Verapamil with Calcium Interaction Details

Brand Names Associated with Verapamil

Brand Names Associated with Calcium

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Dec 03, 2023

Interaction Effect

Reversal of hypotensive effects

Interaction Summary

Concomitant verapamil and calcium therapy may attenuate the antihypertensive effect of verapamil. The enhanced risk of this interaction is dependent on the route of administration (primarily intravenous), dose, and the underlying arrhythmia.

Severity

Moderate

Onset

Rapid

Evidence

Theoretical

How To Manage Interaction

Calcium generally is given to reverse hypotension and improve cardiac conduction defects. Monitor for expected cardiovascular response.

Mechanism Of Interaction

Antagonism

Literature Reports

A) Concomitant verapamil and calcium therapy may result in antagonism of the beneficial effects of verapamil . However, it has also been shown to antagonize some unwanted effects during the treatment of supraventricular tachyarrhythmias .

B) Intravenous calcium gluconate (90 mg) given before or after intravenous verapamil (5 mg) prevented or abolished the fall in arterial pressure without altering the antiarrhythmic effect of verapamil . Avoidance of verapamil's hypotensive effect may be desired in some patients.

C) Administration of intravenous calcium gluconate (1 gm)  or calcium chloride  prior to verapamil significantly blunted the hypotensive effects of verapamil without blocking the antiarrhythmic effects (conversion of multifocal atrial tachycardia).

D) The effects of concomitant intravenous calcium chloride (1 gm) were studied on the pharmacokinetics and pharmacodynamics of intravenous verapamil (10 mg) in healthy volunteers . Calcium pretreatment had no effects on blood pressure, PR interval changes or pharmacokinetics of verapamil in these subjects.

E) Calcium infusions have been used to reverse excessive hypotensive responses to therapeutic doses of intravenous verapamil being used in the treatment of various cardiovascular diseases .

F) Verapamil overdose has been successfully treated with calcium salts . Calcium administration is less effective in massive overdose. Hypotension generally does not respond as well as conduction disturbances to calcium .

Verapamil Overview

• Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Calcium Overview

• Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium is needed by the body for healthy bones, muscles, nervous system, and heart. Calcium carbonate also is used as an antacid to relieve heartburn, acid indigestion, and upset stomach. It is available with or without a prescription.

• This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.