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5Patients with atrial flutter or atrial fibrillation and an accessory bypass tracte.gWolff-Parkinson-WhiteLown-Ganong-Levine syndromessee WARNINGS

DigitalisClinical use of verapamil in digitalized patients has shown the combination to be well tolerated if digoxin doses are properly adjustedChronic verapamil treatment can increase serum digoxin levels by 50 to 75during the first week of therapyand this can result in digitalis toxicityIn patients with hepatic cirrhosis the influence of verapamil on digoxin kinetics is magnifiedVerapamil may reduce total body clearance and extrarenal clearance of digitoxin by 27and 29respectivelyMaintenance and digitalization doses should be reduced when verapamil is administeredand the patient should be carefully monitored to avoid over or underdigitalizationWhenever overdigitalization is suspectedthe daily dose of digitalis should be reduced or temporarily discontinuedUpon discontinuation of ISOPTINverapamil HCIthe patient should be reassessed to avoid underdigitalization.

It is not known whether the use of verapamil during labor or delivery has immediate or delayed adverse effects on the fetusor whether it prolongs the duration of labor or increases the need for forceps delivery or other obstetric interventionSuch adverse experiences have not been reported in the literaturedespite a long history of use of verapamil in Europe in the treatment of cardiac side effects of beta-adrenergic agonist agents used to treat premature labor.

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isoptin does not alter total serum calcium levels.

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