verapamil ER
Verapamil ER (Verelan) is used to treat high blood pressure (hypertension). It's an extended-release (ER) medication that works throughout the day and is available as a tablet and capsule.
What is Verapamil ER (Verelan)?
What is Verapamil ER (Verelan) used for?
- High blood pressure
How Verapamil ER (Verelan) works
Verapamil ER (Verelan) is a calcium channel blocker (CCB). It works by blocking calcium from entering your heart muscle. This helps lower how much your heart works to squeeze (contract) and relax. It also relaxes and opens up your blood vessels, including those of your heart. By relaxing your heart muscle and blood vessels, verapamil ER (Verelan) helps lower your blood pressure.
Drug facts
Side effects of Verapamil ER (Verelan)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Tablet (Calan SR)
- Constipation (7%)
- Dizziness (3%)
- Nausea (3%)
- Low blood pressure (3%)
Capsule (Verelan)
- Constipation (7%)
- Headache (5%)
- Dizziness (4%)
- Tiredness or sluggishness (3%)
- Indigestion (3%)
Capsule (Verelan PM)
- Headache (12%)
- Infection (12%)
- Constipation (9%)
- Flu (4%)
- Swelling of arms or legs (4%)
- Dizziness (3%)
- Sore throat (3%)
- Sinus infection (3%)
- Indigestion (3%)
- Stuffy nose (3%)
Less Common Side Effects
- Headache
- Sleepiness
- Stomach discomfort (e.g., nausea, diarrhea)
- Dry mouth
- Overgrowth of gums (gingival hyperplasia)
- Swelling
- Heart failure and fluid buildup in lungs
- Changes in heart rate
- Chest pain
- Muscle pain or cramps
- Numbness, burning, or tingling in arms or legs
- Sweating
- Sleep disturbances or trouble sleeping (insomnia)
- Confusion
- Blurred vision
- Ringing in ears
- Enlarged breasts
- Frequent urination
- Flushed skin
- Rash
Verapamil ER (Verelan) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart rhythm problems: chest pain, dizziness, shortness of breath, fainting, feeling like your heart skipped a beat, severe tiredness
- Heart failure: shortness of breath, cough, tiredness, swelling of arms or legs, quick weight gain, dizziness
- Liver problems: yellowing of the skin or eyes (jaundice), stomach pain or swelling, loss of appetite, dark urine, nausea, vomiting, confusion
- Low blood pressure: dizziness, lightheadedness, weakness or tiredness, blurred vision, feeling thirsty, sweating, cold or pale skin, confusion, fast breathing
The following Verapamil ER (Verelan) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Blue lips and fingernails
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
confusion
coughing that sometimes produces a pink frothy sputum
difficult, fast, noisy breathing, sometimes with wheezing
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
increased sweating
lightheadedness, dizziness, or fainting
pale skin
shortness of breath
slow or irregular heartbeat
sweating
swelling in legs and ankles
unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Difficulty having a bowel movement (stool)
headache
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Verapamil ER (Verelan)
Pros
- Lowers blood pressure, which lowers the risk of stroke and heart attack
- Only need to take once daily
- Capsule can be opened and contents (pellets) can be mixed in with applesauce for people who have trouble swallowing pills
- Available in a lower-cost generic form
Cons
- Doesn't treat irregular heart rate or chest pain like the immediate-release form
- Has many undesirable side effects, such as headache, dizziness, and swelling of the arms or legs
- Must use with caution in people with liver or kidney disease
Pharmacist tips for Verapamil ER (Verelan)
- If you're switching from the immediate-release form to verapamil ER (Verelan), your total daily dose should stay the same unless your healthcare provider changes your dose. Instead of taking multiple doses throughout the day, you'll only have to take verapamil ER (Verelan) once daily because it's an extended-release medication. This means that the medication is slowly released throughout the day to maintain steady levels in your body.
- If you're taking the capsules (Verelan, Verelan PM) but are having trouble swallowing, you can open the capsule and sprinkle the pellets inside onto 1 tablespoon of applesauce. Swallow the applesauce mixture right away, making sure not to chew or crush the pellets. Then, drink a cold glass of water to make sure you completely swallow the pellets for a full dose. Don't save the mixture or split up the contents of your capsule for later use, because it might not work as well and you won't get the full effects of the medication.
- Verapamil ER (Verelan) doesn't allow your body to remove alcohol like it should. This can lead to high levels of alcohol in your blood and longer lasting effects of alcohol on your body. For your safety, limit alcohol use and let your healthcare provider know if you have a history of alcohol use.
- Let your pharmacist or healthcare provider know if you take a statin medication for high cholesterol. Taking verapamil ER (Verelan) with statins, like atorvastatin (Lipitor) and simvastatin (Zocor), can lead to muscle breakdown and muscle weakness. The dose of your statin medication might need to be lowered before you start using verapamil ER (Verelan).
- Store verapamil ER (Verelan) at room temperature in a place away from heat, light, and moisture. Close your medication bottle tightly and keep it out of reach from children at all times.
