Verapamil

General Toxicity Notes
Headache, edema, flushing, dizziness.
Excreted Unchanged %
<3
Half-Life (Normalesrd) Hours
3-7/2.4-4.0
Plasma Protein Binding %
83-93
Volume Of Distribution L/Kg
3-7.1
Dose For Normal Renal Function
180-480 mg q24h (sustained release)
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
100% [A]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: None, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [A]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [B]
References
Beyerlein C, Csaszar G, Hollmann M, Schumacher A. Verapamil in antihypertensive treatment of patients on renal replacement therapy&#151; clinical implications and pharmacokinetics. Eur J Clin Pharmacol. 1990; 39 Suppl 1: S35-7. [PMID: 2261942] / Brogden RN, Benfield P. Verapamil: a review of its pharmacological properties and therapeutic use in coronary artery disease. Drugs. 1996; 51: 792-819. [PMID: 8861548] / Keefe DL, Yee YG, Kates RE. Verapamil protein binding in patients and in normal subjects. Clin Pharmacol Ther. 1981; 29: 21-6. [PMID: 6970111] / Pritza DR, Bierman MH, Hammeke MD. Acute toxic effects of sustained-release verapamil in chronic renal failure. Arch Intern Med. 1991; 151: 2081-4. [PMID: 1843183] / Shah GM, Winer RL. Verapamil kinetics during maintenance hemodialysis. Am J Nephrol. 1985; 5: 338-41. [PMID: 4061502] / Storstein L, Larsen A, Midtb&#248; K, Saevareid L. Pharmacokinetics of calcium blockers in patients with renal insufficiency and in geriatric patients. Acta Med Scand Suppl. 1984; 681: 25-30. [PMID: 6587753]
Toxicity Notes
Acute renal dysfunction. Active metabolites accumulate, particularly with sustained-release forms. May increase digoxin and cyclosporine levels.