Verapamil

Cardiovascular collapse and marked hyperkalemia reported with IV dantrolene and calcium channel blockers; contraindicated during malignant hyperthermia crisis management.

Cardiovascular collapse and marked hyperkalemia reported with combination; contraindicated in malignant hyperthermia crisis management.

Do not administer disopyramide within 48 hours before or 24 hours after verapamil due to potential serious interactions.

Verapamil increases dofetilide peak plasma levels by 42% and is associated with higher occurrence of Torsade de Pointes. Concomitant use is contraindicated.

In patients with depressed myocardial function, concomitant use can lead to fatal cardiac arrests.

Little experience with coadministration. Should not be administered concurrently unless benefits outweigh risks due to negative inotropic properties.

Moderate CYP3A4 inhibitor; concomitant use is contraindicated due to increased risk of hypotension and syncope.

Coadministration is contraindicated. Non-dihydropyridine calcium-channel antagonist that can increase risk of bradycardia or hypotension.

Moderate CYP3A inhibitor that increases lemborexant AUC and Cmax, increasing risk of adverse reactions. Concomitant use should be avoided.

ZEPOSIA should generally not be initiated in patients concurrently treated with verapamil and a beta blocker due to potential additive effects on heart rate.

Reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers like propranolol.

Rarely associated with ventricular fibrillation when combined with adenosine injection. Use with caution due to potential additive depressant effects on SA and AV nodes.

Negative chronotrope. Potentiates electrophysiologic and hemodynamic effects resulting in bradycardia, sinus arrest, and AV block.

Concomitant use may cause left ventricular failure, AV conduction disturbances, and complete heart block, especially with impaired cardiac function.

Calcium antagonist that depresses myocardium and inhibits AV conduction; use with care when combined with bisoprolol fumarate.

CYP3A4 inhibitor that increased buspirone AUC and Cmax 3.4 fold; adverse events more likely during concomitant use.

Verapamil increased buspirone AUC and Cmax 3.4-fold; adverse events attributable to buspirone may be more likely during concomitant administration.

Concomitant administration may cause hypotension, bradyarrhythmias, and lactic acidosis.

Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported with clonidine and verapamil concomitantly.

Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported with concomitant use of clonidine and verapamil.

Sinus bradycardia resulting in hospitalization and pacemaker insertion has been reported with concurrent use of clonidine and verapamil.

Toxicities reported when colchicine is administered with verapamil, a CYP3A4 inhibitor. Serious and life-threatening toxicity potential.

Postmarketing cases of serotonin syndrome reported during combined use; careful observation advised.

Postmarketing cases of serotonin syndrome reported during combined use with verapamil.

Serotonin syndrome reported during combined use.

Moderate or strong CYP3A4 inhibitor; reduce EMFLAZA dose to one third of recommended dosage when used concomitantly.

Increases digoxin serum concentration by 50-75%. Requires monitoring and dose reduction of 30-50%.

CYP3A4 inhibitor that increases doxorubicin concentration and clinical effect. Clinically significant interaction reported.

Hypotension, bradyarrhythmias, and lactic acidosis observed with concomitant use. CYP3A4-metabolized calcium channel blocker.

Concurrent verapamil use has been associated with hypotension, bradyarrhythmias, and lactic acidosis.

CYP3A4 inhibitor may affect everolimus concentrations; dose adjustment consideration recommended.

CYP3A4 inhibitor may affect everolimus concentrations; dose adjustment should be considered.

Do not exceed 10 mg/10 mg ezetimibe and simvastatin tablets daily due to increased myopathy risk.

Heart rate-slowing calcium channel blocker. Concomitant use during fingolimod initiation may result in severe bradycardia or heart block.

Heart rate-slowing calcium channel blocker. Concomitant use during fingolimod initiation may cause severe bradycardia or heart block. Consider switching.

Heart rate-slowing calcium channel blocker; risk of severe bradycardia or heart block during TASCENSO ODT initiation.

Moderate CYP3A4 inhibitor that increases ivabradine plasma concentrations; avoid concomitant use.

Increases risk of myopathy/rhabdomyolysis, particularly with higher doses of lovastatin.

Moderate CYP3A4 inhibitor increases lurasidone exposure. Lurasidone dose should be reduced to half the original level.

Concomitant use increases risk of bradycardia. Both agents slow atrioventricular conduction and decrease heart rate.

Calcium channel blocker slows atrioventricular conduction and decreases heart rate; concomitant use with metoprolol increases bradycardia risk.

Calcium channel blocker that slows AV conduction and decreases heart rate; concomitant use with metoprolol increases bradycardia risk.

Calcium channel blocker that slows atrioventricular conduction and decreases heart rate; concomitant use with metoprolol increases risk of bradycardia.

Concomitant use increases risk of bradycardia due to additive negative chronotropic effects.

Calcium channel blocker that slows atrioventricular conduction; concomitant use with metoprolol can increase risk of bradycardia.

Calcium channel blocker that may cause excessive reductions in heart rate, blood pressure, and cardiac contractility.

Calcium channel blocker may cause excessive reductions in heart rate, blood pressure, and cardiac contractility.

Heart rate lowering calcium channel blocker; should generally not be initiated with PONVORY due to additive heart rate reduction.

Verapamil significantly reduces hepatic clearance of quinidine with corresponding increases in serum levels and half-life.

In animals, impairment of atrioventricular conduction has been observed when verapamil and sevoflurane are administered concomitantly.

Calcium channel blocker that increases risk of myopathy and rhabdomyolysis. Do not exceed simvastatin 10 mg daily.

Heart-rate lowering calcium channel blocker; treatment with siponimod should generally not be initiated due to additive heart rate effects.

