Verapamil

Generic name
Verapamil
Brand name
ATC Code
C08DA01
Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

After intravenous administration, the average half-life was 9 hours and the average clearance was 30 l/hour in children 7 to 19 years of age (average age: 12 years)

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Hypertension, prophylaxis for supraventricular tachycardia
  • Oral
    • 2 years up to 18 years
      • (Verapamil hydrochloride) 3 - 8 mg/kg/day in 3 doses. Max: 480 mg/day.
Myoclonic epilepsy (Dravet syndrome)
  • Oral
    • 1 year up to 18 years
      • (Verapamil hydrochloride) 1 - 1.5 mg/kg/day in 3 doses.

      • The scientific justification for using verapamil in myoclonic epilepsy is very limited: In one series of cases (n=2, aged 4 and 14 years) by Ianetti (2010), using verapamil in children was seen to be effective. The study by Nicita (2014) showed a partial response in 3 children (identical twins aged 4 years and a girl aged 8 years) with genetically-determined Dravet syndrome.
Severe therapy-resistant supraventricular tachycardia
  • Intravenous
    • 1 year up to 18 years
      • (Verapamil hydrochloride) 0.1 - 0.3 mg/kg/dose, bolus in a minim of 2 minutes. Max single dose: 10 mg/dose. The dose may potentially be repeated after 30 minutes if the patient is haemodynamically stable..

      • Use in consultation with a paediatric cardiologist.

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Hypotension, pulmonary oedema.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Be aware of the possibility of congestive heart failure and combinations with beta-blockers. Can raise digoxin levels significantly. When administering intravenously, calcium gluconate should always be present as the antagonist.

There are cases known of severe (fatal) haemodynamic side effects in children aged < 1 year after intravenous administration of verapamil.

Intravenous administration to children should be done with intensive monitoring and (because of the high risk) it is only justifiable in the treatment of severe refractory supraventricular tachycardia.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

SELECTIVE CALCIUM CHANNEL BLOCKERS WITH DIRECT CARDIAC EFFECTS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

References

  1. Till JA, et al, Supraventricular tachycardia: diagnosis and current acute management, Arch Dis Child, 1991, May;66(5), 647-52
  2. Centrafarm Services BV, SPC Verapamil 2,5 mg/ml (RVG 56335) 05-04-2022, www.geneesmiddeleninformatiebank.nl
  3. Sandoz BV, SPC Verapamil tabletten (RVG 13536), www.cbg-meb.nl, Geraadpleegd 28 oktober 2010, http://db.cbg-meb.nl/IB-teksten/h13536.pdf
  4. Leitner RP, et al, Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children. , Aust Paediatr J. , 1983 , Mar;19(1), 40-4
  5. Soler-Soler J, et al, Effect of verapamil in infants with paroxysmal supraventricular tachycardia, Circulation, 1979, May;59(5), 876-9
  6. Kleinman ME, et al, Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care., Pediatrics., 2010, Nov;126(5), e1361-99
  7. Lim SH, et al, Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia., Resuscitation., 2009, May;80(5):, 523-8
  8. Porter CJ, et al, Verapamil: an effective calcium blocking agent for pediatric patients, Pediatrics., 1983, May;71(5), 748-55
  9. Young GP, et al, Conversion of paroxysmal supraventricular tachycardia in a child with a slow verapamil infusion: case report and literature review, Am J Emerg Med., 1991, Nov;9(6), 603-8
  10. Greco R, et al, Treatment of paroxysmal supraventricular tachycardia in infancy with digitalis, adenosine-5'-triphosphate, and verapamil: a comparative study, Circulation, 1982, Sep;66(3):, 504-8
  11. Flynn JT, et al, Calcium channel blockers: pharmacology and place in therapy of pediatric hypertension, Pediatr Nephrol, 2000, Dec;15(3-4), 302-16
  12. Kugler JD, et al, Management of infants, children, and adolescents with paroxysmal supraventricular tachycardia, J Pediatr, 1996, Sep;129(3):, 324-38
  13. Piovan D, et al, Verapamil and norverapamil plasma levels in infants and children during chronic oral treatment, Ther Drug Monit, 1995, Feb;17(1), 60-7
  14. Iannetti P, et al, Addition of verapamil in the treatment of severe myoclonic epilepsy in infancy, Epilepsy Res, 2009, Jul;85(1), 89-95
  15. Nicita F, et al, Efficacy of verapamil as an adjunctive treatment in children with drug-resistant epilepsy: a pilot, Seizure, 2014, Jan;23(1), 36-40
  16. BGP Products, SmPC Isoptin SR tabletten met gereguleerde afgifte (RVG 15481) 30-9-2015, www.geneesmiddeleninformatiebank.nl
  17. Leitner RP, et al, Intravenous verapamil in the treatment of paroxysmal supraventricular tachycardia in children., Aust Paediatr J., 1983, Mar;19(1), 40-4

Changes

Therapeutic Drug Monitoring


Overdose