Isoptin is a calcium channel blocker, which has an antihypertensive and antiarrhythmic effect, reducing myocardial oxygen demand.
Release form and composition
Isoptin Dosage Forms:
- Coated tablets;
- Solution for on / in the introduction.
The composition of the tablets:
- 40 or 80 mg of verapamil hydrochloride;
- Excipients: croscarmellose sodium, microcrystalline cellulose, calcium hydrogen phosphate dihydrate, magnesium stearate, colloidal silicon dioxide;
- The composition of the shell: sodium lauryl sulfate, hypromellose 3 MPa, titanium dioxide, macrogol 6000.
Isoptin tablets are sold in blisters:
- 10 each, 2 or 10 blisters per package;
- 20 pcs., 1 or 5 blisters per pack.
In one vial with a solution contains:
- 5 mg of verapamil hydrochloride;
- Additional ingredients: 36% hydrochloric acid, sodium chloride and injectable water.
The solution is sold in 2 ml ampoules, 5 or 50 ampoules in a cardboard box.
Indications for use
In tablets Isoptin is used for:
- Paroxysmal supraventricular tachycardia;
- Ischemic heart disease, incl. for angina pectoris due to vasospasm, unstable angina pectoris, chronic stable angina pectoris;
- Flicker or atrial flutter with tachyarrhythmia (with the exception of Laun-Ganng-Levine and Wolf-Parkinson-White syndrome).
In the form of a solution, the drug is used for:
- Restoration of sinus rhythm in paroxysmal supraventricular tachycardia, including Lone-Ganng-Levine syndrome (LGL) and Wolf-Parkinson-White syndrome (WPW);
- Control the frequency of ventricular contractions in atrial fibrillation and atrial flutter, with the exception of LGL and WPW syndromes.
Isoptin application is contraindicated in:
- Cardiogenic shock;
- Syndrome of sick sinus, except for patients with an artificial pacemaker;
- Acute myocardial infarction, complicated by bradycardia, left ventricular failure and severe arterial hypotension;
- Chronic heart failure;
- AV blockade of stage II or III, with the exception of patients with an artificial pacemaker;
- Atrial fibrillation / flutter in the case of additional pathways (for LGL and WPW syndromes).
In addition, the drug is not prescribed:
- In case of hypersensitivity to any component of Isoptin;
- Simultaneously with colchicine;
- Children and teenagers under 18;
- During pregnancy;
- When breastfeeding;
- Simultaneously with beta-blockers (in case of intravenous use of Isoptin).
With caution the drug is used for:
- Severe liver / kidney function;
- AV blockade I degree;
- Diseases associated with neuromuscular transmission, including Duchenne muscular dystrophy, myasthenia gravis, Lambert-Eaton syndrome.
Dosing and Administration
Isoptin solution is designed for slow IV injection with continuous ECG and blood pressure monitoring. Introduce it:
- slowly intravenously (for at least 2 minutes, for older people - 3 minutes) in the initial dose of 5 mg, with inefficiency - in the same dosage again after 5-10 minutes;
- drip in / in (to maintain the effect) at a dose of 5-10 mg / h in a glucose solution, physiological or other solution with a pH of less than 6.5. The total dosage is 100 mg per day.
In the form of tablets Isoptin should be taken with food or immediately after a meal, without breaking and chewing, drinking water.
At the beginning of treatment, 40-80 mg is prescribed three or four times a day. In the future, the dosage is determined individually, taking into account the type of disease and the clinical picture.
The average daily dose is 240-480 mg, but at the maximum you can take the drug only in the hospital.
Isoptin cannot be abolished abruptly, the dosage should be gradually reduced.
When using Isoptin, the following side effects may occur:
- Hypersensitivity reactions;
- Dizziness, headache, paresthesia, fatigue, tremor, extrapyramidal disorders (stiffness of the arms and / or legs, mask-like face, ataxia, difficulty swallowing, trembling hands and fingers, shuffling gait);
- Stopping the sinus node, marked reduction in blood pressure, tachycardia, peripheral edema, sinus bradycardia, AV-blockade (I, II, III century), heart failure, palpitations, flushing of the skin of the face;
- Nausea, vomiting, gingival hyperplasia, intestinal obstruction, constipation, pain or discomfort in the abdomen;
- Pruritus, maculopapular rash, Stevens-Johnson syndrome, urticaria, angioedema, purpura, alopecia, erythema multiforme;
- Muscle weakness, arthralgia, myalgia;
- Galactorrhea, erectile dysfunction, gynecomastia;
- Hyperprolactinemia, increased liver enzymes.
Overdose of verapamil hydrochloride is manifested by a pronounced decrease in blood pressure, hyperglycemia, sinus bradycardia, passing into a high degree AV blockade, stupor, sinus node arrest, and metabolic acidosis. There are data on cases of lethal outcomes. If the patient has taken too large a dose of Isoptin, it is necessary to do a lavage of the stomach and intestines, take activated charcoal. In the future, symptomatic and supportive therapy, parenteral administration of beta adrenomimetics and calcium preparations is indicated. Hemodialysis is ineffective.
The concentration of verapamil in the blood can be increased by clarithromycin, erythromycin, telithromycin, and antiviral drugs for treating HIV infection. Isoptin increases the concentration of sirolimus, tacrolimus, atorvastatin, lovastatin, carbamazepine.
With the simultaneous use of antiarrhythmic drugs and beta-blockers, mutual enhancement of cardiovascular effects is noted, which is manifested by a more pronounced AV blockade, a significant reduction in heart rate, the development of symptoms of heart failure and increased arterial hypotension.
In the case of combined use of Isoptin with quinidine, hypotensive effect may be enhanced, in patients with hypertrophic obstructive cardiomyopathy there is a risk of pulmonary edema.
A decrease in the antihypertensive effect is observed when the drug is combined with sulfinpyrazone and rifampicin.
Verapamil increases the neurotoxicity of lithium, enhances the effect of muscle relaxants.
During the treatment with Isoptin:
- It is not recommended to drink alcoholic beverages;
- Care should be taken when driving and performing potentially hazardous work;
- It is necessary to avoid taking acetylsalicylic acid.
Verapamil, Verapamil-LekT, Verapamil Sopharma, Verapamil-ratiofarm, Verapamil-Ferein, Verapamil-Eskom, Verohalid EP 240, Isoptin CP 240, Finoptin.
Terms and conditions of storage
Isoptin should be stored in a dark place at a temperature of 15-25 ºС. Shelf life - 5 years.