Verapamil Indications and Usage

Cardiovascular Indications

The European Society of Cardiology recommends verapamil as a first-line treatment for stable, narrow-complex tachycardias if rhythm remains uncontrolled or unconverted by adenosine or vagal maneuvers, with a dose of 2.5 to 5 mg IV over 2 minutes 2
The American Heart Association suggests verapamil for ventricular rate control in patients with atrial fibrillation or atrial flutter, with a recommended dose of 5 to 10 mg every 15 to 30 minutes to total dose of 20 to 30 mg 2, 1

The American College of Cardiology advises that verapamil is contraindicated in patients who have taken beta-blockers due to risk of profound bradycardia and hypotension, as well as in patients with significant left ventricular dysfunction, increased risk for cardiogenic shock, and second or third-degree atrioventricular block without a cardiac pacemaker 3, 4
The British Cardiovascular Society recommends using verapamil with caution in patients with severe disabling symptoms and markedly elevated pulmonary arterial pressure in combination with marked outflow obstruction, as well as in patients with obstructive hypertrophic cardiomyopathy in the setting of systemic hypotension or severe dyspnea at rest 5, 6

The American College of Cardiology notes that common side effects of verapamil include constipation, hypotension, bradycardia, and leg edema 3