Calan SR (Oral)

Verapamil is used by itself or with other medicines to treat heart rhythm issues, severe chest pain (angina), or high blood pressure (hypertension). High blood pressure makes the heart and arteries work harder. If it lasts for a long time, it can lead to problems with how the heart and arteries work. This can harm the blood vessels in the brain, heart, and kidneys, leading to a stroke, heart failure, or kidney failure. High blood pressure can also raise the risk of heart attacks. Controlling blood pressure may help reduce the likelihood of these problems.

Verapamil is a calcium channel blocker. It works by changing how calcium moves into the cells of the heart and blood vessels. This helps relax blood vessels, increasing blood and oxygen flow to the heart while lowering its workload.

This medicine is available only with your doctor's prescription.

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and to check for unwanted effects.

Low blood pressure (hypotension) may happen while taking this medicine. Contact your doctor immediately if you experience any of the following symptoms: blurred vision; confusion; severe dizziness, faintness, or lightheadedness when you suddenly get up from lying down or sitting; sweating; or unusual tiredness or weakness.

While you are taking this medicine, be careful to limit the amount of alcohol you drink. Alcohol can increase dizziness and drowsiness and also lowers blood pressure.

In deciding to use a medicine, you and your doctor will need to think about the risks and benefits. Here are important things to consider for this medicine:

Allergies

Inform your doctor if you have ever had any unusual or allergic reactions to this medicine or any other medicines. Also, let your healthcare professional know about any other allergies, like to foods, dyes, preservatives, or animals. For over-the-counter products, read the label or package ingredients carefully.

Pediatric

There have not been enough studies to determine how verapamil affects children. Its safety and effectiveness have not been established in this age group.

Geriatric

Studies so far have not shown any specific problems in older adults that would limit the usefulness of verapamil. However, older patients are more likely to have age-related heart, liver, or kidney issues, which may require a dose adjustment for those taking verapamil.

Breast Feeding

There are not enough studies to determine the risk to infants when this medication is used during breastfeeding. Consider the potential benefits and risks before taking this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while in other cases, two different medicines may be used together even if an interaction might happen. If you are taking this medicine, it is very important that your healthcare professional knows if you are taking any of the following medicines. The interactions listed below are significant but not all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may choose not to treat you with this medication or change some other medicines you take.

• Colchicine
• Dofetilide
• Eliglustat
• Flibanserin
• Lomitapide

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may adjust the dose or frequency of one or both medicines.

• Abametapir
• Acalabrutinib
• Acebutolol
• Adenosine
• Afatinib
• Alfentanil
• Alprazolam
• Amiodarone
• Apixaban
• Aprepitant
• Atazanavir
• Atenolol
• Atorvastatin
• Avapritinib
• Benzhydrocodone
• Berotralstat
• Betaxolol
• Betrixaban
• Bisoprolol
• Bosutinib
• Brexpiprazole
• Brigatinib
• Bupivacaine
• Bupivacaine Liposome
• Buprenorphine
• Carbamazepine
• Carteolol
• Carvedilol
• Celiprolol
• Ceritinib
• Cilostazol
• Clarithromycin
• Clonidine
• Clopidogrel
• Clozapine
• Cobicistat
• Cobimetinib
• Codeine
• Conivaptan
• Cyclobenzaprine
• Dabigatran Etexilate
• Dantrolene
• Daridorexant
• Darunavir
• Deflazacort
• Digoxin
• Dihydrocodeine
• Domperidone
• Doxorubicin
• Doxorubicin Hydrochloride Liposome
• Dronedarone
• Edoxaban
• Elacestrant
• Elexacaftor
• Encorafenib
• Entrectinib
• Epirubicin
• Eplerenone
• Erythromycin
• Esmolol
• Everolimus
• Fedratinib
• Fentanyl
• Fexinidazole
• Finerenone
• Fingolimod
• Fluconazole
• Fosaprepitant
• Fosnetupitant
• Gepirone
• Hydrocodone
• Ibrutinib
• Ifosfamide
• Infigratinib
• Itraconazole
• Ivabradine
• Ivacaftor
• Ivosidenib
• Ketoconazole
• Labetalol
• Lacosamide
• Larotrectinib
• Lefamulin
• Lemborexant
• Levobunolol
• Lovastatin
• Lumateperone
• Lurasidone
• Lurbinectedin
• Mavacamten
• Melphalan
• Meperidine
• Mepivacaine
• Methadone
• Metipranolol
• Metoprolol
• Mitapivat
• Mobocertinib
• Morphine
• Morphine Sulfate Liposome
• Nadolol
• Naloxegol
• Nebivolol
• Neratinib
• Netupitant
• Nilotinib
• Olaparib
• Omaveloxolone
• Oxprenolol
• Oxycodone
• Pacritinib
• Palbociclib
• Palovarotene
• Pemigatinib
• Penbutolol
• Pentazocine
• Pexidartinib
• Phenobarbital
• Pindolol
• Piperaquine
• Pixantrone
• Ponesimod
• Pralsetinib
• Primidone
• Propranolol
• Ranolazine
• Relugolix
• Rimegepant
• Rivaroxaban
• Selpercatinib
• Selumetinib
• Simeprevir
• Simvastatin
• Siponimod
• Sirolimus
• Sirolimus Protein-Bound
• Sonidegib
• Sotalol
• Sparsentan
• Sufentanil
• Tacrolimus
• Talazoparib
• Tazemetostat
• Temsirolimus
• Tenofovir Alafenamide
• Tezacaftor
• Timolol
• Tizanidine
• Tolvaptan
• Topotecan
• Tramadol
• Ubrogepant
• Venetoclax
• Venlafaxine
• Vincristine
• Vincristine Sulfate Liposome
• Voclosporin
• Zanubrutinib
• Zolpidem

Using this medicine with any of the following medicines may raise the risk of certain side effects, but using both may be the best choice for you. If both medicines are prescribed together, your doctor may adjust the dose or frequency of one or both of the medicines.

