Long COVID Patterns in the RECOVER-Adult Study
November 21, 2025
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Brand Name :
Isoptin SR, Verap, Isoptin, Calan
Synonyms :
Verapamil
Class :
Calcium Channel Blockers, Antidysrhythmics Group-IV; Non-dihydropyridines
Dosage Forms & Strengths Â
Tablet Â
120mg Â
80mg Â
40mg Â
Tablet or capsule, extended-release Â
100mg Â
120mg Â
180mg Â
200mg Â
240mg Â
300mg Â
360mg Â
Injectable solution Â
2.5mg/mLÂ Â
Indicated for Angina
Immediate release-80 mg orally three times a day initially, usual dose range 80-120 mg orally three times a day. It should not exceed 480 mg daily.
Extended-release(Covera-HS)- 180 mg every day orally at bedtime as an initial dose.
Maintenance dose-180-540 mg every day orally at bedtime.
Paroxysmal Supraventricular Tachycardia and Chronic Atrial Fibrillation
Immediate release-240-480 mg every day orally in divided doses three-four times a day.
Atrial Fibrillation or Flutter and Supraventricular Arrhythmia
2.5-5 mg intravenously over 2 min; after 15-30 min, 5-10 mg dose may be repeated.
Or
0.075-0.15mg/kg (should not exceed 10 mg) intravenously over 2 min; after 30 min, the dose may be repeated.
Tardive Dyskinesia
40 mg orally three times a day may enhance the dose up to 120 mg three times a day.
Migraine as off-label
As prophylaxis 160-320 mg orally three-four times a day.
Hypertension
Immediate release
Initial dose:80 mg orally three times a day.
Maintenance dose: 80-320 mg orally two times a day.
Extended-release
Isoptin SR, Calan-180 mg every day orally in the morning (if the patient is elderly,120 mg every day); for desired therapeutic response, the dose may enhance to 240 mg every day and then 360 mg every day (i.e., 180 mg two times a day or 240 mg at morning time and 120 mg at evening time)
Verelan-180 mg every day orally in the morning (if the patient is elderly,120 mg every day); for desired therapeutic response, the dose may enhance to 240 mg every day and then 120 mg every day at weekly intervals, should not exceed 480 mg every day.
Covera-HS-180 mg every day orally at bedtime (if the patient is elderly,120 mg every day); for desired therapeutic response, the dose may enhance to 240 mg every day and then 120 mg every day at weekly intervals, should not exceed 480 mg every day.
Verelan PM-200 mg every day orally at bedtime (if the patient is elderly,100 mg every day); the dose may be enhanced by 100 mg every day at weekly intervals, and should not exceed 400 mg every day.
Dosage Forms & Strengths Â
Tablet Â
120mg Â
80mg Â
40mg Â
Tablet or capsule, extended-release Â
100mg Â
120mg Â
200mg Â
240mg Â
300mg Â
360mg Â
Injectable solution Â
2.5mg/mLÂ Â
Supraventricular Tachycardia (SVT)Â
Age 1-15 years
0.1-0.3 mg/kg (should not exceed 5 mg) intravenously over 2 min; after that second dose may be given after 30 min (should not exceed 10 mg).
Or
4-8 mg/kg every day orally in divided doses three times a day.
Dosage Forms & Strengths Â
Tablet Â
120mg Â
80mg Â
40mg Â
Tablet or capsule, extended-release Â
100mg Â
120mg Â
180mg Â
200mg Â
240mg Â
300mg Â
360mg Â
Indicated for Angina
Immediate release-80 mg orally three times a day initially, usual dose range 80-120 mg orally three times a day. It should not exceed 480 mg daily.
Extended-release (Covera-HS)- 180 mg every day orally at bedtime as an initial dose.
Maintenance dose-180-540 mg every day orally at bedtime.
Hypertension
Immediate release
Initial dose:80 mg orally three times a day.
Maintenance dose: 80-320 mg orally two times a day.
Extended-release
Verelan PM-100 mg every day orally at bed time.
Covera-HS-180 mg every day orally at bed time.
Isoptin SR, Calan SR, Verelan-120 mg every day orally in the morning.
Note:
Generally, low doses are warranted, and based on clinical response dose may be adjusted.
