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Calan SR, Isoptin SR verapamil dosing,

Calan SR, Isoptin SR verapamil dosing, 2.5-5 mg IV over 2 minutes; 5-10 mg dose may be repeated after 15-30 minutes Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose 1-15 years old: 0.1-0.3 mg/kg (not to exceed 5 mg) IV over 2 minutes; second dose (not to exceed 10 mg) may be given after 30 minutes Alternatively (not well established), 4-8 mg/kg/day PO divided q8hr Immediate release: 80 mg PO q8hr initially; usual range: 80-120 mg PO q8hr; not to exceed 480 mg/day Extended release (Covera-HS): 180 mg PO at bedtime initially; maintenance: 180-540 mg PO at bedtime Immediate release: 40 mg PO q8hr initially; maintenance: 80-320 mg PO q12hr Extended release (Calan SR, Isoptin SR, Verelan): 120 mg/day PO given in morning Extended release (Covera-HS): 180 mg/day PO at bedtime Extended release (Verelan PM): 100 mg/day PO at bedtime Hypersensitivity to verapamil or other calcium channel blockers Cardiogenic shock Congestive heart failure Symptomatic hypotension Sick sinus syndrome (unless permanent pacemaker in place) 2°/3° AV block (unless permanent pacemaker in place) Aortic stenosis Atrial fibrillation/flutter with accessory bypass tract 1° AV block Hypertrophic cardiomyopathy (eg, idiopathic hypertrophic subaortic stenosis) Hypotension (initially or after dose increases) Exacerbation of angina (during initiation of treatment, after dose increase, or after withdrawal of beta blocker) Neuromuscular transmission defects; may exacerbate myasthenia gravis Hepatic or renal impairment Persistent progressive dermatologic reactions Generic products may not be bioequivalent Do not prescribe Covera-HS or Verelan PM for shift workers Concurrent beta-blocker therapy Concurrent ivabradine therapy Slows AV conduction; use cautiously with beta blockers Hypotension and bradyarrhythmias observed with concurrent use of other CYP3A4 substrates (eg, cyclosporine, telithromycin) because of competitive metabolism Coadministration with CYP3A4 inhibitors (eg, erythromycin, itraconazole) may decrease metabolism and thus increase toxicity Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with concurrent use of clonidine with verapamil; monitor heart rate if coadministered Verapamil is no longer part of Pediatric Advanced Life Support tachyarrhythmia algorithm Potential toxic dose in patients Nondihydropyridine calcium-channel blocker: Inhibits transmembrane influx of extracellular calcium ions across membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentrations, resulting in inhibition of cardiac and vascular smooth muscle contraction and thereby dilating main coronary and systemic arteries Blocks slow inward calcium current responsible for sinus and AV nodal depolarization Bioavailability: 20-35% Onset: Immediate release, 1-2 hr; IV, 1-5 min Duration: IV, 10-20 min; PO, 6-8 hr Peak plasma time: Immediate release, 1-2 hr; extended release, 11 hr (Covera-HS, Verelan PM), 5.21 hr (Calan SR, Isoptin SR), or 7-9 hr (Verelan) Additive: Albumin (human), aminophylline, amphotericin B, floxacillin, hydralazine, trimethoprim/sulfamethoxazole Y-site: Albumin (human), amphotericin B cholesteryl sulfate, ampicillin, nafcillin, oxacillin, penicillin G, propofol, sodium bicarbonate Solution: Most common solvents Additive: Amikacin, amiodarone, ampicillin, ascorbic acid, atropine, bretylium, calcium coride, calcium gluconate, cefamandole, cefazolin, cefotaxime, cefoxitin, coramphenicol, cimetidine, clindamycin, dexamethasone, diazepam, doxin, dobutamine (incompatible at 80 mg in D5W, NS), dopamine, epinephrine, erythromycin, furosemide(? Medscape - Hypertension, angina, atrial fibrillation-specific dosing for Calan SR, Isoptin SR, verapamil, frequency-based adverse effects, comprehensive.

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