Generic Name: Generic calan
What is Generic Calan?
Hemodynamics and myocardial metabolism CALAN reduces afterload and myocardial contractility. Pulmonary function CALAN does not induce bronchoconstriction and, hence, does not impair ventilatory function. Verapamil HCl tablets are contraindicated in: Severe left ventricular dysfunction see WARNINGS Hypotension systolic pressure less than 90 mm Hg or cardiogenic shock Sick sinus syndrome except in patients with a functioning artificial ventricular pacemaker Second- or third-degree AV block except in patients with a functioning artificial ventricular pacemaker Patients with atrial flutter or atrial fibrillation and an accessory bypass tract eg, Wolff-Parkinson-White, Lown-Ganong-Levine syndromes see WARNINGS Patients with known hypersensitivity to verapamil hydrochloride Close Heart failure Verapamil has a negative inotropic effect, which in most patients is compensated by its afterload reduction decreased systemic vascular resistance properties without a net impairment of ventricular performance.
Elevated liver enzymes Elevations of transaminases with and without concomitant elevations in alkaline phosphatase and bilirubin have been reported. Atrioventricular block The effect of verapamil on AV conduction and the SA node may cause asymptomatic first-degree AV block and transient bradycardia, sometimes accompanied by nodal escape rhythms.
General Use in patients with impaired hepatic function Since verapamil is highly metabolized by the liver, it should be administered cautiously to patients with impaired hepatic function. Use in patients with attenuated decreased neuromuscular transmission It has been reported that verapamil decreases neuromuscular transmission in patients with Duchenne's muscular dystrophy, prolongs recovery from the neuromuscular blocking agent vecuronium, and causes a worsening of myasthenia gravis.
Grapefruit juice Grapefruit juice may increase plasma levels of verapamil. Beta-blockers Controlled studies in small numbers of patients suggest that the concomitant use of CALAN and oral beta-adrenergic blocking agents may be beneficial in certain patients with chronic stable angina or hypertension, but available information is not sufficient to predict with confidence the effects of concurrent treatment in patients with left ventricular dysfunction or cardiac conduction abnormalities.
Antihypertensive agents Verapamil administered concomitantly with oral antihypertensive agents e.
Patients who are controlled on antihypertensive agents should be monitored for changes in blood pressure while taking sibutramine. Sildenafil: Verapamil is an inhibitor of CYP3A4 isoenzymes.
Co-administration with verapamil may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as sildenafil. Increased systemic exposure to sildenafil may result in an increase in sildenafil-induced adverse effects.
In theory, antihypertensive drugs that inhibit CYP3A4 such as diltiazem, verapamil, and nicardipine may cause significant increases in silodosin plasma concentrations. Verapamil may also interact with silodosin through its effects as a P-gp inhibitor. Simeprevir: Coadministration of orally administered verapamil with simeprevir, an inhibitor of P-glycoprotein P-gp and intestinal CYP3A4, may result in increased verapamil plasma concentrations.
Sirolimus or verapamil dose adjustments may be necessary. Verapamil is a substrate and inhibitor of CYP3A4 and P-gp. Sirolimus is a substrate for both CYP3A4 and P-gp.
How should I take Generic Calan?
Labetalol: Oral calcium-channel blockers and beta-blockers like labetalol are used together for their therapeutic benefits to reduce angina and improve exercise tolerance. Levomethadyl: Agents that inhibit hepatic cytochrome P450 3A4, such as verapamil, may decrease the metabolism of levomethadyl, increase levomethadyl levels, and may precipitate severe arrhythmias including torsade de pointes. Levomilnacipran: Levomilnacipran has been associated with an increase in blood pressure.
The effectiveness of verapamil may be diminished during concurrent use of levomilnacipran. It is advisable to monitor blood pressure if the combination is necessary. Lidocaine: Concomitant use of systemic lidocaine and verapamil may increase lidocaine plasma concentrations by decreasing lidocaine clearance and therefore prolonging the elimination half-life.
Lisdexamfetamine: Amphetamines increase both systolic and diastolic blood pressure and may counteract the activity of some antihypertensive agents.
What should I avoid while taking Generic Calan?
Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported in association with the use of clonidine concurrently with verapamil. Monitor heart rate in patients receiving concomitant verapamil and clonidine. In clinical experience with 4,954 patients, 87 1. The incidence of hypotension observed in 4,954 patients enrolled in clinical trials was 2.
In hypertensive patients, decreases in blood pressure below normal are unusual. Periodic monitoring of liver function in patients receiving verapamil is therefore prudent. Treatment is usually DC-cardioversion.
Generic Calan side effects
This interaction can be therapeutically advantageous, but dosages must be adjusted accordingly. The manufacturer advises that IV diazoxide should not be administered to patients within 6 hours of receiving other antihypertensive agents. Diclofenac: If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
Serum estrogen concentrations and estrogenic-related side effects e. Diethylpropion: Diethylpropion has vasopressor effects and may limit the benefit of calcium-channel blockers. Although leading drug interaction texts differ in the potential for an interaction between diethylpropion and this group of antihypertensive agents, these effects are likely to be clinically significant and have been described in hypertensive patients on these medications.
Diflunisal: If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control. Verapamil inhibits P-gp, an energy-dependent cellular drug efflux pump.
Common Generic Calan ide effects may include:
Verapamil is a moderate CYP3A4 inhibitor and P-glycoprotein P-gp inhibitor.
Increased serum concentrations of vorapaxar are possible when vorapaxar, a CYP3A4 substrate, is coadministered with verapamil, a CYP3A inhibitor.
Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine.
Simeprevir: Coadministration of orally administered verapamil with simeprevir, an inhibitor of P-glycoprotein P-gp and intestinal CYP3A4, may result in increased verapamil plasma concentrations.
The greatest increase in exposure of dabigatran occurs when verapamil is present in the gut when dabigatran is taken. In a pharmacokinetic study, immediate-release verapamil given 1 hour prior to dabigatran administration produced the greatest increase in exposure.
If verapamil is administered 2 hours after dabigatran administration, the increase in AUC is negligible. Data from the RE-LY trial indicate no significant changes in dabigatran trough concentrations were seen in patients who received concomitant therapy with verapamil.
Where can I get more information?
Tolterodine: In a small portion of patients who poorly metabolize tolterodine via CYP2D6, the CYP3A4 pathway becomes important in tolterodine elimination.
Since verapamil is highly metabolized by the liver, it should be administered cautiously to patients with impaired hepatic function.