles.
• Other, less serious side effects may be more likely to occur. Continue to take Verapamil and talk to your doctor if you experience
  • unusual headache, fatigue, or tiredness;
  • insomnia or trouble sleeping;
  • vivid dreams;
  • hair loss;
  • nausea or diarrhea; or
  • increased urination.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Verapamil?

• Before taking this medication, tell your doctor if you are taking any of the following drugs:
  • cyclosporine (Sandimmune, Neoral);
  • cimetidine (Tagamet, Tagamet HB);
  • carbamazepine (Tegretol, Carbatrol);
  • lithium (Lithobid, Eskalith, others);
  • theophylline (Theo-Dur, Theochron, Theolair, Theobid, Elixophyllin, Slo-Phyllin, others);
  • rifampin (Rifadin, Rimactane);
  • phenobarbital (Luminal, Solfoton);
  • an HMG CoA reductase inhibitor such as atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor), and others; or
  • another heart medication such as propranolol (Inderal), metoprolol (Lopressor, Toprol XL), atenolol (Tenormin), digoxin (Lanoxin), quinidine (Quinora, Quinidex, Quinaglute), flecainide (Tambocor), disopyramide (Norpace), captopril (Capoten), enalapril (Vasotec), and others.
• You may not be able to take Verapamil, or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.
• Drugs other than those listed here may also interact with Verapamil or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.