Parenteral Manual

Verapamil HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Antiarrhthmic; Calcium Channel Blocker
Original Date: 
August 2005
Revised Date: 
September 2011
  • Paroxysmal supraventricular tachycardia    
  • Atrial fibrillation or flutter of recent onset, with rapid ventricular response
  • Hypertension
Reconstitution and Stability: 
  • Available as a 2.5 mg/mL solution
  • Stable at room temperature
  • Protect from light
  • Diluted solutions stable 48 hours at room temperature at 40 mg/L in D5W and NS

- Solutions Compatible: D5W, NS, ringer's solution, ringer's lactate

- Additive/Above Cassette Compatible: heparin, morphine, KCl (up to 80 mmol/L)

- Y-site Compatible: ciprofloxacin, milrinone

- Incompatible: albumin, aminophylline, amphotericin, co-trimoxazole, propofol, sodium bicarbonate, possible precipitaton in solutions having pH >6


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

IV Direct YES, cardiac monitoring, blood pressure monitoring
Usual dilution: 0.5-2.5 mg/mL
Infusion time: 2-3 minutes
Infusion rate: do not exceed 2.5 mg/minute
IV Intermittent Infusion NO
IV Continuous Infusion YES, cardiac monitoring, blood pressure monitoring
Usual dilution: 0.5-2.5 mg/mL




(For neonatal dosages, refer to Neonatal IV Drug Manual.)

- <1 year: Not Recommended, Continuous ECG Monitoring 

  • 0.1-0.2 mg/kg IV; may repeat in 30 minutes if inadequate response

- 1-16 years:

  • 0.1-0.3 mg/kg/dose IV; may repeat in 30 minutes if inadequate response
  • Maximum:  5-10 mg/dose      


  • 2.5-10 mg or 0.0375-0.15 mg/kg IV Push
  • If no response, may repeat in 15-30 minutes after the first dose
  • Maximum total dose: 20 mg IV

- Continuous IV Infusion:

  • Loading dose: 2.5-10 mg IV
  • Maintenance: 5-10 mg/hour IV (up to 24 mg/hour has been used)


  • CrCl <10 mL/minute: Administer 50-75% of normal dose
Potential hazards of parenteral administration: 
  • AV block and severe hypotension
  • Ventricular fibrillation, bradycardia, transient asystole               
  • Worsening of heart failure
  • Headache, dizziness, nausea, constipation, bronchospasm, dyspnea
  • Continuous ECG, HR and BP monitoring is required due to possibility of AV block, severe hypotension and bradycardia
  • Contraindicated in severe congestive heart failure, advanced heart block, cardiogenic shock, sinus bradycardia   
  • IV use in neonates and young infants is not recommended due to severe apnea, bradycardia and hypotension
  • Calcium chloride or calcium gluconate may be used to control verapamil induced hypotension
  • Increased cardiovascular adverse effects with concomitant uses of beta-blockers
  • Phenobarbital and rifampin decrease serum verapamil concentrations
  • Onset: 1-5 minutes
  • Duration: 10-20 minutes

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