Verapime

Uses

Verapime Hydrochloride is used for the treatment of the following infections:

• Pneumonia (moderate to severe)

• Uncomplicated and Complicated Urinary Tract Infections (including pyelonephritis)

• Uncomplicated Skin and Skin Structure Infections

• Complicated Intra-abdominal Infections

• Empiric Therapy for Febrile Neutropenic Patients.

Verapime is also used to associated treatment for these conditions: Bacterial Infections, Complicated Intra-Abdominal Infections, Complicated Urinary Tract Infection, Febrile Neutropenia, Meningitis, Bacterial, Pyelonephritis, Severe Pneumonia, Uncomplicated Urinary Tract Infections, Moderate Pneumonia, Uncomplicated skin and subcutaneous tissue bacterial infections

How Verapime works

Cephalosporins are bactericidal and have the same mode of action as other beta-lactam antibiotics (such as penicillins). Cephalosporins disrupt the synthesis of the peptidoglycan layer of bacterial cell walls. The peptidoglycan layer is important for cell wall structural integrity, especially in Gram-positive organisms. The final transpeptidation step in the synthesis of the peptidoglycan is facilitated by transpeptidases known as penicillin binding proteins (PBPs).

Dosage

Verapime dosage

Recommended dosage schedule for adults with normal renal function

Type of Infection Dose Frequency Duration (Days)

Moderate to severe Pneumonia 1-2 g IV q12h 10

Empiric Therapy for Febrile Neutropenic Patients 2 g IV q8h 7

Mild to moderate Uncomplicated or Complicated Urinary 0.5-1 g IV/IM q12h 7-10

Tract Infections (including pyelonephritis)

Severe Uncomplicated or Complicated Urinary 2 g IV q12h 10

Tract Infections (including pyelonephritis)

Moderate to severe Uncomplicated Skin and Skin Structure 2 g IV q12h 10

Infections

Complicated Intra-abdominal Infections 2 g IV q12h 7-10

Pediatric Patients (2 months up to 16 years)

The maximum dose for pediatric patients should not exceed the recommended adult dose.

Type of Infection Pediatric patients up to 40 kg in weight

Dose Frequency Duration

(Days)

Uncomplicated and Complicated Urinary Tract Infections 50 mg/kg q12h 7-10

(including pyelonephritis)

Uncomplicated Skin and Skin Structure Infections 50 mg/kg q12h 10

Pneumonia 50 mg/kg q12h 10

Febrile Neutropenic Patients 50 mg/kg q8h 7

Impaired Hepatic Function - No adjustment is necessary for patients with impaired hepatic function.

Impaired Renal Function - In patients with impaired renal function (creatinine clearance <60 ml/min), the dose of Verapime should be adjusted. The recommended initial dose of Verapime should be the same as in patients with normal renal function except in patients undergoing hemodialysis. The recommended doses of Verapime in patients with renal insufficiency are presented in the following table:

Creatinine Clearance Recommended Maintenance Schedule

(ml/min)

>60 500 mg q12h 1g q12h 2g q12h 2g q8h

Normal recommended

dosing schedule

30-60 500 mg q24h 1g q24h 2g q24h 2g q12h

11-29 500 mg q24h 500 mg q24h 1g q24h 2g q24h

<11 250 mg q24h 250 mg q24h 500 mg q24h 1g q24h

CAPD 500 mg q48h 1g q48h 2g q48h 2g q48h

Hemodialysis 1g on day 1, then 500 mg q24h thereafter 1g q24h

Preparation of Solutions of Verapime Hydrochloride

Single-dose vial Administration Amount of diluent to be added

500 mg IM 1.3 ml

500 mg IV 5 ml

1 gm IM 2.4 ml

1 gm IV 10 ml

These solutions may be stored up to 24 hours at room temperature or 7 days in a refrigerator.

