From the Guidelines
Verapamil is known to cause gastrointestinal side effects, with constipation being the most common stomach-related issue, affecting patients due to its effects on smooth muscle function throughout the body, including the gastrointestinal tract, as noted in the american college of cardiology/european society of cardiology clinical expert consensus document on hypertrophic cardiomyopathy 1.
Management of Stomach Side Effects
The management of these side effects can be approached through several methods:
- Increasing dietary fiber to 25-30g daily to help regulate bowel movements
- Maintaining adequate hydration with at least 8 glasses of water per day
- Regular physical activity to stimulate intestinal motility
- For constipation, the use of stool softeners like docusate sodium (100mg once or twice daily) or osmotic laxatives such as polyethylene glycol (17g in 8oz water daily) may be considered
- Taking verapamil with food can help reduce nausea and abdominal discomfort by minimizing irritation to the stomach lining
- Switching to an extended-release formulation of verapamil may also reduce gastrointestinal symptoms by providing a more gradual drug release, as suggested by the effects of verapamil on symptoms and hemodynamics in patients with hypertrophic cardiomyopathy 1
Alternative Considerations
If these measures are insufficient and side effects remain intolerable, consulting with a healthcare provider about alternative calcium channel blockers like amlodipine, which typically causes fewer gastrointestinal effects, may be necessary, considering the potential for adverse consequences associated with verapamil, especially in certain patient populations 1.
From the FDA Drug Label
Verapamil is known to decrease gastrointestinal transit time. In overdose, tablets of verapamil hydrochloride extended-release have occasionally been reported to form concretions within the stomach or intestines.
The stomach side effects of Verapamil include decreased gastrointestinal transit time and formation of concretions within the stomach in cases of overdose. Management of these side effects is primarily supportive, and in cases of massive overdose with prolonged symptoms, endoscopy might be considered. 2
From the Research
Stomach Side Effects of Verapamil
The stomach side effects of Verapamil include:
- Constipation, which is a well-known side effect of calcium channel blockers such as Verapamil 3, 4
- Abdominal pain and dry mouth, as noted in a study comparing Verapamil to placebo in normal male volunteers 5
- Delayed colonic transit, which may contribute to the constipating effect of Verapamil 5
- Local gastrointestinal symptoms, such as nausea 4
Management of Stomach Side Effects
The management of stomach side effects of Verapamil may involve:
- Monitoring for constipation and taking measures to prevent or treat it, such as increasing fiber intake or using laxatives 3, 4
- Adjusting the dose or switching to a different calcium channel blocker if side effects are severe or intolerable 3, 4
- Considering the use of Verapamil in patients with diseases associated with altered gastric emptying, as it does not significantly delay gastric emptying in normal subjects 6
Effects of Verapamil on Gastric Acid Secretion and Ulceration
Verapamil has been shown to: