From the Guidelines
Verapamil SR dosing is not limited to only once daily, as it can be administered in divided or single doses with long-acting formulations. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, the initial daily dose of verapamil is 120 mg daily in divided or single dose with long-acting formulations, and the maintenance dose is 480 mg daily in divided or single dose with long-acting formulations. This suggests that verapamil SR can be administered in a variety of dosing regimens, including once daily or divided doses, depending on the specific formulation and the condition being treated. Some key points to consider when prescribing verapamil SR include:
- The potential adverse effects, such as hypotension, worsening HF in patients with pre-existing ventricular dysfunction, pulmonary edema in patients with hypertrophic cardiomyopathy, bradycardia, and abnormal liver function studies 1
- The precautions and interactions, including AV block greater than first degree or SA node dysfunction, decompensated systolic HF/severe LV dysfunction, hypotension, and interactions with other medications such as dofetilide, itraconazole, and grapefruit juice 1 It's essential to carefully evaluate the patient's individual needs and medical history when determining the optimal dosing regimen for verapamil SR.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Essential hypertension: ... Initiate therapy with 180 mg of sustained-release verapamil HCl, verapamil hydrochloride extended-release tablets, given in the morning ... 180 mg each morning plus 180 mg each evening; or 240 mg each morning plus 120 mg each evening, 240 mg every 12 hours
- The dosing frequency of verapamil SR is not limited to only once daily, as it can be given in divided doses, such as 180 mg each morning plus 180 mg each evening, or 240 mg every 12 hours.
- Approved dosing includes options for both once daily and divided doses, depending on the patient's response and therapeutic needs 2.
From the Research
Verapamil SR Dosing
- Verapamil SR dosing is not limited to only once daily, as it can be administered twice daily when higher doses are needed 3.
- The sustained-release formulation of verapamil allows for once-daily dosing up to 240 mg/d, but higher doses require twice-daily administration 3.
- A new pellet-filled capsule formulation of verapamil (Verelan) provides controlled absorption, 24-hour blood pressure control, and improved peak-to-trough plasma levels, enabling once-daily dosing regardless of dosage size 3.
Sustained-Release Verapamil Formulations
- Sustained-release verapamil formulations are available for oral administration and can be given as a single daily dose, which is as effective in lowering blood pressure over 24 hours as equivalent doses of conventional verapamil formulations given 3 times daily 4.
- These formulations are designed to provide a consistent release of verapamil, allowing for once-daily dosing and improving patient compliance.