Verapamil, sold under various trade names,[1] is a calcium channel blocker medication used for the treatment of high blood pressure, angina (chest pain from not enough blood flow to the heart), and supraventricular tachycardia.[7] It may also be used for the prevention of migraines and cluster headaches.[8][9] It is given by mouth or by injection into a vein.[7]
Common side effects include headache, low blood pressure, nausea, and constipation.[7] Other side effects include allergic reactions and muscle pains.[10] It is not recommended in people with a slow heart rate or heart failure.[10] It is believed to cause problems for the fetus if used during pregnancy.[2] It is in the non–dihydropyridine calcium channel blocker family of medications.[7]
Verapamil was approved for medical use in the United States in 1981.[7][11] It is on the World Health Organization's List of Essential Medicines.[12][13] Verapamil is available as a generic medication.[7] Long acting formulations exist.[10] In 2020, it was the 151st most commonly prescribed medication in the United States, with more than 3 million prescriptions.[14][15]
Verapamil is used for controlling ventricular rate in supraventricular tachycardia and migraine headache prevention.[16] It is a class-IV antiarrhythmic and more effective than digoxin in controlling ventricular rate.[17] Verapamil is not listed as a first line agent by the guidelines provided by JAMA in JNC-8.[18] However, it may be used to treat hypertension if patient has co-morbid atrial fibrillation or other types of arrhythmia.[19][20]
Verapamil is also used intra-arterially to treat cerebral vasospasm.[21] Verapamil is used to treat the condition cluster headache.[22] Tentative evidence supports the use of verapamil topically to treat plantar fibromatosis.[23]
Use of verapamil is generally avoided in people with severe left ventricular dysfunction, hypotension (systolic blood pressure less than 90 mm Hg), cardiogenic shock, and hypersensitivity to verapamil.[4] It is also contraindicated in people with atrial flutter or fibrillation and an existing accessory tract such as in Wolff-Parkinson-White syndrome.[24][4]