Calcium channel blocker; concomitant use increases risk of bradycardia and hypotension.

P-gp inhibitor that increases talazoparib concentrations; avoid coadministration or reduce talazoparib dose and monitor for increased adverse reactions.

Left ventricular failure and AV conduction disturbances reported with concomitant use; additive effects in prolonging AV conduction time.

CYP1A2 inhibitor; concomitant use should be avoided due to potential for hypotension, bradycardia, or excessive drowsiness.

Concomitant use should be avoided due to potential interactions. If clinically necessary, initiate with 2 mg and titrate cautiously.

Should be avoided due to CYP1A2 inhibition. If necessary, initiate tizanidine at 2 mg and titrate cautiously; monitor for hypotension, bradycardia, or excessive drowsiness.

CYP1A2 inhibitor that increases warfarin effect and INR; requires close monitoring.

P-glycoprotein inhibitor that increases afatinib exposure. Reduce GILOTRIF dose by 10 mg per day if not tolerated.

Calcium antagonist that may depress myocardium and inhibit AV conduction. Use with caution when combined with bisoprolol.

CYP3A4 inhibitor that increases carbamazepine plasma levels. Close monitoring of carbamazepine levels and dosage adjustment may be required.

Calcium channel blocker may affect ECG and/or blood pressure when used with carvedilol.

Calcium channel blocker that may affect ECG and/or blood pressure when used with carvedilol.

Moderate CYP3A4 inhibitor causing significant increase in colchicine plasma concentration. Monitor for toxicity signs.

Increases cyclosporine concentrations via CYP3A4 inhibition. Dosage adjustment essential.

P-gp inhibitor that does not require dosage adjustment of dabigatran etexilate but increases exposure, especially with renal impairment.

Moderate CYP3A4 inhibitor; no dosing adjustments recommended for darifenacin when co-administered with verapamil.

Moderate to strong CYP3A4 inhibitor can increase plasma concentrations of estrogen or progestin or both.

Moderate or strong CYP3A4 inhibitor that can increase plasma concentrations of estrogen or progestin or both.

Moderate to strong CYP3A4 inhibitor that can increase plasma concentrations of estrogen or progestin.

Moderate CYP3A inhibitor; do not exceed 25 mg once daily in post-MI HFrEF patients; initiate at 25 mg once daily in hypertension patients.

CYP3A4 inhibitor that increases serum concentrations of estradiol and dienogest.

Moderate CYP3A4 inhibitor. No dosing adjustments recommended in the presence of this drug.

Fluconazole has potential to increase systemic exposure of verapamil. Frequent monitoring for adverse effects recommended.

Care should be taken when using labetalol concomitantly with verapamil, a calcium antagonist.

Inhibits P450-3A4 enzyme system, increasing midazolam half-life from 5 to 7 hours and prolonging sedation.

Inhibits P450-3A4 enzyme system, increasing midazolam half-life from 5 to 7 hours, resulting in prolonged sedation.

P450-3A4 inhibitor may result in prolonged sedation. Increases midazolam half-life from 5 to 7 hours.

May result in prolonged sedation due to decreased plasma clearance of midazolam.

P-glycoprotein inhibitor increasing plasma naldemedine concentrations; monitor for adverse reactions.

Moderate CYP3A4 inhibitor that increases naloxegol concentrations; avoid concomitant use or reduce dosage to 12.5 mg once daily and monitor for adverse reactions.

Concomitant use can potentiate electrophysiologic and hemodynamic effects, resulting in bradycardia, sinus arrest, and AV block.

CYP3A inhibitor that increases nifedipine exposure during concomitant therapy. Blood pressure should be monitored and dose reduction of nifedipine considered.

Moderate CYP3A4 inhibitor and calcium channel blocker that may increase nimodipine plasma concentration and blood pressure lowering effect. Blood pressure monitoring and dose reduction of nimodipine may be necessary.

Significantly reduces hepatic clearance of quinidine with corresponding increases in serum levels and half-life.

CYP3A inhibitor that increases ranolazine exposure. Limit ranolazine to 500 mg twice daily.

Weak/moderate CYP3A4/P-gp inhibitor that may increase sirolimus concentrations; verapamil concentrations may also increase. Monitor and adjust dosage as needed.

Moderate CYP3A4 inhibitor that may increase silodosin concentration. Monitor patients for adverse events.

Moderate CYP3A inhibitor; recommended suvorexant dose is 5 mg, may increase to 10 mg if needed.

Mild or moderate CYP3A inhibitor calcium channel blocker that may affect tacrolimus concentrations. Monitor tacrolimus whole blood trough concentrations.

Verapamil increases terazosin AUC by 11-24%, Cmax by 25%, and Cmin by 32% after 3 weeks of concomitant use, with decreased Tmax from 1.3 to 0.8 hours.

Data from clinical studies of similar benzodiazepines suggest possible drug interaction with triazolam. Caution recommended.

Moderate CYP3A4 inhibitor resulting in increased ubrogepant exposure. Dose adjustment recommended.

Moderate CYP3A4 inhibitor that increases voclosporin exposure; dosage reduction of voclosporin required.

P-gp inhibitor that does not require dosage adjustment of PRADAXA.

Moderate CYP3A4 inhibitor; no dosing adjustments recommended.

Decreases dutasteride clearance and increases dutasteride exposure, but this change is not clinically significant and no dose adjustment is recommended.

CYP3A inhibitor not expected to have significant effect on prasugrel active metabolite pharmacokinetics.

P-gp substrate. In vitro studies suggest pretomanid may inhibit P-gp, potentially increasing verapamil exposure. Clinical impact unknown; monitor for adverse reactions.