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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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Applies to verapamiloral capsule extended releaseoral capsule extended release 24 hroral tabletoral tablet extended releaseoral tablet extended release 24 hr.

In healthy manorally administered ISOPTIN undergoes extensive metabolism in the liverTwelve metabolites have been identified in plasmaall except norverapamil are present in trace amounts onlyNorverapamil can reach steadystate plasma concentrations approximately equal to those of verapamil itselfThe cardiovascular activity of norverapamil appears to be approximately 20that of verapamilApproximately 70of an administered dose is excreted as metabolites in the urine and 16or more in the feces within 5 daysAbout 3to 4is excreted in the urine as unchanged drugApproximately 90is bound to plasma proteinsIn patients with hepatic insufficiencymetabolism of immediate release verapamil is delayed and elimination half-life prolonged up to 14 to 16 hourssee PRECAUTIONSthe volume of distribution is increased and plasma clearance reduced to about 30of normalVerapamil clearance values suggest that patients with liver dysfunction may attain therapeutic verapamil plasma concentrations with one third of the oral daily dose required for patients with normal liver function.

Lab and/or medical testssuch as liver functionshould be done while you are taking this medicationKeep all medical and lab appointmentsConsult your doctor for more details.

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