Summary

Commonly reported side effects of verapamil include: sinus bradycardia. Other side effects include: pulmonary edema, severe hypotension, and second degree atrioventricular block. Continue reading for a comprehensive list of adverse effects.

Applies to verapamil: oral capsule extended release, oral tablet, oral tablet extended release. Other dosage forms:

• intravenous solution

Serious side effects of Verapamil

Along with its needed effects, verapamil 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 while taking verapamil:

Less common

• Blue lips and fingernails
• blurred vision
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• chest pain
• 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
• sore throat
• sweating
• swelling in legs and ankles
• unusual tiredness or weakness

Rare

• Chills
• cold sweats
• feeling of warmth
• redness of the face, neck, arms and occasionally, upper chest

Other side effects of Verapamil

Some side effects of verapamil 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

Less common

• Acid or sour stomach
• belching
• difficulty in moving
• heartburn
• indigestion
• joint pain
• muscle aching or cramping
• muscle pains or stiffness
• nausea
• rash
• stomach discomfort, upset, or pain
• trouble sleeping
• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
• swollen joints

For Healthcare Professionals

Applies to verapamil: compounding powder, intravenous solution, oral capsule extended release, oral tablet, oral tablet extended release.

General

The most commonly reported side effects include constipation, dizziness, and headache.^[Ref]

Nervous system

Seizures occurred rarely with IV administration.

Paralysis/tetraparesis was reported in a patient taking this drug and colchicine concurrently.^[Ref]

Very common (10% or more): Headache (up to 12.1%)

Common (1% to 10%): Dizziness, lethargy

Rare (0.01% to 0.1%): Seizures

Frequency not reported: Rotary nystagmus, sleepiness, vertigo, lightheadedness, tingling, numbness, neuropathy

Postmarketing reports: Syncope, cerebrovascular accident, equilibrium disorders, parkinsonism/extrapyramidal symptoms/syndrome, paresthesia, shakiness/tremor, paralysis/tetraparesis, somnolence^[Ref]

Cardiovascular

Common (1% to 10%): Symptomatic hypotension/hypotension/abrupt blood pressure fall, sinus bradycardia/bradycardia (heart rate less than 50 beats/minute), severe tachycardia, ankle edema/edema, development/aggravation of congestive heart failure (CHF), atrioventricular (AV) block, peripheral edema

Uncommon (0.1% to 1%): Second-/third-degree AV block, palpitations, orthostasis

Postmarketing reports: Angina pectoris/chest pain, AV dissociation, ECG abnormal, claudication, hypertension, myocardial infarction, sinus arrest with asystole, decreased myocardial contractility, cardiogenic shock, bradyarrhythmia in atrial fibrillation, vasculitis, erythromelalgia^[Ref]

Cardiovascular side effects may occur with greater intensity at higher doses or in patients with a history of myocardial damage.

Approximately 15% of patients who had atrial flutter/fibrillation and received this drug and digoxin developed resting ventricular rates below 50 beats/min; in the same trial, asymptomatic hypotension occurred in approximately 5% of patients.

Asystole occurred after second/third degree AV block and was usually short in duration, with spontaneous cardiac action returning within seconds in the form of a sinus rhythm.^[Ref]

Gastrointestinal

Common (1% to 10%): Constipation, dyspepsia, nausea, diarrhea, flatulence

Uncommon (0.1% to 1%): Abdominal discomfort/pain

Frequency not reported: Non-obstructive paralytic ileus/ileus, bloating

Postmarketing reports: Dry mouth, gastrointestinal stress, gingival hyperplasia, vomiting^[Ref]

Non-obstructive paralytic ileus was reversible when treatment was stopped.

Gingival hyperplasia occurred when this drug was given over a prolonged period of time, and was reversible once the drug was discontinued.^[Ref]

Respiratory

Common (1% to 10%): Pulmonary edema, pharyngitis, sinusitis, rhinitis, dyspnea

Rare (0.01% to 0.1%): Broncho/laryngeal spasm^[Ref]

Bronchospasm and laryngeal spasm occurred during hypersensitivity reactions.^[Ref]

Other

Common (1% to 10%): Fatigue, tiredness/malaise, accidental injury, pain

Frequency not reported: Infection, flu syndrome

Postmarketing reports: Tinnitus, asthenia^[Ref]

Dermatologic

Common (1% to 10%): Scalp irritation, rash

Uncommon (0.1% to 1%): Itching, urticaria, flushing, exanthema

Frequency not reported: Diaphoresis, photodermatitis

Postmarketing reports: Ecchymosis, bruising, alopecia/hair loss, hyperkeratosis, macules, Stevens-Johnson syndrome, hyperhidrosis/sweating, erythema multiforme, Quincke's edema/angioneurotic edema^[Ref]

Itch and urticaria occurred in hypersensitivity reactions.^[Ref]

Psychiatric

Common (1% to 10%): Sleep disturbance

Uncommon (0.1% to 1%): Bad dreams, depression/emotional depression

Postmarketing reports: Confusion, psychotic symptoms, insomnia, nervousness^[Ref]

Musculoskeletal

Common (1% to 10%): Myalgia

Frequency not reported: Muscle fatigue

Postmarketing reports: Muscle cramps, arthralgia^[Ref]

Hepatic

Uncommon (0.1% to 1%): Elevated liver enzymes (transaminases, alkaline phosphatase)^[Ref]

Reversible elevations liver enzymes occurred during treatment, and are likely the result of a hypersensitivity reaction (e.g., allergic hepatitis).^[Ref]

Hypersensitivity

Rare (0.01% to 0.1%): Hypersensitivity/allergic reactions

Postmarketing reports: Allergy aggravated^[Ref]

Metabolic

Frequency not reported: Lowered glucose tolerance

Postmarketing reports: Hyperkalemia^[Ref]

Genitourinary

Postmarketing reports: Galactorrhea, increased blood prolactin/hyperprolactinemia, increased urination, spotty menstruation, erectile dysfunction/impotence^[Ref]

Renal

Postmarketing reports: Renal failure^[Ref]

Endocrine

Postmarketing reports: Gynecomastia^[Ref]

Gynecomastia occurred in older male patients on prolonged treatment, and was reversible upon discontinuation of this drug.^[Ref]

Hematologic

Postmarketing reports: Purpura^[Ref]

Ocular

Postmarketing reports: Blurred vision^[Ref]