From the Guidelines
Verapamil SR dosing is not limited to once-daily administration, as it can be given in divided doses or as a single dose 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 can be 120 mg daily in divided or single dose with long-acting formulations. This suggests that the dosing frequency of verapamil SR can be adjusted based on the specific formulation and the patient's response to therapy.
Some key points to consider when dosing verapamil SR include:
- The potential for adverse effects such as hypotension, worsening heart failure, and bradycardia 1
- The need for precautions or contraindications in certain patient populations, such as those with AV block greater than first degree or SA node dysfunction 1
- The importance of monitoring for drug interactions, particularly with other medications that may affect cardiac conduction or blood pressure 1
In terms of specific dosing recommendations, the guideline suggests that verapamil can be initiated at a dose of 120 mg daily, with a maintenance dose of up to 480 mg daily in divided or single dose with long-acting formulations 1. However, the actual dosing frequency and amount will depend on the individual patient's needs and response to therapy. It is essential to carefully evaluate the patient's condition and adjust the verapamil SR dosing regimen accordingly to minimize the risk of adverse effects and optimize therapeutic outcomes.
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 ... The antihypertensive effects of verapamil hydrochloride extended-release tablets are evident within the first week of therapy If adequate response is not obtained with 180 mg of verapamil hydrochloride extended-release tablets, the dose may be titrated upward in the following manner: 240 mg each 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 of verapamil SR is not limited to once daily, as it can be administered in a split dose (e.g., 180 mg each morning plus 180 mg each evening) or every 12 hours (e.g., 240 mg every 12 hours) 2.
- Approved dosing regimens include once daily (e.g., 180 mg, 240 mg) and twice daily (e.g., 180 mg each morning plus 180 mg each evening, 240 mg each morning plus 120 mg each evening) 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.