Last update Sept. 1, 2022

Verapamil Hydrochloride

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

It is a phenylalkylamine calcium channel blocker and a class IV antiarrhythmic used in the treatment of angina, arrhythmia, and hypertension. Oral or intravenous administration in two to three daily doses.

It is excreted in breast milk in clinically non-significant amount (Anderson 1987, Miller1986, Inoue 1984, de Swiet 1984, Andersen 1983) and no problems have been observed in infants whose mothers were receiving this treatment. (Anderson 1987, Miller1986, Andersen 1983)

Plasma levels in these infants were undetectable or very low. (Anderson 1987, Miller1986, Andersen 1983)

Verapamil may induce to an increase of plasma Prolactin levels and galactorrhea. (Krysiak 2005, Kelley 1996, Fearrington 1983, Gluskin 1981)

Several medical societies and expert authors consider the use of this medication possible during breastfeeding. (Hale, LactMed, Malachias 2016, Briggs 2015, Schaefer 2015, Serrano 2015, Davanzo 2014, Rowe 2013, Jürgens 2009, Tan 2001, , de Swiet 1984). American Academy of Pediatrics: usually compatible with breastfeeding medication (AAP 2001). WHO List of Essential Medicines 2002: compatible with breastfeeding. (WHO 2002)

Alternatives

  • Nifedipine ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Nimodipine ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Verapamil Hydrochloride is also known as


Verapamil Hydrochloride in other languages or writings:

Groups

Verapamil Hydrochloride belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Verapamil Hydrochloride in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 20 - 30 %
Molecular weight 491 daltons
Protein Binding 90 %
VD 4 - 7 l/Kg
pKa 9.68 -
Tmax 1 - 2 hours
4.5 - 12 hours
M/P ratio 0.9 -
Theoretical Dose 0.01 - 0.05 mg/Kg/d
Relative Dose 0.01 - 0.98 %
Ped.Relat.Dose 0.8 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Malachias MV, Figueiredo CE, Sass N, Antonello IC, Torloni MR, Bortolotto MRF L. 7th Brazilian Guideline of Arterial Hypertension: Chapter 9 - Arterial Hypertension in pregnancy Arq Bras Cardiol. 2016 Abstract Full text (link to original source) Full text (in our servers)
  4. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015 Jan 20;144(2):73-9. Abstract
  5. Schaefer C, Peters P, Miller RK. Drugs During Pregnancy and Lactation. Treatment options and risk assessment. Elsevier, Third Edition. 2015
  6. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  7. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  8. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  9. Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia. 2009 Abstract
  10. Krysiak R, Okopieh B, Herman ZS. [Verapamil-induced hyperprolactinemia--a case report]. Pol Arch Med Wewn. 2005 Abstract
  11. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  12. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  13. Tan HL, Lie KI. Treatment of tachyarrhythmias during pregnancy and lactation. Eur Heart J. 2001 Abstract Full text (link to original source) Full text (in our servers)
  14. Kelley SR, Kamal TJ, Molitch ME. Mechanism of verapamil calcium channel blockade-induced hyperprolactinemia. Am J Physiol. 1996 Abstract
  15. Anderson P, Bondesson U, Mattiasson I, Johansson BW. Verapamil and norverapamil in plasma and breast milk during breast feeding. Eur J Clin Pharmacol. 1987;31(5):625-7. Abstract
  16. Miller MR, Withers R, Bhamra R, Holt DW. Verapamil and breast-feeding. Eur J Clin Pharmacol. 1986 Abstract
  17. de Swiet M. Excretion of verapamil in human milk. Br Med J (Clin Res Ed). 1984 Abstract Full text (link to original source) Full text (in our servers)
  18. Inoue H, Unno N, Ou MC, Iwama Y, Sugimoto T. Level of verapamil in human milk. Eur J Clin Pharmacol. 1984 Abstract
  19. Andersen HJ. Excretion of verapamil in human milk. Eur J Clin Pharmacol. 1983 Abstract
  20. Fearrington EL, Rand CH Jr, Rose JD. Hyperprolactinemia-galactorrhea induced by verapamil. Am J Cardiol. 1983 May 1;51(8):1466-7. No abstract available. Abstract
  21. Gluskin LE, Strasberg B, Shah JH. Verapamil-induced hyperprolactinemia and galactorrhea. Ann Intern Med. 1981 Jul;95(1):66-7. No abstract available. Abstract

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