Common questions about Verapamil ER (Verelan)
Verapamil ER (Verelan) starts working within 1 week. When you first start the medication, your healthcare provider might make changes to your dose on a weekly basis depending on how well you're tolerating the medication and how well it's working to lower your blood pressure. If you don't notice a difference in your blood pressure within 1 week, let your healthcare provider know.
Since verapamil ER (Verelan) lowers your blood pressure, taking verapamil ER (Verelan) with other blood pressure medications can lead to even lower blood pressure and a slowed heart rate. Some people with poorly controlled blood pressure might need to take multiple medications to lower their blood pressure to healthy levels. Discuss the risks and benefits of combining blood pressure medications with your healthcare provider, and regularly follow up with your provider so your doses can be adjusted if needed.
Verelan and Verelan PM are both extended-release capsules of verapamil ER (Verelan) and are used to lower blood pressure. The extended-release capsules slowly release medication into your body, and they continue to work throughout the day to maintain steady levels in your body. The main difference is the time of day you should take them. Verelan is typically taken once daily in the morning, whereas Verelan PM is taken once daily at bedtime. Verelan PM is made in a special way that allows for a delayed start and doesn't start releasing medication until 4 to 5 hours after you take it. This allows Verelan PM to reach its highest levels in your body in the morning, when your blood pressure tends to be higher compared to the rest of the day.
There aren't any studies looking at the safety of verapamil ER (Verelan) in pregnant humans, but harmful effects have been observed in animal studies. If you're pregnant or plan on becoming pregnant, discuss the risks and benefits of taking verapamil ER (Verelan) with your healthcare provider and only use it if absolutely necessary.
Verapamil ER (Verelan) can pass into human breast milk, which might lead to serious harm for your baby. Don't breastfeed if you're taking verapamil ER (Verelan). Discuss with your healthcare provider if you would like to switch to a safer medication while breastfeeding.
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Risks and warnings for Verapamil ER (Verelan)
Verapamil ER (Verelan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart failure
- Risk factors: History of heart disease
Verapamil ER (Verelan) can cause heart failure and fluid buildup in your lungs. Heart failure means your heart isn't pumping blood as well as it should. If you have a history of heart disease or heart-related problems, let your healthcare provider know before you start verapamil ER (Verelan). You might need to take other medications, such as water pills (diuretics), to help manage your heart problem. Symptoms of heart failure include shortness of breath, tiredness, swelling of the feet, legs, or stomach, quick weight gain, dizziness, and cough.
Low blood pressure
- Risk factors: History of low blood pressure | Taking blood pressure medications
Verapamil ER (Verelan) can sometimes cause your blood pressure to drop to seriously low levels. This isn't very common if you have high blood pressure, but it's still possible. Tell your healthcare provider if you have symptoms of low blood pressure, including dizziness, lightheadedness, or weakness or tiredness, and especially if you experience blurred vision, thirst (dehydration), sweating, cold or pale skin, fast breathing, or confusion.
Liver problems
- Risk factors: History of liver disease
Verapamil ER (Verelan) can raise the level of liver proteins in your blood. These levels are checked when you get bloodwork done to monitor the health of your liver. Some of these elevations are harmless and disappear as you continue using verapamil ER (Verelan). Other times, it can lead to more serious liver problems. If you have a history of liver disease, let your healthcare provider know before starting verapamil ER (Verelan). You might need routine bloodwork to make sure your labs are within the normal range. Let your provider know right away if you notice yellowing of your skin or eyes (jaundice), stomach pain or swelling, loss of appetite, dark urine, nausea, vomiting, tiredness, weakness, or confusion. These can be signs of liver injury.
Heart rhythm problems
- Risk factors: Taking other blood pressure medications, especially beta-blockers
Verapamil ER (Verelan) can cause changes in your heart rhythm, including temporarily lowering your heart rate. Rarely, it can also cause a heart rhythm problem called heart block (AV block), which can be life-threatening. If this occurs, your dose might have to be lowered or you might have to completely stop taking verapamil ER (Verelan). Call for emergency medical help if you have chest pain, dizziness, shortness of breath, severe tiredness, feel like fainting, or feel like your heart skipped a beat.
Complications in people with certain heart rhythm problems
- Risk factors: Wolff-Parkinson-White or Lown-Ganong-Levine syndrome | Hypertrophic cardiomyopathy | Taking verapamil by injection
Before starting verapamil ER (Verelan), make sure your healthcare provider knows your full medical history, especially if you have any heart-related problems.
If you have an irregular heart rate (e.g., atrial fibrillation or A-fib, atrial flutter) and you're born with extra heart muscle tissue, don't take verapamil ER (Verelan), as this medication might put you at a higher risk for ventricular fibrillation (V-fib). This is a serious heart rhythm condition that can be life-threatening if not treated right away. V-fib was seen in people taking the injection form of verapamil, but you should still take similar precautions with oral forms of verapamil as well. Symptoms of V-fib include chest pain or pressure, shortness of breath, nausea, and vomiting.
