Verapamil is a synthetic papaverine derivative, first introduced in 1962 as an anti-anginal agent. It has since been found to have anti-arrhythmic and anti-hypertensive properties, attributable to its ability to inhibit transmembrane calcium flux in excitable tissues. Daily adult oral maintenance doses range from 240 – 480 mg, while single i.v doses of 5 – 10 mg are used for hypertensive crises.
Adverse effects associated with verapamil administration include nausea, weakness, dizziness, bradycardia, hypotension and atrioventricular block. Intravenous calcium gluconate may be able to reverse cardiac toxicity observed.
For TDM, sample should be taken prior to dose. If toxicity is suspected, take sample at earliest opportunity
Verapamil measured by HPLC-DAD.
Therapeutic use of verapamil is associated with blood concentrations of up to 0.4 mg/L. Toxicity is associated with verapamil levels > 1 mg/L. (Schulz et al. Critical Care 2012, 16:R136).
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