Veracal-SR
Verapamil hydrochloride 240 mg sustained release tablet

Presentation
Each sustained release tablet contains Verapamil Hydrochloride USP 240 mg.

Description
Veracal-SR is a calcium ion influx inhibitor that inhibits the inward movement of calcium into cardiomyocytes, smooth muscle cells and His-Purkinje system.

Indications
1.Essential hypertension
2.Angina pectoris and prevention of re-infarction
3.Supraventricular arrhythmias

Dosage and Administration
The dose of Verapamil SR should be individualized by titration and the drug should be administered with food.
For essential hypertension the initial dose should be given 180 mg in the morning. If adequate response is not obtained with 180 mg of Verapamil then the dose may be titrated by following manner:
240 mg each morning
180 mg each morning plus 180 mg each evening.
240 mg every 12 hourly.

For angina the usual dose is 80 mg to 120 mg three times a day.

For arrythmias in digitalized patients, Verapamil should be given 240 mg to 360 mg in divided doses, depending on the severity of the condition. Divided doses up to 180 mg/day may occasionally be needed.

Side effects
Verapamil is generally well tolerated. The following reaction to orally administered Verapamil appeared clearly drug related or occurred at rates greater than 1% in clinical trials with approximately 5000 patients. Digestive system: constipation, nausea. Cardiovascular system: hypotension, edema, CHF, pulmonary edema, bradycardia, AV block. Respiratory system: upper respiratory tract infections. Nervous system: dizziness, headache, fatigue. Skin: rash, flashing. Hepatic: elevated liver enzyme.

Contraindications
Severe left ventricular dysfunction; Hypotension or cardiogenic shock; Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker); Second or third-degree atrioventricular (AV) block (except in patients with a functioning artificial pacemaker); Patients with atrial flutter or atrial fibrillation and an accessory by pass tract [eg. Wolff-Parkinson-White (WPW), Lown-Ganong-Levine syndrome]; Patients with known hypersensitivity to verapamil hydrochloride.

Precautions
Care should be taken in 1st degree AV block, bradycardia<50 beats/minutes, hypotension<90 mm Hg systolic pressure, atrial fibrillation/flutter and simultaneous pre-excitation syndrome e.g. WPW syndrome, heart failure (previous compensation with cardiac glycosides/diuretics required).
Verapamil may impair ability to drive or operate machinery, particularly in the initial stages of treatment and with concomitant consumption of alcohol.
Verapamil markedly slows down the elimination of alcohol and prolongs the duration of the effects of alcohol.

Use in pregnancy and lactation
There are no adequate and well-controlled studies in pregnant women, so this drug should be used during pregnancy only if clearly needed. Verapamil crosses the placental barrier and can be detected in umbilical vein blood during delivery. Verapamil is excreted in human milk. So nursing should be discontinued while Verapamil is administered.

Over dosage
Treatment of overdose should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solution may increase calcium ion influx across the slow channel and have been used in the treatment of overdose with Verapamil. Verapamil cannot be removed by haemodialysis.

Commercial Pack
Veracal-SR: Each box contains 3 blister strips of 10 sustained release tablets.