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Verapamil hydrochloride parenteral


Solution for injection containing verapamil hydrochloride

Drugs List

  • SECURON IV 5mg/2ml injection
  • verapamil 5mg/2ml injection
  • Therapeutic Indications


    Atrial flutter/fibrillation: Reduction of ventricular rate
    Supra-ventricular tachycardia



    5mg to 10mg should be administered over 2 minutes via slow intravenous injection.
    If necessary e.g. in paroxysmal tachycardia, a further 5mg may be given after 5 to 10 minutes.


    (See Dosage; Adult)
    Administer dose over 3 minutes to reduce the risk of adverse effects.


    Children aged 15 to 18 years
    (See Dosage; Adult)

    Children aged 1 to 15 years
    100micrograms/kg to 300micrograms/kg (usual single dose range 2mg to 5mg) over 2 to 3 minutes via slow intravenous injection with ECG monitoring.

    Children aged up to 1 year
    100micrograms/kg to 200micrograms/kg (usual single dose range 0.75mg to 2mg) over 2 to 3 minutes via slow intravenous injection with ECG monitoring.

    The doses may be repeated 30 minutes after the initial dose where necessary. Many cases are well controlled using doses at the lower end of the range and the injection can be stopped once the desired effect is achieved.


    For slow intravenous injection only.


    Systolic blood pressure < 90mmHg
    Bradycardia - if treating myocardial infarction
    Bradycardia with pulse rate at rest < 50 beats per minute
    Cardiogenic shock
    Decompensated cardiac failure
    History of cardiac failure
    Hypotension - if treating myocardial infarction
    Left ventricular dysfunction - if treating myocardial infarction
    Lown-Ganong-Levine syndrome
    Non paced second/third degree AV block
    Non-paced sinus node dysfunction
    Severe left ventricular failure
    Sinoatrial exit block
    Wolff-Parkinson-White syndrome

    Precautions and Warnings

    Cardiac failure
    Duchenne muscular dystrophy
    First degree atrioventricular block
    Myasthenia gravis
    Myasthenic Eaton-Lambert syndrome
    Severe hepatic impairment
    Severe renal impairment

    Control cardiac failure before starting treatment
    Not removed via dialysis
    Children under 18: Treatment to be initiated/supervised by a specialist
    Monitor blood pressure and ECG continuously throughout treatment
    Monitor patients for signs and symptoms of cardiac failure
    May precipitate or aggravate cardiac failure even in controlled cases
    Pregnancy: This medication may inhibit labour
    Advise patient not to take aspirin unless advised by clinician
    Advise patient not to take simvastatin unless advised by clinician
    Advise patient not to take St John's wort concurrently
    Advise patient grapefruit products may increase plasma level

    Verapamil injection should not be given to patients recently treated with beta blockers because of the risk of hypotension and asystole. The suggestion that when verapamil injection has been given first, an interval of 30 minutes before giving a beta-blocker is sufficient has not been confirmed.

    Duration of action may be prolonged in patients with significant renal or hepatic impairment.

    Pregnancy and Lactation


    Use verapamil hydrochloride with caution during pregnancy.

    Verapamil should not be given during the first trimester of pregnancy unless it is considered essential. Verapamil crosses the placenta and can be detected in umbilical vein blood at delivery. Verapamil may inhibit labour and reduce uterine blood flow with foetal hypoxia. In some cases it has been associated with maternal hyperprolactinaemia and galactorrhoea.

    Briggs (2015) suggests that the use of verapamil hydrochloride appears to be low risk during any stage of pregnancy.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use verapamil hydrochloride with caution during breastfeeding.

    Verapamil is excreted in breast milk in small amounts and is unlikely to be harmful. Schaefer (2015) notes that verapamil hydrochloride is one of the calcium antagonists of choice during breastfeeding. Briggs (2015) also concludes that verapamil hydrochloride is probably compatible with breastfeeding.

    LactMed comments that low levels of verapamil are found in breast milk but verapamil would not be expected to cause any adverse effects in nursing infants, especially if the infant is older than 2 months.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Abdominal pain
    Allergic reaction
    Ankle oedema
    Cardiac conduction disturbances
    Cardiac failure
    Extrapyramidal effects
    Gingival hyperplasia
    Hepatic impairment
    Hypersensitivity reactions
    Increased prolactin
    Increases in hepatic enzymes (reversible)
    Myocardial depression
    Second and third degree AV block
    Stevens-Johnson syndrome
    Worsening heart failure


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2017

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    Summary of Product Characteristics: Securon I.V. Mylan Products Limited. Revised November 2016.

    NICE Evidence Services Available at: Last accessed: 24 August 2017

    The Norwegian Porphyria Centre (NAPOS).
    Available at:
    Last revised: 16 April 2010
    Last accessed: 16 January 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Verapamil. Last revised: 10 March 2015
    Last accessed: 16 January 2016

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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