It may enhance serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance hypotensive effect when combined with Blood Pressure Lowering Agents
verapamil may increase the serum concentration when combined with Talazoparib
CYP3A strong enhancers of the small intestine may reduce the bioavailability of verapamil 
verapamil increases the effect of entrectinib by altering the intestinal or hepatic CYP3A4 enzyme metabolism
verapamil increases the effect of encorafenib by altering the intestinal or hepatic CYP3A4 enzyme metabolism
may increase toxicity of each other by unspecified interaction mechanism
may increase the level of effectiveness through P-glycoprotein MDR1 efflux transporter
it reduces the efficacy of metformin
may diminish the metabolism of verapamil
It may enhance the effect when combined with cannabidiol by affecting CYP3A4 metabolism
verapamil: they may diminish the serum concentration of CYP3A4 Inducers
verapamil: they may diminish the serum concentration of CYP3A4 Inducers
verapamil: they may diminish the serum concentration of CYP3A4 Inducers
verapamil: they may diminish the serum concentration of CYP3A4 Inducers
verapamil: they may diminish the serum concentration of CYP3A4 Inducers
It may enhance the serum concentration when combined with CYP3A4 Substrates
It may enhance the serum concentration when combined with CYP3A4 Substrates
It may enhance the serum concentration when combined with CYP3A4 Substrates
It may enhance the serum concentration when combined with CYP3A4 Substrates
when bromazepam and verapamil are used together, there is a potential reduction in the bromazepam's metabolism
the hypotensive effect of pramipexole is increased with verapamil
diatrizoate has the potential to increase the serum level of verapamil by slowing down its excretion rate
when metronidazole and verapamil are combined, their metabolism can be slowed down
verapamil may lower the excretion rate of n-acetyl tyrosine, potentially resulting in elevated serum levels
verapamil may lower the excretion rate of sulbactam, potentially resulting in a higher serum level
verapamil has the potential to modify the metabolism of propoxyphene, resulting in increased levels of propoxyphene in the bloodstream
the chances of bleeding may be heightened when verapamil is combined with carbaspirin calcium
the metabolism of doxofylline can be lowered when combined with verapamil
there is a additive effect when calcium channel blockers are combined with antiglaucoma agents
verapamil: it may enhance serum concentrations of simvastatin
verapamil: it may enhance the serum concentration of HMG-CoA Reductase Inhibitors
verapamil: it may enhance the serum concentration of HMG-CoA Reductase Inhibitors
verapamil: it may enhance the serum concentration of HMG-CoA Reductase Inhibitors
verapamil: it may enhance the serum concentration of HMG-CoA Reductase Inhibitors
verapamil: it may enhance the serum concentration of HMG-CoA Reductase Inhibitors
when both drugs are combined, there may be a reduced metabolism of erlotinib  
increase the therapeutic effect of daunorubicin by P-glycoprotein efflux transporter
the effect of verapamil is decreased by lorlatinib, by altering intestinal or hepatic CYP3A4 enzyme metabolism
may increase serum levels of docetaxel
fedratinib increases the effect of verapamil by altering the intestinal/ hepatic CYP3A4 enzyme metabolism
it increases the effect or level of palbociclib by altering the intestinal or hepatic CYP3A4 enzyme metabolism
increase the therapeutic effect of idarubicin by P-glycoprotein efflux transporter
may increase the level by affecting the hepatic enzyme CYP3A4 metabolism
the rate of metabolism of dihydrocodeine may be reduced
the rate of excretion of verapamil may be reduced
reduction in bloop pressure is seen with carnosine when used in combination
it increases the effect or level of finasteride by altering the intestinal/hepatic enzyme CYP3A4 metabolism
it increases the effect or level of dutasteride by altering the intestinal/hepatic enzyme CYP3A4 metabolism
Actions and Spectrum
It inhibits calcium influx into cardiac and smooth muscle cells, reducing heart muscle contractility and blood vessel contractility, reducing blood pressure, and increasing coronary blood flow. It is used to treat cardiovascular conditions like hypertension, angina pectoris, and supraventricular tachycardia.Â