Verapime Hydrochloride is compatible at concentrations between 1 and 40 mg/ml with the following IV infusion fluids: (1) 0.9% Sodium chloride, (2) 5% and 10% Dextrose.

IV infusion: Add 5 mL, 10 mL, or 10 mL of a compatible IV soln to a vial labeled as containing 500 mg, 1 g, or 2 g, respectively, to provide soln containing approx 100 mg/mL, 100 mg/mL, or 160 mg/mL of the drug, respectively. The appropriate dose of the drug should then be added to a compatible IV soln.

IM inj: Add 1.3 mL or 2.4 mL of an appropriate diluent (e.g. sterile water for inj, NaCl 0.9%) to a vial labeled as containing 500 mg or 1 g respectively, to provide a soln containing approx 280 mg/mL.

Side Effects

Generally Verapime is well tolerated. However, few side-effects including rash, pruritus, urticaria, fever, headache, nausea, vomiting, diarrhea, dizziness, oral moniliasis may occur.

Toxicity

Symptoms of overdose include seizures, encephalopathy, and neuromuscular excitability.

Precaution

In patients with impaired renal function (creatinine clearance <60 ml/min), the dose of Verapime should be adjusted. Verapime should be prescribed with caution in individuals with a history of gastrointestinal diseases, particularly colitis.

Interaction

Increased potential for nephrotoxicity and ototoxicity of aminoglycosides. Increased risk of nephrotoxicity with potent diuretics (e.g. furosemide).

Food Interaction

Verapime Drug Interaction

Moderate: furosemide, furosemideUnknown: ciprofloxacin, ciprofloxacin, apixaban, apixaban, sodium chloride, sodium chloride, acetaminophen, acetaminophen, pantoprazole, pantoprazole, acetaminophen, acetaminophen, cyanocobalamin, cyanocobalamin, cholecalciferol, cholecalciferol, ondansetron, ondansetron

Verapime Disease Interaction

Major: colitisModerate: renal dysfunction, dialysis, liver disease, seizure disorders

Volume of Distribution

• 18.0 ±2.0 L
• 0.3 ±0.1 L/kg [Pediatric]

Elimination Route

The absolute bioavailability of cefepime after an IM dose of 50 mg/kg was 82.3 (±15)% in eight patients.

Half Life

2.0 (± 0.3) hours in normal patients. The average half-life in patients requiring hemodialysis was 13.5 (± 2.7) hours and in patients requiring continuous peritoneal dialysis was 19.0 (± 2.0) hours.

Clearance

• 120 mL/min [Healthy adult male receiving a single 30-minute IV infusions of cefepime]
• 3.3 +/-1.0 mL/min/kg [Petriatic patients (2 months – 11 years of age) receiving a single IV dose]

Elimination Route

Elimination of cefepime is principally via renal excretion with an average (±SD) half-life of 2 (±0.3) hours and total body clearance of 120 (±8) mL/min in healthy volunteers. Verapime is excreted in human milk.

Pregnancy & Breastfeeding use

Pregnancy: There are no adequate and well-controlled studies of Verapime use in pregnant women. Verapime should be used during pregnancy only if clearly needed.

Lactation: Verapime is excreted in human breast milk in very low concentrations. Caution should be exercised when Verapime is administered to a nursing woman.

Contraindication

Hypersensitivity to cefepime or other cephalosporins.

Acute Overdose

Patients who receive an overdose should be carefully observed and given supportive treatment. Symptoms of overdose include encephalopathy (disturbance of consciousness including confusion, hallucinations, stupor, and coma), myoclonus, seizures, and neuromuscular excitability.

Interaction with other Medicine

Renal function should be monitored carefully if high doses of aminoglycosides are to be administered with Verapime because of the increased potential of nephrotoxicity and ototoxicity of aminoglycoside antibiotics. Nephrotoxicity has been reported following concomitant administration of other cephalosporins with potent diuretics such as furosemide.

Storage Condition

Verapime Hydrochloride should be stored in a cool & dry place and protected from light.

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