verapamil - maximum dosage

[cynthiaG]

what is the maximum dose you can take of verapamil?

[Burton Borrok]

Re: verapamil - maximum dosage

Here you go – more then you ever cared to find out.
Burt

DOSAGE AND ADMINISTRATION
Immediate-Release Tablets
The dose of verapamil must be individualized by titration. The usefulness and safety of dosages exceeding 480 mg/day have not been established; therefore, this daily dosage should not be exceeded. Since the half-life of verapamil increases during chronic dosing, maximum response may be delayed.

Angina: Clinical trials show that the usual dose is 80 mg to 120 mg three times a day. However, 40 mg three times a day may be warranted in patients who may have an increased response to verapamil (e.g., decreased hepatic function, elderly, etc). Upward titration should be based on therapeutic efficacy and safety evaluated approximately eight hours after dosing. Dosage may be increased at daily (e.g., patients with unstable angina) or weekly intervals until optimum clinical response is obtained.

Arrhythmias: The dosage in digitalized patients with chronic atrial fibrillation (see PRECAUTIONS) ranges from 240 to 320 mg/day in divided (tid or qid) doses. The dosage for prophylaxis of PSVT (non-digitalized patients) ranges from 240 to 480 mg/day in divided (tid or qid) doses. In general, maximum effects for any given dosage will be apparent during the first 48 hours of therapy.

Essential Hypertension: Dose should be individualized by titration. The usual initial monotherapy dose in clinical trials was 80 mg three times a day (240 mg/day). Daily dosages of 360 and 480 mg have been used but there is no evidence that dosages beyond 360 mg provided added effect. Consideration should be given to beginning titration at 40 mg three times per day in patients who might respond to lower doses, such as the elderly or people of small stature. The antihypertensive effects of verapamil HCl are evident within the first week of therapy. Upward titration should be based on therapeutic efficacy, assessed at the end of the dosing interval.
Sustained-Release Caplets
Essential Hypertension: The dose of verapamil HCl should be individualized by titration and should be administered with food. Initiate therapy with 180 mg of sustained-release verapamil HCl given in the morning. Lower initial doses of 120 mg a day may be warranted in patients who may have an increased response to verapamil HCl (e.g., the elderly or small people). Upward titration should be based on therapeutic efficacy and safety evaluated weekly and approximately 24 hours after the previous dose. The antihypertensive effects of verapamil HCl sustained release are evident within the first week of therapy.

If adequate response is not obtained with 180 mg of verapamil HCl sustained-release, the dose may be titrated upward in the following manner:

(a) 240 mg each morning.
(b) 180 mg each morning plus 180 mg each evening; or 240 mg each morning plus 120 mg each evening.
(c) 240 mg every 12 hours.

When switching from immediate-release to sustained-release verapamil HCl the total daily dose in milligrams may remain the same.
Sustained-Release Capsules
Essential Hypertension: The dose of verapamil HCl should be individualized by titration. The usual daily dose of sustained-release verapamil, in clinical trials has been 240 mg given by mouth once daily in the morning. However, initial doses of 120 mg a day may be warranted in patients who may have an increased response to verapamil (e.g., elderly, small people, etc.). Upward titration should be based on therapeutic efficacy and safety evaluated approximately 24 hours after dosing. The antihypertensive effects of verapamil HCl are evident within the first week of therapy.

If adequate response is not obtained with 120 of verapamil HCl, the dose may be titrated upward in the following manner:

(a) 180 mg in the morning.
(b) 240 mg in the morning.
(c) 360 mg in the morning.
(d) 480 mg in the morning.

Verapamil HCl sustained-release capsules are for once-a-day administration. When switching from immediate-release verapamil to verapamil HCl capsules, the same total daily dose of verapamil HCl can be used.

As with immediate-release verapamil, dosages of verapamil HCl capsules should be individualized and titration may be needed in some patients.
Sustained-Release, Controlled-Onset Capsules
Essential Hypertension: Verapamil HCl, extended-release, controlled-onset should be administered once daily at bedtime. Clinical trials studied doses of 100 mg, 200 mg, 300 mg and 400 mg. The usual daily dose of verapamil HCl, extended-release, controlled-onset capsules in clinical trials has been 200 mg given by mouth once daily at bedtime. In rare instances, initial doses of 100 mg a day may be warranted in patients who have an increased response to verapamil [e.g., patients with impaired renal function (see PRECAUTIONS), impaired hepatic function, elderly, small people, etc.]. Upward titration should be based on therapeutic efficacy and safety evaluated approximately 24 hours after dosing. The antihypertensive effects of verapamil HCl, extended-release, controlled-onset capsules are evident within the first week of therapy.

If an adequate response is not obtained with 200 mg of verapamil HCl, extended-release, controlled-onset capsules, the dose may be titrated upward in the following manner:

(a) 300 mg each evening.
(b) 400 mg each evening (2x200 mg).

When verapamil HCl, extended-release, controlled-onset capsules is administered at bedtime, office evaluation of blood pressure during morning and early afternoon hours is essentially a measure of peak effect. The usual evaluation of trough effect, which sometimes might be needed to evaluate the appropriateness of any given dose of verapamil HCl, extended-release, controlled-onset capsules would be just prior to bedtime.

As with immediate-release and sustained-release verapamil, dosages of verapamil HCl, extended-release, controlled-onset capsules should be individualized and titration may be needed in some patients.

[bryan]

Re: verapamil - maximum dosage

Cynthia,
Im sorry I wish I had an answer for you. Im currently on 570mg of Verapamil SA. Dr Udelson and Dr Maron said thats as high as they wanted tog o with me.

Bryan