Verapamil Tablet: Uses, Dosage & Side Effects in Pakistan

Verapamil Tablet Uses, Dosage, Side Effects & Price in Pakistan

1. Quick Info (Mukhtasir Maloomat)

2. What is Verapamil Tablet?

Verapamil (Cordilox / Isoptin) is a non-dihydropyridine calcium channel blocker (CCB) — it acts on both the heart and blood vessels. It blocks L-type voltage-gated calcium channels, slowing heart rate (SA node effect), slowing AV node conduction (anti-arrhythmic), and slightly reducing the pumping force of the heart. It is fundamentally different from amlodipine/nifedipine (dihydropyridines) — those are selectively vascular; verapamil is primarily cardiac. It is an Rx medicine — do not take without a doctor. NEVER take with a beta-blocker — this combination can be fatal.

3. Uses

• Angina pectoris
• Supraventricular Tachycardia (SVT) — rate control
• Atrial Fibrillation / Atrial Flutter — rate control
• Hypertension (high blood pressure)
• Migraine prophylaxis
• Cluster headache prophylaxis

4. Who Should Take

• Angina patients who also need rate control (dual benefit)
• AF/SVT patients who need ventricular rate control
• Hypertension patients where a CCB is appropriate
• Migraine patients for whom beta-blockers are contraindicated

5. When NOT to Take

• With beta-blockers — CONTRAINDICATED (severe heart block / asystole risk)
• Heart failure patients — negative inotropy worsens LV function
• Wolff-Parkinson-White syndrome with AF — CONTRAINDICATED (potentially fatal)
• Severe bradycardia, sick sinus syndrome (without pacemaker)
• 2nd/3rd degree AV block

6. Dosage

• As prescribed — depends on the strength and indication

• As prescribed by doctor; SR tablets with food

• Do not exceed the recommended limit; dose reduction in liver disease

• If you miss a dose, take it as soon as you remember. If the next dose is close, skip the missed dose. Never take a double dose.

7. How to Take

• Take SR (slow-release) tablets with food — absorption remains consistent

• Crushing releases the full dose at once — risk of hypotension or bradycardia

• Monitor BP and heart rate regularly — especially at the start

• Food is necessary with SR formulations

8. Best Time

• Take at the same time every day for consistency

• Always take SR tablets with a meal

9. Empty Stomach or After Food

• Take SR tablets with food. For regular tablets — follow your doctor's instruction. Never crush SR tablets.

10. Warnings

• NEVER take with beta-blockers — both suppress the AV node; the combined effect can cause fatal bradycardia or asystole
• CONTRAINDICATED for AF in Wolff-Parkinson-White (WPW) syndrome — accessory pathway conduction increases — life-threatening ventricular rate

• Negative inotropy worsens heart failure — do not use in HF patients

• Very common side effect — take more fibre, drink more water, stay physically active; ask pharmacist for a stool softener if needed

11. Precautions

• Store in a cool, dry place
• Keep away from direct sunlight
• Keep out of the reach of children

• Verapamil is heavily metabolised by the liver (CYP3A4) — dose reduction is necessary in liver disease

• With simvastatin / lovastatin, CYP3A4 inhibition dramatically increases statin levels; rhabdomyolysis risk; always inform your doctor

12. Side Effects

• Constipation, Bradycardia, Dizziness, Headache, Flushing, Peripheral oedema, Gingival hyperplasia

• Severe bradycardia / heart block
• Severe hypotension
• Heart failure exacerbation
• Severe constipation / bowel obstruction (rare)

13. Drug Interactions

• Beta-blockers — CONTRAINDICATED; severe bradycardia, heart block, asystole
• Digoxin — Verapamil increases digoxin levels; reduce digoxin dose; monitor for toxicity
• Simvastatin / lovastatin — CYP3A4 inhibition causes massive statin level increase; rhabdomyolysis risk (muscle pain, dark urine)
• Carbamazepine, ciclosporin, theophylline — Verapamil increases their levels; monitor for toxicity
• Rifampicin — dramatically decreases Verapamil levels; efficacy is reduced
• Colchicine — P-gp inhibition increases risk of colchicine toxicity

Always inform your doctor about Verapamil before starting any new medicine.

14. When to See Doctor

• Very slow heartbeat / fainting (severe bradycardia / heart block)
• Chest pain
• Worsening breathlessness or ankle swelling (heart failure sign)
• Severe constipation (bowel obstruction risk)
• Muscle pain or dark urine (rhabdomyolysis — especially statin users)

15. Alternatives

16. Price in Pakistan

Price varies by pharmacy and strength. Search: "verapamil cordilox isoptin tablet price pakistan dawaai"

17. FAQs

Q: What is Verapamil used for?

A: Doctors prescribe Verapamil for angina, atrial fibrillation and SVT (irregular heartbeat), and hypertension (high BP). It is also used for migraine and cluster headache prevention.

Q: What are the side effects of Verapamil?

A: The most common side effect is constipation — take more fibre and water. Dizziness, bradycardia, and headache may also occur. Do not take with a beta-blocker at all — severe heart block can occur.

Q: Why should Verapamil not be taken with a beta-blocker?

A: Both drugs slow AV node conduction — the combined effect can cause severe bradycardia, heart block, or asystole. This combination is potentially fatal. Taking them together is CONTRAINDICATED.

Q: What is the price of Verapamil in Pakistan?

A: Price varies by pharmacy and strength (40mg/80mg/120mg/240mg SR). Check the updated price at Dawaai.pk or a local registered pharmacy.

Q: Why does Verapamil cause constipation?

A: Verapamil also blocks calcium channels in the smooth muscle of the GI tract, slowing bowel motility. This occurs more than with dihydropyridine CCBs (amlodipine). Take more fibre and water.

18. Medical Review

Compiled by the PakVita Editorial Team · AI-assisted drafting with editorial review · Sourced from DRAP, WHO, BNF · Last updated: 2026-06-17

19. Disclaimer

The information on this page is for awareness only. It is not medical advice. Always consult your doctor or pharmacist before taking any medicine. PakVita is not responsible for any harm.