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Pharmacokinetics and MetabolismWith the immediate release formulationmore than 90of the orally administered dose of ISOPTIN is absorbedBecause of rapid biotransformation of verapamil during its first pass through the portal circulationbioavailability ranges from 20to 35Peak plasma concentrations are reached between 1 and 2 hours after oral administrationChronic oral administration of 120 mg of ISOPTIN every 6 hours resulted in plasma levels of verapamil ranging from 125 to 400 ng/mL with higher values reported occasionallyA nonlinear correlation between the verapamil dose administered and verapamil plasma levels does exist.
Use in Patients with Impaired Hepatic FunctionsSince verapamil is highly metabolized by the liverit should be administered cautiously to patients with impaired hepatic functionSevere liver dysfunction prolongs the elimination half-life of immediate release verapamil to about 14 to 16 hourshenceapproximately 30of the dose given to patients with normal liver function should be administered to these patientsCareful monitoring for abnormal prolongation of the PR interval or other signs of excessive pharmacologic effectssee OVERDOSAGEshould be carried out.
Uncommon0.1to 1Elevated liver enzymestransaminasesalkaline phosphataseRef]
ISOPTINverapamil HClis a calcium ion influx inhibitorslow channel blocker or calcium ion antagonistthat exerts its pharmacologic effects by modulating the influx of ionic calcium across the cell membrane of the arterial smooth muscle as well as in conductile and contractile myocardial cells.
Reversible elevations liver enzymes occurred during treatmentand are likely the result of a hypersensitivity reactione.gallergic hepatitisRef]
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