Presocor tablets

Presocor

  • Active Ingredient: Verapamil
  • 240 mg, 120 mg, 80 mg
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What is Presocor?

The active ingredient of Presocor brand is verapamil. Verapamil is a calcium channel blocker. It works by relaxing the muscles of your heart and blood vessels. Benzeneacetonitrile, α-[3-[[2-(3,4-dimethoxyphenyl)ethyl]methylamino]propyl]-3,4-dimethoxy α-(1-methylethyl) hydrochloride Verapamil hydrochloride, USP is an almost white, crystalline powder, practically free of odor, with a bitter taste. It is soluble in water, chloroform, and methanol. Verapamil hydrochloride is not chemically related to other cardioactive drugs. Inactive ingredients include calcium sulfate, colloidal silicon dioxide, croscarmellose sodium, hydroxypropyl cellulose, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, pregelatinized starch (corn), sodium lauryl sulfate, talc and titanium dioxide.

Used for

Presocor is used to treat diseases such as: Angina, Arrhythmia, Bipolar Disorder, Cluster Headaches, High Blood Pressure, Idiopathic Hypertrophic Subaortic Stenosis, Migraine Prevention, Nocturnal Leg Cramps, Supraventricular Tachycardia.

Side Effect

Possible side effects of Presocor include: unusual tiredness or weakness; blurred vision; pale skin; joint pain; coughing that sometimes produces a pink frothy sputum; trouble sleeping; intravenous solution.

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Allergy warning

Presocor can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives
  • rash or itching
  • swollen or peeling skin
  • fever
  • chest tightness
  • swelling of your mouth, face, or lips

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

Before taking Presocor,

  • tell your doctor and pharmacist if you are allergic to Presocor, any other medications, or any ingredients in Presocor. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alpha blockers such as prazosin (Minipress); antifungals such as itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral); aspirin; beta blockers such as atenolol (Tenormin, in Tenoretic), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), propranolol (Inderal, Innopran, in Inderide), and timolol (Blocadren, in Timolide); carbamazepine (Carbatrol, Epitol, Equetro, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin, in Prevpac); cyclosporine (Neoral, Sandimmune); digoxin (Lanoxin); disopyramide (Norpace); diuretics (''water pills''); erythromycin (E.E.S., Eryc, Erythrocin); flecainide; certain HIV protease inhibitors such as indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra); quinidine (in Nuedexta); lithium (Lithobid); medications to treat high blood pressure; nefazodone; phenobarbital; pioglitazone (Actos, in Duetact, in Oseni); rifampin (Rifadin, Rimactane); telithromycin (Ketek); and theophylline (Theochron, Theolair, Uniphyl). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with Presocor, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
  • tell your doctor what herbal products you are taking, especially St. John's wort.
  • tell your doctor if you have or have ever had narrowing or blockage of your digestive system or any other condition that causes food to move through your digestive system more slowly; heart failure; heart, liver, or kidney disease; muscular dystrophy (inherited disease that causes gradual weakening of muscles); or myasthenia gravis (condition that causes certain muscles to weaken).
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking Presocor, call your doctor.
  • if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking Presocor.
  • talk to your doctor about the safe use of alcoholic beverages during your treatment with Presocor. Presocor may cause the effects of alcohol to be more severe and longer-lasting.

What is Presocor, and how does it work (mechanism of action)?

Presocor belongs to a class of medications called calcium channel blockers (CCBs), which includes amlodipine (Norvasc), diltiazem (Cardizem, Dilacor), nifedipine (Adalat, Procardia) as well as others. These medications block the movement of calcium into the muscle cells of the coronary arteries (the arteries supplying the heart with blood) as well as the other arteries of the body. Since calcium triggers contraction of muscles, blocking entry of calcium relaxes the muscles that surround the arteries. This relaxation allows arteries to become larger so that more blood can flow through them. Thus, Presocor is useful in treating and preventing chest pain (angina) resulting from spasm (contraction) of the coronary arteries that reduces the flow of blood to the heart. Relaxing muscles in the arteries of the rest of the body lowers blood pressure and thereby reduces the pressure against which the heart must pump blood. As a result, the heart works less and requires less oxygen-carrying blood. This allows the heart to work with the reduced flow of blood caused by coronary artery disease and prevents angina (which occurs whenever the flow of blood to the heart is inadequate). Presocor also decreases the conduction of electrical impulses through the heart that control the coordination of contraction. As a result, the rate of contraction slows. Presocor was approved by the FDA in March 1982.

Which drugs or supplements interact with Presocor?

Concurrent use of Presocor with a beta blocker (another class of medications that slow heart rate) can cause profound and dangerous reductions in heart rate. Presocor can raise the levels of some drugs in blood including digoxin (Lanoxin), theophylline (Slo-Bid), cyclosporin, and carbamazepine (Tegretol). Therefore, monitoring of the levels of these drugs is important to avoid toxicity.

