Introduction
Mil is used to treat angina (heart-related chest pain), high blood pressure and some types of irregular heartbeats (arrhythmia). It works by relaxing blood vessels to lower blood pressure. This helps to reduce the workload of the heart.
Mil may be taken with or without food, but it is better to take it regularly at a fixed time each day as advised by your doctor. Keep using this medicine even if you feel well. If you stop taking it suddenly, your condition may worsen. This medicine is only part of a treatment program that should include a healthy diet, regular exercise, and weight reduction as advised by your doctor.
Common side effects seen with this medicine include swelling of the ankles or feet (oedema), dizziness, headache, nausea, constipation, flushing, rash, and fatigue. These are usually mild and disappear after a short time. Consult your doctor if they bother you or do not go away. It may also make you feel sleepy or dizzy, so be careful if you drive or do anything that requires you to be alert. Drinking alcohol should be avoided while taking this medicine as it may worsen the side effects.
Before taking this medicine, let your doctor know if you have any liver or kidney problems. Also, inform your doctor if you have very low blood pressure (hypotension), heart failure, or if you recently had a heart attack and have fluid in your lungs. Your doctor may want to monitor your blood pressure while using it and you may need frequent blood tests. Pregnant or breast-feeding women should consult their doctor before taking it.
Uses of Mil
- Hypertension (high blood pressure)
- Angina (heart-related chest pain)
- Arrhythmia
Side effects of Mil
Common
- Headache
- Constipation
- Infection
- Dizziness
- Sinus infection
- Flu-like symptoms
- Peripheral edema
How to use Mil
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Mil is to be taken with food.
How Mil works
Mil is a calcium channel blocker. It blocks the action of calcium on the heart and blood vessels, thereby widening the blood vessels and allowing more blood and oxygen to reach the heart. This reduces blood pressure and decreases the chances of angina (chest pain).
Indication
Essential hypertension, Angina pectoris, and prevention of re-infarction, Supraventricular arrhythmias, Paroxysmal supraventricular tachycardias, Atrial fibrillation, with rapid ventricular response (except WPWS), Atrial flutter with rapid conduction, Extrasystoles, Acute hypertension, Acute coronary insufficiency, For the prophylaxis and / or therapy of ectopic arrhythmias (predominantly ventricular extrasystoles) in halothane anaesthesia and in the application of adrenaline in halothane anaesthesia respectively.
Administration
Should be taken with food.
Adult Dose
Oral
Hypertension
Adult:
Immediate release
80 mg PO q8hr initially; maintenance: 80-320 mg PO q12hr
Extended release
180 mg/day PO (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day PO, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day
Angina
Immediate release
80 mg PO q8hr initially; usual range: 80-120 mg PO q8hr; not to exceed 480 mg/day
Extended release
180 mg/day PO at bedtime initially; maintenance: 180-480 mg/day PO at bedtime
Chronic Atrial Fibrillation & Paroxysmal Supraventricular Tachycardia
Treatment of chronic atrial fibrillation (rate control); prevention of paroxysmal supraventricular tachycardia
Immediate release: 240-480 mg/day PO divided q6-8hr
Tardive Dyskinesia
40 mg PO q8hr; may be titrated to 120 mg q8hr
Intravenous
2.5-5 mg IV over 2 minutes; 5-10 mg dose may be repeated after 15-30 minutes
Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose
Hepatic impairment: In cirrhosis, reduce dose by 20-50% of normal for oral and IV administration
Child Dose
Supraventricular Tachycardia
1-15 years old: 0.1-0.3 mg/kg (not to exceed 5 mg) IV over 2 minutes; second dose (not to exceed 10 mg) may be given after 30 minutes
Alternatively (not well established), 4-8 mg/kg/day PO divided q8hr
Renal Dose
Renal impairment: Use with caution; monitor ECG; for Verelan PM, manufacturer recommends 100 mg at bedtime initially; if CrCl <10 mL/min, reduce dose by 25-50%
Contraindication
Cardiogenic shock, hypotension (systolic pressure <90 mmHg), marked bradycardia, uncompensated heart failure, 2nd- or 3rd-degree AV block (unless pacemaker is fitted), sick-sinus syndrome, severe ventricular dysfunction, atrial flutter or atrial fibrillation and accessory bypass tract (e.g. Wolff-Parkinson-White, Lown-Ganong-Levine syndromes).
Mode of Action
Verapamil inhibits entry of calcium ions into arterial smooth muscle cells as well as the myocytes and conducting tissue. These actions lead to reversal and preventions of coronary artery spasm, reduction in afterload through peripheral vasodilatation and reduction in ventricular rate in patients with chronic atrial flutter or fibrillation and reduction in the occurrence of paroxysmal supraventricular tachycardia. Verapamil reduces BP, relieves angina and slows AV conduction.
Precaution
Patient w/ bradycardia or 1st-degree AV block, attenuated neuromuscular transmission, hypertrophic cardiomyopathy. Avoid abrupt withdrawal. Renal and hepatic impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor BP, heart rate, ECG, LFTs (periodically).
Lactation: Distributed in milk; nursing infant doses range from <0.01% to 0.1% of mother’s dose; manufacturer suggests refraining from nursing (though American Academy of Pediatrics committee states that drug is compatible with nursing)
Side Effect
>10%
Headache,Gingival hyperplasia
1-10%
Constipation (9%),Dizziness (4%),Hypotension (4%),Dyspepsia (3%),Nausea (3%),Edema (2%),Rash (2%),Increased liver enzymes (1%),Sleep disturbance (1%),Dyspnea
Interaction
Increased cardiac depressant effects with beta-blockers and flecainide. Increased risk of additive bradycardia, conduction disturbances and digoxin toxicity with digoxin. Increased risk of bradycardia and hypotension with remifentanil and sufentanil. Increased levels of both everolimus and verapamil on concurrent use. May increase doxorubicin, buspirone, carbamazepine, ciclosporin, epirubicin, eplerenone, quinidine, statins, sirolimus, tacrolimus, quinupristin/dalfopristin levels. Verapamil increase blood alcohol levels. Unpredictable interactions with lithium. Decreased verapamil concentrations with phenobarbital, sulfinpyrazone, rifampicin, rifabutin and rifapentine. Increased verapamil concentrations with protease inhibitors and cimetidine.
Potentially Fatal: Increased cardiac depressant effects with amiodarone. Increased risk of QT prolongation with dofetilide, ranolazine, sertindole. Additive bradycardia with ivabradine. Increased risk of heart block with clonidine. Increased risk of acute hyperkalaemia and CV collapse with dantrolene.