Veratard 180

Veratard 180 is a selective Ca antagonist, primarily affecting cardiac function.

Indications Veratarda 180

It is used for elevated blood pressure, and also to prevent attacks of angina pectoris and attacks of paroxysmal supraventricular tachycardia.

Release form

The medicine is released in capsules, in the amount of 10 pieces inside a packaging pack. A box contains 3 or 5 such packs.

Pharmacodynamics

Verapamil is a derivative of the element phenylalkylamine, selectively blocks Ca channels. It has antianginal, hypotensive, antiarrhythmic and antiischemic activity.

The therapeutic effect of the drug develops by blocking Ca2+ channels, as well as suppressing transmembrane transport of Ca2+ ions (mainly inside the smooth muscle cells of the myocardium with vessels).

In case of myocardial ischemia, the drug eliminates the disproportion between the oxygen demand and supply of the heart, and in addition, reduces myocardial contractility and has a vasodilatory effect. Weakening the tone of peripheral arteries leads to a decrease in blood pressure and total peripheral vascular resistance.

Verapamil suppresses sinoatrial and AV conduction and has an antiarrhythmic effect.

Pharmacokinetics

After oral administration of the drug, verapamil is gradually released, thereby maintaining its constant level in the blood. It takes 5-7 hours to obtain plasma Cmax values. The process of substance release is almost linear, over 8-12 hours.

It undergoes the first intrahepatic passage, as a result of which several metabolic products are formed. The main metabolic product is the substance norverapamil, which has a weaker antihypertensive effect than the unchanged active element of the drug. Intraplasmic protein synthesis is 90%.

Due to the first liver pass effect, the values of drug bioavailability after a single dose are 30%, and the half-life is approximately 7 hours. After repeated use of the drug, the half-life averages 12 hours due to saturation of the liver enzyme systems and an increase in the plasma level of verapamil.

Excretion of the drug occurs largely in the urine (70%) in the form of metabolic products, and another portion is excreted in the feces.

Dosing and administration

The dosage can only be selected by a medical specialist, individually for each patient. At the initial stage of therapy, Veratard 180 is used in the amount of 1 capsule, 1 time per day, in the morning. The portion can be increased after 14 days of taking the drug. The increase occurs up to 0.36 g per day (taking 1 capsule in the morning, as well as in the evening, the interval between uses is approximately 12 hours). Exceeding the permissible portion is allowed only for an extremely short period and under close medical supervision.

The use of therapeutic forms of the drug with a slow release rate together with food increases the time to reach peak values of verapamil with norverapamil in the blood plasma, but their bioavailability level remains the same. Because of this, the drug is allowed to be used with food, before it and after it. The capsules are not chewed or dissolved; they are swallowed with plain water.

Use Veratarda 180 during pregnancy

The use of the drug during pregnancy (especially in the 1st and 3rd trimesters), and also lactation, is allowed only in situations where the likelihood of helping the woman is more expected than the negative impact on the fetus or baby.

Contraindications

Among the contraindications:

• presence of hypersensitivity to verapamil;
• having an acute form of heart failure;
• severe degree of bradycardia (heart rate values are <50 beats/minute);
• SSSU;
• having 2nd or 3rd degree AV block;
• WPW syndrome;
• reduced blood pressure values (systolic pressure level below 90 mm Hg);
• CHF;
• having a pronounced degree of disorder in the functioning of the liver.

Side effects Veratarda 180

The use of the drug may provoke the occurrence of the following side effects:

• lesions associated with the cardiovascular system: sinus bradycardia, sinoatrial or AV block, reddening of the skin on the face, asystole, decreased blood pressure, as well as heart failure and atrial fibrillation, which is bradyarrhythmic in nature;
• dysfunction of the nervous system: paresthesia, dizziness, feeling of nervousness, lethargy or fatigue, as well as headaches;
• gastrointestinal disorders: nausea, atonic constipation and heartburn;
• other signs: allergy symptoms (rash or itching), transient increase in liver alkaline phosphatase or transaminase levels, arthralgia with myalgia and swelling in the ankle area.

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Overdose

Drug intoxication leads to AV block, severe bradycardia, heart failure, asystole, cardiogenic shock, and in addition to this, to sinoatrial block and a decrease in blood pressure.

To eliminate these disorders, gastric lavage is performed (if the period from the moment of taking the drug is less than 12 hours). It can also be performed later if weakened intestinal motility is noted (no intestinal noises occur during auscultation). In addition, symptomatic procedures are performed.

As an antidote, 10-20% calcium gluconate (2.25-4.5 mmol) can be administered intravenously. If necessary, such an injection can be repeated or an additional infusion procedure can be performed through a dropper (the rate is 5 mmol/hour). Correction of the hemodynamic disorders that have arisen is performed. The hemodialysis procedure does not produce results.

Interactions with other drugs

Medicinal combination with the component amiodarone is prohibited - it increases the risk of cardiac arrest.

Use together with carbamazepine potentiates the activity of the latter, because its metabolic processes are suppressed. As a result, negative symptoms develop in the form of NS intoxication.

The combination of the drug with long-term lithium-based agents can cause increased sensitivity of the body to lithium, and also provoke NS poisoning.

Taking it together with rifampicin causes a weakening of the antibacterial properties of this drug.

When combined with phenobarbital, a weakening of the depressant effect of this element is observed.

When combined with cimetidine, the pharmacological properties of Veratard 180 are potentiated.

When used together with inhalation anesthetics, β-blockers, antiarrhythmic drugs of the Ia subtype and SG, a mutual potentiation of the suppressive effect on myocardial conduction together with contractility, AV conduction, and also on the automaticity of the sinus angle is observed.

Administration together with imipramine-type antidepressants, baclofen or neuroleptics may lead to potentiation of the antihypertensive activity of the drug.

Use in combination with organic nitrates is considered rational, because with it the antihypertensive and antianginal effects are summed up, and the reflex tachycardia that develops under the influence of nitrates is weakened.

Combination with theophylline, digoxin, as well as quinidine or cyclosporine increases plasma levels of these agents.

Taking it together with other antihypertensive drugs (thiazide diuretics, vasodilators and ACE inhibitors) leads to mutual potentiation of antihypertensive activity.

Administration in combination with drugs that actively undergo protein synthesis in blood plasma (such as warfarin, tolbutamide, diazoxide, chlorpromazine, prazosin with phenytoin, as well as non-selective monoamine inhibitors (reverse neuronal uptake), phenylbutazone with propranolol and furosemide) causes an increase in the level of the free fraction of such drugs, which requires correction of the portion size.

Use with macrolides significantly increases the risk of ventricular fibrillation.

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Storage conditions

Veratard 180 should be kept in a dark and dry place, out of the reach of small children. Temperature marks should not exceed 25°C.

Shelf life

Veratard 180 can be used for a period of 24 months from the date of release of the pharmaceutical product.

Application for children

The use of Veratard 180 in pediatrics is prohibited (for persons under 14 years of age).

Analogues

Analogues of the drug are Verapamil, Lekoptin and Verogalid with Isoptin.