From the Guidelines
Verapamil should not be stopped abruptly but should be tapered off gradually under medical supervision. When discontinuing verapamil, a typical tapering schedule might involve reducing the dose by 25-50% every 3-7 days until completely stopped. The exact tapering schedule depends on your current dose, how long you've been taking it, and your underlying medical condition. Abrupt discontinuation of verapamil can lead to rebound hypertension, increased angina, or worsening of arrhythmias because your body has adapted to the calcium channel blocking effects of the medication. According to the European Society of Cardiology guidelines 1, it is acceptable to taper and discontinue treatment 6 –12 months after angina has disappeared, which suggests that a gradual taper is necessary to avoid potential complications.
Some key points to consider when tapering verapamil include:
- Monitoring blood pressure and heart rate regularly during the tapering process
- Being aware of potential symptoms such as chest pain, severe headaches, significant blood pressure elevation, or irregular heartbeat
- Contacting your healthcare provider immediately if you experience any of these symptoms during the tapering process
- Understanding that verapamil affects calcium channels in heart muscle and blood vessels, and sudden withdrawal can cause these channels to overreact, potentially causing dangerous cardiovascular effects, as noted in the guidelines on the management of stable angina pectoris 1.
It's essential to work closely with your healthcare provider to determine the best tapering schedule for your specific situation, taking into account your medical history, current health status, and the reasons for discontinuing verapamil. By doing so, you can minimize the risk of complications and ensure a safe and successful tapering process.
From the Research
Verapamil Discontinuation
- Verapamil, a calcium channel blocker, can be discontinued abruptly without causing a rebound effect or withdrawal symptoms in patients with chronic stable angina pectoris 2.
- A study comparing the effects of abrupt withdrawal of propranolol and verapamil in angina pectoris found that all 20 patients were withdrawn from verapamil without evidence of a rebound increase in frequency of anginal attacks or deterioration in exercise tolerance 3.
- In contrast to beta-blockers, which can cause symptoms when stopped without tapering, verapamil does not appear to require a taper when discontinued 4.
- The efficacy and safety of verapamil have been well established in the treatment of patients with hypertension, angina pectoris, and other cardiovascular conditions 5, 6.
- However, it is essential to note that individual patient responses may vary, and healthcare professionals should exercise caution when discontinuing any medication, including verapamil.
Key Findings
- Verapamil can be safely discontinued abruptly in patients with chronic stable angina pectoris 2, 3.
- No evidence of drug tachyphylaxis or abrupt withdrawal syndrome was found in patients with chronic stable angina pectoris 2.
- Verapamil is effective in the treatment of patients with stable angina pectoris and appears to be an alternative to beta-blockers in selected patients as late start secondary prevention after acute myocardial infarction 5.