Serious adverse reactions are uncommon when Calan therapy is initiated with upward dose titration within the recommended single and total daily dose. See WARNINGS for discussion of heart failure , hypotension , elevated liver enzymes , AV block, and rapid ventricular response. Reversible (upon discontinuation of verapamil) non-obstructive, paralytic ileus has been infrequently reported in association with the use of verapamil. The following reactions to orally administered verapamil occurred at rates greater than 1.0% or occurred at lower rates but appeared clearly drug-related in clinical trials in 4,954 patients: Constipation 7.3% Dyspnea 1.4% Dizziness 3.3% Bradycardia (HR 1.4% Nausea 2.7% AV block total (1, 2, 3) 1.2% Hypotension 2.5% 2 and 3 0.8% Headache 2.2% Rash 1.2% Edema 1.9% Flushing 0.6% CHF, Pulmonary edema 1.8% Fatigue 1.7% Elevated liver enzymes (see WARNINGS ) In clinical trials related to the control of ventricular response in digitalized patients who had atrial fibrillation or flutter , ventricular rates below 50 at rest occurred in 15% of patients and asymptomatic hypotension occurred in 5% of patients. The following reactions, reported in 1.0% or less of patients, occurred under conditions (open trials, marketing experience) where a causal relationship is uncertain; they are listed to alert the physician to a possible relationship: Cardiovascular: angina pectoris , atrioventricular dissociation , chest pain , claudication , myocardial infarction ,
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