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Chronovera

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Indications:

Supraventricular arrhythmias, Angina pectoris.

Contraindications:

Cardiogenic shock, severe bradycardia, severe left ventricular dysfunction, uncompensated heart failure, hypotension (systolic pressure <90 mm Hg), porphyria. Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes). 2nd or 3rd degree AV block (unless pacemaker is fitted).

Adverse reactions:

Bradycardia, CHF, MI, AV block, worsening heart failure, transient asystole, hypotension, pulmonary and peripheral oedema, nausea. Constipation, fatigue, hypotension, dizziness, headache, palpitation, flushing, nausea, rashes, alopecia, hyperprolactinaemia, increased LFT and arthralgia. Potentially Fatal: Heart block and cardiac failure in patients with preexisting cardiac disease. Hepatotoxicity.

Interactions:

Increased cardiac depressant effects with β-blockers and flecainide. Increased risk of additive bradycardia, conduction disturbances and digoxin toxicity with digoxin. Increased risk of bradycardia and hypotension with remifentanil and sufentanil. Increased levels of both everolimus and verapamil on concurrent use. May increase doxorubicin, buspirone, carbamazepine, ciclosporin, epirubicin, eplerenone, quinidine, statins, sirolimus, tacrolimus, quinupristin/dalfopristin levels. Verapamil increase blood alcohol levels. Unpredictable interactions with lithium. Decreased verapamil concentrations with phenobarbital, sulfinpyrazone, rifampicin, rifabutin and rifapentine. Increased verapamil concentrations with protease inhibitors and cimetidine. Potentially Fatal: Increased cardiac depressant effects with amiodarone. Increased risk of QT prolongation with dofetilide, ranolazine, sertindole. Additive bradycardia with ivabradine. Increased risk of heart block with clonidine. Increased risk of acute hyperkalaemia and CV collapse with dantrolene.

Warnings:

1st degree AV block. Hypertrophic cardiomyopathy, patients with decreased neuromuscular transmission. Bradycardia or conduction disturbances. Hepatic or renal impairment. For IV admin, verapamil to be given slowly under continuous ECG and BP monitoring. Conventional tablets, extended-release capsules, extended-release core tablets, and controlled extended-release capsules can be admin without regard to food while extended-release tablets to be admin with food. Slower infusion rates (over >3 min) in elderly. Periodic monitoring of LFT during long-term therapy. Avoid sudden withdrawal. Infants and neonates, elderly. Pregnancy and lactation.

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Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology
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