verapamil

[zzyzx]

In our service we carry verapamil and have protocols to give it to someone in stable SVT who does not respond to adenosine. I've never given this drug nor known anyone who's given in recently. A few of the old timers here used it before adenosine was around. I did have a patient a few months ago who was in uncontrolled AF (I think the rate was 180 or so). I didn't need to give verapamil as we were just a few minutes from the ER and the patient was perfectly stable with a history of similar episodes. I wondering though if I can get some feedback from people who've used this drug.

Is verapamil always contraindicated in someone who's got a history of CHF?

How effective is it in controlling the rate of uncontrolled AF?

Has anyone had bad experiences or unusual reactions when using it?

[Just Plain Ruff]

They don't call it verapakill for nothing.

I've had patients code on it

I've had patients projectile vomit in the ED with it.

It's really if I remember right fallen out of favor. There are much better drugs out there for stable patients.

[bassnmedic]

18 yrs in the field and have never given it, it's been in the box, but not given.

[Just Plain Ruff]

when I first started it was given quite a bit in our little ER but then again we really didn't have anything better to give. Then along came the better class of drugs like adenocard and that worked wonders.

Then the wisdom changed to sedation and cardioversion which worked very very well on most stable patients that we performed it on, some would not do so well.

Now I believe there are better drugs even now so I think Verapamil should basically go the way of the dodo and Leave-em-dead(nor-epinephrine).

[AZCEP]

There are few medications as potent as Verapamil. Good or bad. There are times when it is the only drug that will work, and times where the best response will be a cardiac arrest. :roll:

Cardizem has replaced it in most systems, but we still have it. For the patient with uncontrolled Afib, Verapamil is the drug of choice--since we don't have Cardizem. If the patient doesn't respond to Adenosine, and they are maintaining their vitals, Verapmil can and will work very well. If you are aware of the side effects, and how it works, it is just as safe as anything else.

Projectile vomiting typically happens when it is given too fast, and cardiac arrest tends to show up when the patient is too compromised to receive it. I've had good luck using it, but haven't needed to in about a year.

[Ridryder 911]

Yes, we there were treatments way before adenocard, cardizem, etc.. yes Verapamil. I used it for years in the field, and yes I had good experiences and bad as well. I agree, for tachyarrhythmias, Adenacard is much more effective and less riskier than Calan.

U have had the dreaded brady-aystole with patients commonly on Lanoxin, and Calan therapy. The most adverse effect I had sen was profuse vomiting, and hypotension.

Like others had described all medications has good effects and adverse, dependent on the indication, and as well as other medication is invented it will change the usage.

R/r 911

[flight-lp]

Since we are on the topic of "old school" SVT drugs, does anyone still use or remember using Endrophonium (Tensilon)? I remember carrying it years ago with great results. A heck of a lot better than Verapamil (Verapakill, I like that!!!!). I never had that whole "calcium channel blocked and you are now dead" asystolic issue.....

[chbare]

I admit that I have never used Verapamil either. I have used Adenosine with variable results. I have used Diltiazem many times and have used it with good results. I have even used Amiodarone a few times. (complicated cases of A-Fib)

Take care,

chbare.

[Medic26]

I have used verapakill twice, both times it worked fine but the pucker factor is high. We actually just removed it from our bags about a month ago.

[brock8024]

I have not used either since i just got out of pharm and have been checked off to give drugs. The one thing they beat into our head is that EVERY drug is a poison. No matter what it is used for they are all poisons and you have to know what will happen when you give it. I know my school wants us to know the reason and the side effects when giving a drug and doses.