2 Before you take
Do not take Verapamil tablets and tell your doctor if you:
- are allergic (hypersensitive) to verapamil hydrochloride or any of the other ingredients in Verapamil tablets (see section 6)
- have heart failure or severe problems with the impulses and rhythms of the heart ( second or third degree atrioventricular block or sick sinus syndrome) unless you have a pacemaker
- have heart failure and are taking beta blockers
- have recently suffered a heart attack
- suffer from a slow heart rate (bradycardia)
- have low blood pressure (hypotension)
- have Wolff-Parkinson-White syndrome (rapid heart rate sometimes associated with dizziness or faintness).
- are already taking a medicine containing ivabradine for the treatment of certain heart diseases
Check with your doctor or pharmacist before taking Verapamil tablets if you:
- have had a heart attack or have problems with the impulses of the heart (first degree atrioventricular block)
- have liver disease
- have kidney failure.
Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Especially:
- alpha or beta blockers (particularly important if having a beta blocker by injection) and other drugs to treat high blood pressure e.g. prazosin
- cimetidine (to treat stomach ulcers)
- phenobarbital, carbamazepine or phenytoin (to treat epilepsy)
- rifampicin (to treat infections)
- lithium (to treat depression)
- ciclosporin (to prevent organ transplant rejection)
- theophylline (to treat asthma)
- digoxin (to treat certain heart conditions)
- midazolam (used as sedative or anaesthetic)
- statins e.g. simvastatin, atorvastatin (to lower cholesterol levels)
- erythromycin, clarithromycin (to treat infections)
- aspirin (for pain, fever or to prevent blood clots)
- dabigatran (medicine to prevent the formation of blood clots)
- quinidine (to treat arrhythmias)
- colchicine (for gout)
- immunosupressants such as ciclosporin, sirolimus, everolimus and tacrolimus (to prevent organ transplant rejection).
- dantrolene (to control muscle spasms)
- if you are about to receive surgery where an anaesthetic will be used (including dentistry)
Pregnancy and breast-feeding
If you are pregnant, planning to become pregnant or are breast-feeding, tell your doctor or pharmacist before taking this medicine.
Driving and using machines
Verapamil may make you feel drowsy, particularly when you first start the treatment and when changing over from another medicine. Make sure you are not affected before you drive or operate machinery, especially if taken with alcohol
Verapamil may increase the amount of alcohol in the body and the time it takes for alcohol to leave the body. You should avoid excessive amounts of alcohol whilst taking Verapamil tablets.
Important information about one of the ingredients in Verapamil tablets
Each tablet contains sunset yellow aluminium lake (E110) which may cause allergic reactions.
You should tell your doctor you are taking Verapamil tablets if you are having an operation or anaesthetic.
3 How to take
Always take Verapamil tablets exactly as your doctor has told you. If you are not sure, check with your doctor or pharmacist
Do not eat or drink products containing grapefruit juice whilst taking verapamil, as grapefruit juice increases the effects of verapamil.
Swallow the tablets with water.
High blood pressure: Initially 120mg twice a day increasing to 160mg twice a day. In some cases, up to a maximum of 480mg a day can be taken in divided doses.
Angina: Usually 120mg three times a day. For some patients 80mg three times a day may be sufficient.
Abnormal heart beats: 40-120mg three times a day.
Up to 2 years: 20mg two or three times a day.
2 years and over: 40-120mg two or three times a day.
Elderly with heart or liver problems: you may be given a different dose.
If you take more than you should
If you (or someone else) swallow a lot of tablets at the same time, or you think a child may have swallowed any contact your nearest hospital casualty department or tell your doctor immediately. Overdose can lead to low blood pressure and in rare cases heart failure.
If you forget to take the tablets
Do not take a double dose to make up for a forgotten dose. If you forget to take a dose, take it as soon as you remember. If it is nearly time for the next dose, skip the missed dose and take the next dose at the right time.
If you stop taking the tablets
Talk to your doctor before you stop taking the tablets and follow their advice.
4 Possible side effects
Like all medicines, Verapamil tablets can cause side effects, although not everybody gets them.
Contact your doctor at once if any of the following symptoms occur:
- allergic reaction: itching, rashes, difficulty breathing and swelling of the face, lips or tongue
- palpitations, chest pains for the first time or chest pains becoming more frequent.
Tell your doctor if you notice any of the following side effects, they get worse or you notice any other effects not listed:
Nervous system – headaches, dizziness, ‘pins and needles’, involuntary shaking or spasm
Ears – spinning sensation, ‘ringing in the ears’
Heart /blood vessels – fast, slow or irregular heart beat, low blood pressure, flushing/reddening of the skin, swelling of the ankles, hands or feet
Stomach – constipation, feeling or being sick, pain or discomfort in the stomach, swelling of the gums
Skin – hair loss, skin rash or itching, discolouring, tingling or prickling feeling, blisters, ulcers, numbness
Muscles – weakness, aches, pains in the joints and/or muscles
Reproductive system – impotence, enlarged breasts in men (reversible when treatment is stopped)
Other – tiredness, liver problems which can be detected by blood tests done by your doctor.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard
By reporting side effects you can help provide more information on the safety of this medicine.
5 How to store
Keep out of the reach and sight of children.
Store below 25°C in a dry place.
Do not use Verapamil tablets after the expiry date stated on the label/carton/bottle. The expiry date refers to the last day of that month.
Return any unused medicine to your pharmacist for safe disposal.