Active Ingredient: Verapamil
Supraventricular tachycardias such as paroxysmal supraventricular tachycardia, atrial fibrillation/flutter with rapid ventricular response (except in WPW syndrome or LGL syndrome).
For this indication, competent medicine agencies globally authorize below treatments:
For:
Oral, between 40 milligrams verapamil and 120 milligrams verapamil, 3 to 4 times daily to meals. The maximum allowed total dose is 480 milligrams verapamil daily.
In cases of supraventricular tachycardia the usual dose is 40 mg to 120 mg 3 to 4 times daily according to the severity of the patient’s condition.
Verapamil should be taken preferably with or shortly after meals.
Verapamil should not be taken with grapefruit juice.
For:
Intravenous, 5 milligrams verapamil, one dose. Afterwards, in case that there is absent response to treatment, intravenous, 5 milligrams verapamil, one dose. Afterwards, intravenous, between 5 milligrams verapamil and 10 milligrams verapamil, once hourly.
Initial dose: 5 mg initially, given slowly (over approximately 2 minutes), keeping the patient under constant observation and if possible under ECG and blood pressure monitoring.
Repeat dose: If the therapeutic effect is not achieved, a further 5 mg may be injected after 5 to 10 minutes.
Drip infusion to maintain the therapeutic effect: 5‐10 mg/hour in physiological saline, glucose, laevulose or similar solutions (pH ≤ 6.5) on average up to a total dose of 100mg/day.
For:
Regimen A: In case that patient age in years is ≤ 2, oral, 20 milligrams verapamil, 2 to 3 times daily to meals. The maximum allowed total dose is 360 milligrams verapamil daily.
Regimen B: In case that patient age in years is > 2, oral, between 40 milligrams verapamil and 120 milligrams verapamil, 2 to 3 times daily to meals. The maximum allowed total dose is 360 milligrams verapamil daily.
Up to 2 years: 20 mg, 2-3 times a day.
2 years and above: 40-120 mg, 2-3 times a day, according to age and effectiveness.
Verapamil should be taken preferably with or shortly after meals.
Verapamil should not be taken with grapefruit juice.
For:
Regimen A: In case that patient age in years is ≤ 1, intravenous, between 0.1 milligrams verapamil per kilogram of body weight and 0.2 milligrams verapamil per kilogram of body weight, one dose. Afterwards, in case that patient age in years is ≤ 1 and there is absent response to treatment, intravenous, between 0.1 milligrams verapamil per kilogram of body weight and 0.2 milligrams verapamil per kilogram of body weight, one dose.
Regimen B: In case that patient age in years is ≥ 1 and patient age in years is ≤ 15, intravenous, between 0.1 milligrams verapamil per kilogram of body weight and 0.3 milligrams verapamil per kilogram of body weight, one dose. Afterwards, in case that patient age in years is ≤ 1 and patient age in years is ≤ 15 and there is absent response to treatment, intravenous, between 0.1 milligrams verapamil per kilogram of body weight and 0.3 milligrams verapamil per kilogram of body weight, one dose.
Verapamil must always be administered under ECG monitoring in young patients.
0-1 year: 0.1-0.2 mg/kg bodyweight (usual single dose range: 0.75-2 mg).
1-15 years: 0.1-0.3 mg/kg bodyweight (usual single dose range: 2-5 mg).
The dose may be repeated after 30 minutes if necessary. Many cases are controlled by doses at the lower end of the range. The injection should be stopped at the onset of the desired effect.
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