If you have a genetic heart condition called hypertrophic cardiomyopathy (HCM), take verapamil ER (Verelan) with caution. HCM causes your heart muscle to grow thicker, making it harder for your heart to pump blood to the rest of your body. If you have HCM, verapamil ER (Verelan) can cause serious complications, such as fluid buildup in your lungs, severely low blood pressure, slow heart rate, heart block, and even death. Let your healthcare provider know if you have HCM because you might need to use a lower dose of verapamil ER (Verelan).
Verapamil ER (Verelan) dosage
Typical dosage for Verapamil ER (Verelan)
Your healthcare provider will adjust your dose based on how well you tolerate the medication and how well the medication is working for you.
Note: Sustained-release (SR) is another term for the extended-release form.
Tablet (brand-name Calan SR):
- The typical starting dose is 180 mg by mouth once daily in the morning.
Capsule
- Brand-name Verelan: The typical dose is 240 mg by mouth once daily in the morning.
- Brand-name Verelan PM: The typical dose is 200 mg by mouth once daily at bedtime.
Your dose might differ if you're of older age, have low body weight, or have liver or kidney problems.
More on Verapamil ER (Verelan) dosage
Interactions between Verapamil ER (Verelan) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Colchicine
- Dofetilide
- Eliglustat
- Flibanserin
- Lomitapide
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Acalabrutinib
- Acebutolol
- Adenosine
- Afatinib
- Alfentanil
- Alprazolam
- Alprenolol
- Amiodarone
- Aprepitant
- Atazanavir
- Atenolol
- Atorvastatin
- Avapritinib
- Benzhydrocodone
- Berotralstat
- Betaxolol
- Betrixaban
- Bevantolol
- Bisoprolol
- Bosutinib
- Brexpiprazole
- Brigatinib
- Bucindolol
- Bupivacaine
- Bupivacaine Liposome
- Buprenorphine
- Carbamazepine
- Carteolol
- Carvedilol
- Celiprolol
- Ceritinib
- Cilostazol
- Clarithromycin
- Clonidine
- Clopidogrel
- Clozapine
- Cobimetinib
- Codeine
- Conivaptan
- Cyclobenzaprine
- Dabigatran Etexilate
- Dantrolene
- Deflazacort
- Digoxin
- Dihydrocodeine
- Dilevalol
- Domperidone
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Dronedarone
- Edoxaban
- Elexacaftor
- Encorafenib
- Entrectinib
- Epirubicin
- Eplerenone
- Erythromycin
- Esmolol
- Everolimus
- Fentanyl
- Fingolimod
- Fosaprepitant
- Fosnetupitant
- Hydrocodone
- Ibrutinib
- Ifosfamide
- Ivabradine
- Ivacaftor
- Ivosidenib
- Ketoconazole
- Labetalol
- Lacosamide
- Lefamulin
- Lemborexant
- Levobunolol
- Lovastatin
- Lumateperone
- Lurasidone
- Lurbinectedin
- Meperidine
- Mepindolol
- Mepivacaine
- Methadone
- Metipranolol
- Metoprolol
- Morphine
- Morphine Sulfate Liposome
- Nadolol
- Naloxegol
- Nebivolol
- Neratinib
- Netupitant
- Nilotinib
- Olaparib
- Oxprenolol
- Oxycodone
- Palbociclib
- Pemigatinib
- Penbutolol
- Pentazocine
- Pexidartinib
- Pindolol
- Piperaquine
- Pixantrone
- Ponesimod
- Propranolol
- Ranolazine
- Relugolix
- Rimegepant
- Selpercatinib
- Selumetinib
- Simeprevir
- Simvastatin
- Siponimod
- Sirolimus
- Sonidegib
- Sotalol
- Sufentanil
- Tacrolimus
- Talazoparib
- Talinolol
- Tazemetostat
- Temsirolimus
- Tertatolol
- Tezacaftor
- Timolol
- Tizanidine
- Tolvaptan
- Topotecan
- Tramadol
- Ubrogepant
- Venetoclax
- Vincristine
- Vincristine Sulfate Liposome
- Voclosporin
- Zanubrutinib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Apixaban
- Buspirone
- Cyclosporine
- Dalfopristin
- Digitoxin
- Dutasteride
- Flecainide
- Fosphenytoin
- Indinavir
- Lithium
- Metformin
- Midazolam
- Nevirapine
- Oxcarbazepine
- Pancuronium
- Phenobarbital
- Phenytoin
- Quinidine
- Quinupristin
- Rifapentine
- Rivaroxaban
- St John's Wort
- Suvorexant
- Tedisamil
- Telithromycin
- Tubocurarine
- Vecuronium
How much does Verapamil ER (Verelan) cost?
Verapamil ER (Verelan) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Verapamil ER (Verelan) will not be safe for you to take.
- Complication on the left side of your heart (left ventricular dysfunction)
- Low blood pressure (systolic pressure less than 90 mmHg) or heart unable to pump enough blood (cardiogenic shock)
- Heart rhythm problem (sick sinus syndrome)
- 2nd- or 3rd-degree heart block
- Irregular heart rate (e.g., atrial fibrillation or atrial flutter) and being born with extra heart muscle tissue (Wolff-Parkinson-White or Lown-Ganong-Levine syndrome)
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