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Prescribing Information
Covera-HS® (verapamil hydrochloride)
Dosage and Administration
Return to the COVERA Product Center

COVERA-HS should be administered once daily at bedtime. Clinical trials explored dose ranges between 180 mg and 540 mg given at bedtime and found effects to persist throughout the dosing interval.

COVERA-HS tablets should be swallowed whole and not chewed, broken, or crushed.

For both hypertension and angina, the dose of COVERA-HS should be individualized by titration. Initiate therapy with 180 mg of COVERA-HS.

If an adequate response is not obtained with 180 mg of COVERA-HS, the dose may be titrated upward in the following manner:

    a) 240 mg each evening
    b) 360 mg each evening (2 x 180 mg)
    c) 480 mg each evening (2 x 240 mg)

When COVERA-HS is administered at bedtime, office evaluation of blood pressure during morning and early afternoon hours is essentially a measure of peak effect. The usual evaluation of trough effect, which sometimes might be needed to evaluate the appropriateness of any given dose of COVERA-HS, would be just prior to bedtime.

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COVERA-HS Indication and Important Safety Information
 

Please scroll to see the Indication below.

Important Safety Information

COVERA-HS is indicated for the management of hypertension and angina.

COVERA-HS is contraindicated in patients with severe left ventricular dysfunction, hypotension or cardiogenic shock, sick sinus syndrome, 2° or 3° AV block, or atrial flutter or atrial fibrillation and an accessory bypass tract.

The most commonly reported side effects of COVERA-HS (N=572) compared with placebo (N=261) were constipation (11.7%*/2.7%), headache (6.6%/7.3%), upper respiratory infection (5.4%/4.6%), dizziness (4.7%/2.7%), fatigue (4.5%/3.8%), edema (3.0%/3.1%), nausea (2.1%/1.9%), 1° AV block (1.7%/0.0%), elevated liver enzymes (1.4%/0.8%), and bradycardia (1.4%/0.4%).

Concomitant therapy with β-adrenergic blockers and verapamil may result in additive negative effects on heart rate, AV conduction, and/or cardiac contractility. There have been reports of excessive bradycardia and AV block, including complete heart block. The combination should be used only with caution and close monitoring.

Potential clinically significant interactions can be seen with concomitant therapy of verapamil with digitalis, disopyramide, flecamide, quinidine, lithium, carbamazepine and theophylline as well as other agents. These interactions may result in, but are not limited to, digitalis toxicity, significant hypotension, heart failure, or an increased concentration/sensitivity of the concomitant medication.

Concomitant therapy with oral hypertensive agents, including ACE inhibitors, will usually have an additive effect on lowering BP; patients receiving these combinations should be appropriately monitored.

Since verapamil is highly metabolized by the liver it should be administered cautiously to patients with hepatic impairment. In patients with severe hepatic dysfunction approximately 30% of the recommended dosage may be given; patients should be appropriately monitored.

*At the typical 240-mg dose, incidence of constipation was 7.2%.

Indication

COVERA-HS is indicated for the management of hypertension and angina.

COVERA-HS is contraindicated in:

  1. Severe left ventricular dysfunction
  2. Hypotension (systolic pressure less than 90 mmHg) or cardiogenic shock
  3. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)
  4. Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker)
  5. Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (eg, Wolff-Parkinson-White, Lown-Ganong-Levine syndromes)
  6. Patients with known hypersensitivity to verapamil hydrochloride
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