Verapamil Hydrochloride Tablets are contraindicated in:1.
Severe left ventricular dysfunction (see WARNINGS)2.
Hypotension (systolic pressure less than 90 mm Hg) or cardiogenic shock3.
Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)4.
Second-or-third-degree AV block (except in patients with a functioning artificial ventricular pacemaker)5.
Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes).
(see WARNINGS)6.Patients with known hypersensitivity to verapamil hydrochloride.
Verapamil has a negative inotropic effect, which in most patients is compensated by its afterload reduction (decreased systemic vascular resistance) properties without a net impairment of ventricular performance.
In clinical experience with 4,954 patients, 87 (1.8%) developed congestive heart failure or pulmonary edema.
Verapamil should be avoided in patients with severe left ventricular dysfunction (e.g., ejection fraction less than 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker (see Drug interactions).
Patients with milder ventricular dysfunction should, if possible, be controlled with optimum doses of digitalis and/or diuretics before verapamil treatment.(Note interactions with digoxin under PRECAUTIONS.)