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Verapamil Side Effects

In Summary

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

For the Consumer

Applies to verapamil: oral capsule extended release, oral capsule extended release 24 hr, oral tablet, oral tablet extended release, oral tablet extended release 24 hr

Other dosage forms:

As well as its needed effects, verapamil may cause unwanted side effects that require medical attention.

Severity: Major

If any of the following side effects occur while taking verapamil, check with your doctor immediately:

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

Severity: Minor

Some verapamil side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned 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

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

Common (1% to 10%): Pulmonary edema, pharyngitis, sinusitis, rhinitis, dyspnea
Rare (0.01% to 0.1%): Broncho/laryngeal spasm[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]

References

1. "Product Information. Verelan PM (verapamil)." Schwarz Pharma, Mequon, WI.

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

4. "Product Information. Covera-HS (verapamil)." Searle, Skokie, IL.

5. "Product Information. Calan (verapamil)." Searle, Skokie, IL.

6. "Product Information. Isoptin (verapamil)." Knoll Pharmaceutical Company, Whippany, NJ.

It is possible that some side effects of verapamil may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.

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