Presocor may reduce blood levels of lithium (Eskalith, Lithobid) in some patients. For unclear reasons some patients who took both Presocor and lithium have noticed increased side effects of lithium without increases in their blood levels of lithium.

The use of "statins" (for example, simvastatin or lovastain) in combination with Presocor has been associated with reports of myopathy/rhabdomyolysis because Presocor reduces the break down of these statins in the liver. The dose of simvastatin in patients on Presocor should not exceed 10 mg daily and the dose of lovastatin (Mevacor, Altoprev) should not exceed 40 mg daily. Lower starting and maintenance doses of other statins (for example, atorvastatin ) may be required since Presocor also may increase the plasma concentration of these drugs also. Rifampin and phenobarbital increase the elimination of Presocor, potentially reducing the effect of Presocor.

Presocor Overdose

If you suspect an overdose, contact a poison control center or emergency room immediately.

You can get in touch with a poison control center at (800) 222-1222.

Patients With Hypertrophic Cardiomyopathy (IHSS)

In 120 patients with hypertrophic cardiomyopathy (most of them refractory or intolerant to propranolol) who received therapy with Presocor at doses up to 720 mg/day, a variety of serious adverse effects were seen. Three patients died in pulmonary edema; all had severe left ventricular outflow obstruction and a past history of left ventricular dysfunction. Eight other patients had pulmonary edema and/or severe hypotension; abnormally high (greater than 20 mm Hg) pulmonary wedge pressure and a marked left ventricular outflow obstruction were present in most of these patients. Concomitant administration of quinidine (see DRUG INTERACTIONS) preceded the severe hypotension in 3 of the 8 patients (2 of whom developed pulmonary edema). Sinus bradycardia occurred in 11% of the patients, second-degree AV block in 4%, and sinus arrest in 2%. It must be appreciated that this group of patients had a serious disease with a high mortality rate. Most adverse effects responded well to dose reduction, and only rarely did Presocor use have to be discontinued.

What Is Presocor and How Does It Work?

Presocor may also be used to treat Migraines.

Presocor is available under the following different brand names: Isoptin SR, Calan SR, Covera HS, Isoptin, Isoptin IV, Calan, Verap, Presocor SR, Verelan, and Verelan PM.

Dosages of Presocor:

Adult and Pediatric Dosage Forms and Strengths

Tablet/capsule, extended release

Dosage Considerations – Should be Given as Follows:

  • Adult, Immediate release: 80 mg orally every 8 hours initially; usual range: 80-120 mg orally every 8 hours; not to exceed 480 mg/day
  • Adult, Extended release: Covera-HS: 180 mg/day orally at bedtime initially; maintenance: 180-540 mg/day orally at bedtime
  • Geriatric, Immediate release: 80 mg orally every 8 hours initially; usual range: 80-120 mg orally every 8 hours; not to exceed 480 mg/day
  • Geriatric, Extended release (Covera-HS): 180 mg orally at bedtime initially; maintenance: 180-540 mg orally at bedtime

Adult, Immediate release: 80 mg orally every 8 hours initially; maintenance: 80-320 mg orally every 12 hours

Adult, Extended release

  • Calan, Isoptin SR: 180 mg/day orally given in morning (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day, then to 360 mg/day (either 180 mg every 12 hours or 240 mg in morning and 120 mg in evening)
  • Verelan: 180 mg/day orally (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day orally, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day
  • Verelan PM: 200 mg/day orally at bedtime (100 mg/day if patient elderly or of small stature); may be increased by 100 mg/day at weekly intervals as needed; not to exceed 400 mg/day
  • Covera-HS: 180 mg/day orally at bedtime (120 mg/day initially if patient elderly or of small stature); for desired response, may be increased to 240 mg/day, then by 120 mg/day at weekly intervals; not to exceed 480 mg/day

  • Immediate release: 40 mg orally every 8 hours initially; maintenance: 80-320 mg orally every 12 hours
  • Extended release (Calan SR, Isoptin SR, Verelan): 120 mg/day orally given in morning
  • Extended release (Covera-HS): 180 mg/day orally at bedtime
  • Extended release (Verelan PM): 100 mg/day orally at bedtime

Supraventricular Arrhythmia and Atrial Fibrillation/Flutter

  • 2.5-5 mg intravenously (IV) over 2 minutes; 5-10 mg dose may be repeated after 15-30 minutes
  • Alternatively, 0.075-0.15 mg/kg (not to exceed 10 mg) IV over 2 minutes; dose may be repeated once 30 minutes after first dose

Chronic Atrial Fibrillation and Paroxysmal Supraventricular Tachycardia

  • Treatment of chronic atrial fibrillation (rate control); prevention of paroxysmal supraventricular tachycardia
  • Immediate release: 240-480 mg/day orally divided every 6-8 hours

Supraventricular Tachycardia, Pediatric

  • Children 1-15 years old: 0.1-0.3 mg/kg (not to exceed 5 mg) intravenously (IV) over 2 minutes; second dose (not to exceed 10 mg) may be given after 30 minutes
  • Alternatively (not well established), 4-8 mg/kg/day orally divided every 8 hours

  • 40 mg orally every 8 hours; may be titrated to 120 mg every 8 hours

  • Renal impairment: Use with caution; monitor ECG; for Verelan PM, manufacturer recommends 100 mg at bedtime initially; if CrCl less than 10 mL/min, reduce dose by 25-50%
  • Hepatic impairment: In cirrhosis, reduce dose by 20-50% of normal for oral and intravenous (IV) administration
  • Geriatric: In general, lower initial doses are warranted; doses should be adjusted on basis of clinical response

In a few reported cases, co-administration of Presocor with aspirin has led to increased bleeding times greater than observed with aspirin alone.

Summary

Presocor (Calan, Verelan, Verelan PM, ) is a medication prescribed for the prevention and treatment of the heart pain of angina, high blood pressure, and abnormally fast heart rhythms such as atrial fibrillation. Although Presocor is not an approved indication for migraine, it is used for preventing migraine headaches.

Q: I take Presocor ER tabs. Is it true that after years of taking high blood pressure medicine it can enlarge your aorta?

A: Presocor HCl ER (brand names Calan, Verelan) belongs to the group of medications known as calcium channel blockers. Presocor works to keep blood vessels open, making it easier for the heart to pump blood through the body. Presocor ER is an extended-release form of Presocor that is used to treat high blood pressure. The prescribing information does not specifically list enlarged aorta as a possible long-term side effect of Presocor use. The aorta is the large blood vessel that comes out of the heart to deliver blood to the body. The aorta can become enlarged at any point over its 2- to 3-foot length. Enlargement of the aorta is generally caused by conditions that change the properties of the blood vessel wall. The most common causes are cigarette smoking, high blood pressure (or hypertension), and high cholesterol levels. Genetics (meaning your family history) may also play a role. Controlling blood pressure and obtaining appropriate evaluations and diagnostic tests by your healthcare provider is the best way to prevent the aorta from getting larger over time. Michelle McDermott, PharmD

Q: Can Presocor and/or tramadol impair driving?

A: Tramadol is in a drug class called opiate agonists. Tramadol is used for the management of moderate to moderately severe pain. Tramadol works by altering pain sensation in the body. The most common side effects with tramadol are: dizziness/vertigo; nausea; constipation; headache; sleepiness; vomiting; itching; central nervous system stimulation (i.e., nervousness, anxiety, agitation, continuous muscle contraction, euphoria, emotional instability, and hallucinations); lack or loss of strength and energy; sweating; upset stomach; dry mouth and diarrhea. According to tramadol prescribing information, tramadol may impair the mental or physical abilities required to perform potentially hazardous tasks, like driving a motor vehicle or operating machinery. Caution should be used accordingly. Presocor is in a drug class called calcium channel blockers. Presocor is used to lower high blood pressure. Presocor is also used to manage angina (chest pain). In addition, the immediate release version of Presocor is used alone or combined with other medications to prevent or treat conditions that cause abnormal heartbeats. Presocor works by relaxing blood vessels. This allows the heart to not have to pump as hard. Presocor also allows for a greater supply of blood and oxygen to the heart. Presocor controls heart rate by slowing electrical activity in the heart. The most common side effects with Presocor are: constipation; dizziness; nausea; low blood pressure; headache; swelling of tissues due to accumulation of fluid; congestive heart failure/fluid in the lungs; fatigue; difficulty breathing; slow heart beat; and impairment of electrical impulses in the heart. Other side effects with Presocor include confusion; balance disorders; shakiness; sleepiness; and blurred vision. Prescribing information for Presocor does not carry the same warning as tramadol about impairment of mental or physical abilities required to perform potentially hazardous tasks. However, people who experience certain side effects with Presocor (e.g., dizziness, confusion; balance disorders; shakiness; sleepiness; and blurred vision) may have an impaired ability to drive a motor vehicle or operate machinery. Derek Dore, PharmD

By Julie Marks | Medically Reviewed by Ruthan White, PharmD

Latest Update: 2014-10-28 Copyright © 2014 Everyday Health Media, LLC

Animal Pharmacology And/Or Animal Toxicology

In chronic animal toxicology studies, Presocor caused lenticular and/or suture line changes at 30 mg/kg/day or greater, and frank cataracts at 62.5 mg/kg/day or greater in the beagle dog but not in the rat. Development of cataracts due to Presocor has not been reported in man.

Availability

Presocor is available for injection as 2.5 mg/mL in 2-mL and 4-mL ampules.

Presocor may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • constipation
  • heartburn
  • dizziness or lightheadedness
  • headache

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