Adverse Reaction  Â
Frequency defined Â
>10%Â Â
Gingival hyperplasia Â
Headache Â
1-10%Â Â
Nausea (3%)Â Â
Hypotension (4%)Â Â
Dyspnea Â
Dizziness (4%)Â Â
Sleep disturbance (1%)Â Â
Rash (2%)Â Â
Edema (2%)Â Â
Increased liver enzymes (1%)Â Â
Constipation (9%)Â Â
Dyspepsia (3%)Â Â
Black Box Warning:Â
The black box warning for use with potent CYP3A4 inhibitors and strong CYP3A4 inducers can increase or decrease plasma levels potentially leading to hypotension, bradycardia, or cardiac arrest.Â
Contraindication Â
It is contraindicated for patients with known hypersensitivity, severe hypotension, cardiogenic shock, second/third-degree AV block, sick sinus syndrome, Wolff-Parkinson-White syndrome, left ventricular dysfunction, and concurrent use of ivabradine. It is used to treat heart failure and angina, as it can cause hypotension, reduce cardiac output and blood pressure, worsen left ventricular dysfunction, and increase the risk of bradycardia and atrioventricular block.Â
Caution Â
Verapamil should be used cautiously in patients with impaired hepatic, renal, pregnancy, breastfeeding, elderly patients, concomitant illnesses, bradycardia, atrial fibrillation, and hypotension. Â
Its clearance may be reduced in patients with impaired hepatic function, renal function, pregnancy, and breastfeeding and may be excreted in breast milk. Â
Elderly patients may be more sensitive to the drug effects and dose adjustments may be necessary. Concomitant illnesses, bradycardia, atrial fibrillation, and hypotension should also be considered.Â
Pregnancy consideration:Â Â Â
AU TGA pregnancy category: CÂ Â
US FDA pregnancy category: CÂ Â Â
Lactation:   Â
Excreted into human milk: Yes. Â
Pregnancy category:Â Â
Pharmacology: Â
Verapamil prevents calcium ions from entering heart and blood vessels cells specifically the L-type calcium channels.Â
Pharmacodynamics:Â Â
It acts as a calcium-channel blocker inhibits the extracellular calcium influx across myocardial and vascular smooth muscle cells by causing cardiac and vascular smooth muscle contraction, dilation of arteries, and reduced heart rate and conduction velocity.Â
Pharmacokinetics:Â Â
Absorption Â
The bioavailability ranges from 20-35% with onset of action 1-2 hours orally and 1-5 minutes intravenously. Â
Action durations range from 10-20 minutes orally and 6-8 hours. Peak plasma time varies for extended-release formulations.Â
Distribution Â
The highly protein-bound is 94%, volume of distribution shows 3.8 L/kg. Â
Metabolism Â
This is metabolized by the hepatic P450 enzyme CYP3A4.Â
Elimination and Excretion Â
Half-life ranges from 4.4-6.9 hours, half-life is prolonged in patients with severe hepatic impairment ranging from 14-16 hours.  Â
The clearance is 0.5-1 L/hr/kg. Â
The primarily eliminates through urine (70%) with a smaller amount eliminated in feces (9-16%). Â
Administration:Â Â Â
Verapamil is available in various formulations like immediate-release tablets, extended-release tablets, and injectable solutions. The dosage depends on the condition and treatment response. The injection administered as a slow intravenous infusion over 2-3 minutes. Patient should not abruptly stop taking verapamil without consulting the doctor. If a dose is missed take it immediately or skip the next scheduled dose and avoid taking a double dose.Â
Patient information leaflet Â
Generic Name: verapamil  Â
Pronounced: [ ver-AP-a-mil ] Â
Why do we use verapamil? Â
Verapamil is a calcium channel blocker that treats cardiovascular conditions like hypertension and chronic stable angina. It blocks calcium influx into heart and blood vessels by reducing heart rate and blood pressure. It can be used alone or in combination with other drugs.Â
In certain cardiac arrhythmias like supraventricular tachycardia and atrial fibrillation it reduces heart rate and improving symptoms.Â
It helps to prevent migraines in patients by reducing the frequency and severity of attacks although its mechanism of action is not fully understood.Â
 Verapamil can treat Raynaud’s phenomenon by improving blood flow and reducing attacks.Â
It treats hypertrophic cardiomyopathy by improving symptoms like shortness of breath and chest pain.Â
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