Alternate Name(s):
ISOPTIN® IV
Classification:
Antiarrhthmic; Calcium Channel Blocker
Original Date:
August 2005
Revised Date:
September 2011
Indications:
- 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
Compatibility:
- 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
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| 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 |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- <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
Adult:
- 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)
DOSING ADJUSTMENT IN RENAL IMPAIRMENT:
- 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
Notes:
- 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
References: