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Verapamil

What works?

Learn more about the effects of these drugs. The most reliable research is summed up for you in our featured article.

By mouth

Verapamil is used alone or together with other medicines to treat heart rhythm problems, severe chest pain (angina), or high blood pressure (hypertension)… Read more

Brand names include: Calan, Calan SR

By injection

Verapamil is used to control rapid heartbeats or abnormal heart rhythms. It belongs to a group of drugs called calcium channel blocking agents. Verapamil… Read more

Drug classes About this
Antianginal, Antiarrhythmic, Group IV, Antihypertensive, Antimigraine, Cardiovascular Agent
Combinations including this drug

What works? Research summarized

Evidence reviews

Calcium channel blocking drugs for Duchenne muscular dystrophy

Duchenne muscular dystrophy is a progressive wasting condition of muscles which starts in early childhood, leads to dependence on a wheelchair by the age of thirteen and respiratory failure by late teens. The condition is due to absence of dystrophin, a large muscle protein that has several functions within muscle cells. We know that calcium molecules build up in the muscle cells of people with Duchenne muscular dystrophy and this is associated with cell death. The rationale behind this review was to ascertain whether randomised controlled trials using drugs that block calcium entry into muscle would result in a reduction in progression of the condition. Although these trials were conducted over ten years ago a systematic review was not done at that time, and so a potential effect of calcium blocking drugs (antagonists) on the course of DMD may have been missed. If it were to exist, calcium antagonists might be an effective treatment in their own right or, more likely, could be used in combination with newer treatments such as corticosteroids or potential treatments such as gene related therapies.

Treatment of high blood pressure for people with peripheral arterial disease

When blood pressure is consistently high it can lead to complications such as a heart attack (myocardial infarction) or stroke. Both peripheral arterial disease (PAD), a condition that affects the blood vessels (arteries) carrying the blood to the legs, arms, and stomach area, and high blood pressure (hypertension) are associated with atherosclerosis. This is hardening of the arteries which is caused by deposits of fat, cholesterol and other substances inside the blood vessels. PAD is diagnosed when the blood supply to the legs is restricted causing pain and cramping that limits walking (intermittent claudication). It is measured by the walking distance (on a treadmill) before onset of pain (claudication distance) or ankle brachial index (ABI), the ratio of the blood pressure in the arms to the blood pressure in the legs. If the blood pressure is lower in the legs compared to the arms (ABI of less than 1.0) this indicates blocked arteries in the legs (or PAD). PAD can progress to pain at rest and critical limb ischaemia (sudden lack of blood flow to a limb caused by a blood clot or fatty deposit blockage) that requires revascularisation (restoring the blood flow by opening up the blocked blood vessel) or amputation. Treatment of hypertension to reduce cardiovascular events (heart attack or stroke) and death needs careful consideration in people with PAD. Anti‐hypertensive medications may worsen the PAD symptoms by further reducing blood flow and supply of oxygen to the limbs, and may have long‐term effects on disease progression. The evidence from randomised controlled trials (RCTs) examining the risks and benefits of various anti‐hypertensive drugs on measures of PAD is lacking.

The relative efficacy of adenosine versus verapamil for the treatment of stable paroxysmal supraventricular tachycardia in adults: a meta-analysis

This review concluded that adenosine and verapamil had similar efficacy in treating paroxysmal supraventricular tachycardia. Adenosine had a higher rate of overall adverse events than verapamil but verapamil had a higher rate of hypertension. Conclusions on efficacy are likely to be reliable although generalisability is unclear; there is more uncertainty surrounding the adverse events, particularly for hypotension.

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Summaries for consumers

Calcium channel blocking drugs for Duchenne muscular dystrophy

Duchenne muscular dystrophy is a progressive wasting condition of muscles which starts in early childhood, leads to dependence on a wheelchair by the age of thirteen and respiratory failure by late teens. The condition is due to absence of dystrophin, a large muscle protein that has several functions within muscle cells. We know that calcium molecules build up in the muscle cells of people with Duchenne muscular dystrophy and this is associated with cell death. The rationale behind this review was to ascertain whether randomised controlled trials using drugs that block calcium entry into muscle would result in a reduction in progression of the condition. Although these trials were conducted over ten years ago a systematic review was not done at that time, and so a potential effect of calcium blocking drugs (antagonists) on the course of DMD may have been missed. If it were to exist, calcium antagonists might be an effective treatment in their own right or, more likely, could be used in combination with newer treatments such as corticosteroids or potential treatments such as gene related therapies.

Treatment of high blood pressure for people with peripheral arterial disease

When blood pressure is consistently high it can lead to complications such as a heart attack (myocardial infarction) or stroke. Both peripheral arterial disease (PAD), a condition that affects the blood vessels (arteries) carrying the blood to the legs, arms, and stomach area, and high blood pressure (hypertension) are associated with atherosclerosis. This is hardening of the arteries which is caused by deposits of fat, cholesterol and other substances inside the blood vessels. PAD is diagnosed when the blood supply to the legs is restricted causing pain and cramping that limits walking (intermittent claudication). It is measured by the walking distance (on a treadmill) before onset of pain (claudication distance) or ankle brachial index (ABI), the ratio of the blood pressure in the arms to the blood pressure in the legs. If the blood pressure is lower in the legs compared to the arms (ABI of less than 1.0) this indicates blocked arteries in the legs (or PAD). PAD can progress to pain at rest and critical limb ischaemia (sudden lack of blood flow to a limb caused by a blood clot or fatty deposit blockage) that requires revascularisation (restoring the blood flow by opening up the blocked blood vessel) or amputation. Treatment of hypertension to reduce cardiovascular events (heart attack or stroke) and death needs careful consideration in people with PAD. Anti‐hypertensive medications may worsen the PAD symptoms by further reducing blood flow and supply of oxygen to the limbs, and may have long‐term effects on disease progression. The evidence from randomised controlled trials (RCTs) examining the risks and benefits of various anti‐hypertensive drugs on measures of PAD is lacking.

Drugs used as add‐on therapy to heart procedure following heart attack

Acute myocardial infarction (AMI), or heart attack, is one of the major causes of mortality worldwide. Approximately one‐third of people suffering heart attacks die before they reach the hospital. Primary percutaneous coronary intervention (PPCI) is a procedure whereby the coronary artery is widened without surgery, using a stent. Although this procedure restores blood flow through the coronary artery, perfusion through all areas of the heart may not occur. This is known as no‐reflow. To try to resolve this problem, healthcare workers have tried drugs such as adenosine and verapamil as add‐on treatment. We include 11 studies in this review with a total of 1027 participants. Ten studies compared adenosine or placebo as an addition to PPCI, and one compared verapamil or placebo.

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