• Amlodipine
• Buspirone
• Cyclosporine
• Dalfopristin
• Digitoxin
• Dutasteride
• Flecainide
• Fosphenytoin
• Indinavir
• Lithium
• Metformin
• Midazolam
• Nevirapine
• Oxcarbazepine
• Pancuronium
• Phenytoin
• Quinidine
• Quinupristin
• Rifapentine
• St John's Wort
• Suvorexant
• Tedisamil
• Telithromycin
• Tubocurarine
• Vecuronium

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken at or near mealtimes because interactions may occur. Drinking alcohol or using tobacco with certain medicines may also lead to interactions. The following interactions are significant but not all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be necessary in some situations. If used together, your doctor may adjust the dose or frequency of this medicine, or give you specific instructions about the use of food, alcohol, or tobacco.

• Tobacco

Using this medicine with any of the following may increase the risk of certain side effects but may be necessary in some cases. If used together, your doctor may change the dose or frequency of this medicine, or provide special instructions regarding food, alcohol, or tobacco.

• Ethanol
• Grapefruit Juice

Other Medical Problems

Having other medical issues may affect the use of this medicine. Be sure to tell your doctor about any other medical conditions, especially:

• Congestive heart failure or
• Muscle disease (e.g., Duchenne's muscular dystrophy, myasthenia gravis) or
• Pulmonary edema (fluid in the lungs)—Use with caution. May worsen these conditions.

• Heart block (a type of abnormal heartbeat) or
• Heart problems (e.g., Wolff-Parkinson-White syndrome, Lown-Ganong-Levine syndrome) or
• Low blood pressure (hypotension) or
• Sick sinus syndrome (a heart rhythm issue; can use if there is a properly working pacemaker)—Should not be used in patients with these conditions.

• Kidney problems or
• Liver problems—Use with caution. The effects may be stronger because the body may remove the medicine more slowly.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do, they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

• Blue lips and fingernails
• blurred vision
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• chest pain
• confusion
• coughing that sometimes produces a pink frothy sputum
• difficult, fast, noisy breathing, sometimes with wheezing
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• increased sweating
• lightheadedness, dizziness, or fainting
• pale skin
• shortness of breath
• slow or irregular heartbeat
• sore throat
• sweating
• swelling in legs and ankles
• unusual tiredness or weakness

Rare

• Chills
• cold sweats
• feeling of warmth
• redness of the face, neck, arms, and occasionally, upper chest

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue, are bothersome, or if you have any questions about them:

More common

• Difficulty having a bowel movement (stool)
• headache

Less common

• Acid or sour stomach
• belching
• difficulty in moving
• heartburn
• indigestion
• joint pain
• muscle aching or cramping
• muscle pains or stiffness
• nausea
• rash
• stomach discomfort, upset, or pain
• trouble sleeping
• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
• swollen joints

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Calan
• Calan SR
• Covera-HS
• Isoptin SR
• Verelan
• Verelan PM

Available Dosage Forms:

• Tablet
• Tablet, Extended Release
• Capsule, Extended Release

Therapeutic Class: Cardiovascular Agent

Pharmacologic Class: Calcium Channel Blocker

Chemical Class: Phenylalkylamine

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Swallow the extended-release tablet whole with a full glass of water. Do not break, crush, or chew it. It is best to take this medicine with food.

If you cannot swallow the verapamil extended-release capsules, you may open it and sprinkle the pellets contained in the capsule on one tablespoon of applesauce. This mixture must be swallowed immediately with a glass of cool water. The applesauce should not be hot and should be soft enough to be swallowed without chewing. Do not chew or crush the pellets.

If you are taking the extended-release tablets, you may sometimes notice what looks like a tablet in your stool. This is the empty tablet shell that is left after the medicine has been absorbed.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For chest pain: For oral dosage form (tablets): Adults—The usual dose is 80 to 120 milligrams (mg) three times a day. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor. For oral dosage form (extended-release tablets, 24 hr): Adults—At first, 180 milligrams (mg) once daily at bedtime. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor.
• For heart rhythm problems:For oral dosage form (tablets): Adults—The total usual dose is 240 to 480 milligrams (mg) divided in three or four equal doses per day. Children—Use and dose must be determined by your doctor.
• For high blood pressure: For oral dosage form (tablets): Adults—At first, 80 milligrams (mg) three times a day. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor. For oral dosage form (extended-release capsules): Adults—At first, 200 milligrams (mg) once daily at bedtime. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor. For oral dosage form (extended-release tablets): Adults—At first, 180 milligrams (mg) once daily in the morning. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor. For oral dosage form (extended-release tablets, 24 hr): Adults—At first, 180 milligrams (mg) once daily at bedtime. Your doctor may adjust your dose if needed. Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.