Verapamil

Verapamil is a calcium channel blocker with a dual action on the heart and blood vessels, making it useful across a broader range of cardiovascular conditions than most calcium channel blockers in current use. Verapamil tablets are a prescription-only medicine used in adults for hypertension treatment, angina support, and heart rhythm management. Unlike dihydropyridine calcium channel blockers such as amlodipine, Verapamil acts significantly on cardiac muscle as well as blood vessel walls, giving it rate-slowing and antiarrhythmic properties. A prescription can only be issued following a clinical consultation.

Verapamil tablets are an oral prescription medicine containing Verapamil hydrochloride as the active ingredient. Verapamil is a phenylalkylamine calcium channel blocker, classified as a non-dihydropyridine calcium channel blocker. This places it in a different subclass from the dihydropyridine calcium channel blockers (such as amlodipine, nifedipine, and felodipine) and gives it a different pharmacological profile and clinical application.

Verapamil immediate-release tablets are licensed in the UK for: treatment of mild to moderate hypertension; treatment and prevention of angina pectoris including vasospastic angina; treatment of supraventricular tachycardias including paroxysmal atrial flutter and fibrillation; rate control in chronic atrial fibrillation; and prophylaxis of paroxysmal supraventricular tachycardia.

This page covers the immediate-release tablet formulation. A modified-release capsule formulation of Verapamil (Securon SR, Univer, and others) also exists with different dosing and some different indications and is a separate product.

Five tablet strengths are available: 40 mg, 80 mg, 120 mg, 160 mg, and 240 mg. The wide range of strengths reflects Verapamil's use across multiple indications with different dose requirements. The appropriate strength is always determined by your prescriber.

Verapamil lowers blood pressure, prevents angina, and controls heart rhythm through calcium channel blockade in both the heart and blood vessel walls.

Calcium Channel Blockade in Blood Vessels

In vascular smooth muscle, calcium entry through voltage dependent calcium channels triggers contraction and narrowing of blood vessels. Verapamil blocks these channels in the smooth muscle of arteries, preventing calcium entry and causing the muscle to relax. Blood vessels widen, peripheral vascular resistance falls, and blood pressure decreases. This mechanism is shared with dihydropyridine calcium channel blockers such as amlodipine.

Cardiac Effects: Rate and Conduction

Verapamil also blocks calcium channels in the cardiac muscle cells and in the sinoatrial node (the heart's natural pacemaker) and the atrioventricular node (the electrical bridge between the upper and lower chambers). Blocking calcium entry in these nodes slows the heart rate and reduces the speed of electrical conduction through the atrioventricular node. These cardiac effects are responsible for Verapamil's antiarrhythmic properties and its usefulness in controlling heart rate in atrial fibrillation and supraventricular tachycardias.

This cardiac activity distinguishes Verapamil from dihydropyridine calcium channel blockers, which act predominantly on blood vessels with much less effect on the heart. As a result, Verapamil is used both for hypertension and blood pressure control and for heart rhythm management, applications for which dihydropyridines are not suitable. However, the cardiac effects also mean that Verapamil carries a risk of excessive heart rate slowing when combined with other medicines that slow the heart, particularly beta blockers.

Always take Verapamil exactly as your prescriber instructs. The information below summarises key points from the current UK SmPC. Read the Patient Information Leaflet supplied with your medicine before starting treatment.

• Verapamil immediate-release tablets are taken two or three times daily depending on the indication and dose. This is different from many other blood pressure medicines, which are taken once daily.
• Take Verapamil with or just after food. Food reduces the rapid peak in blood levels that can cause side effects such as flushing.
• Swallow the tablet whole with a glass of water.
• Take each dose at approximately the same times each day to maintain consistent blood levels.
• If you miss a dose, take it as soon as you remember. If it is close to the time of your next scheduled dose, skip the missed dose and continue as normal. Do not take two doses at once.
• Do not stop taking Verapamil suddenly without speaking to your prescriber first. Stopping Verapamil abruptly can allow blood pressure, angina, or heart rhythm problems to return.
• Your prescriber will review your blood pressure and heart rate response to treatment and may adjust the dose.
• Verapamil can cause constipation in some patients, particularly at higher doses. This is a recognised side effect and your prescriber can advise on management.
• Attend all follow up appointments so your treatment can be safely assessed.

Verapamil immediate-release tablets are available in five strengths. The appropriate dose depends on the indication being treated and your individual clinical response. All dose decisions are made by your prescriber.

Verapamil 40 mg Tablets

The 40 mg tablet is the lowest available strength and is used for cautious dose initiation in certain patient groups, or as part of a low dose regimen for supraventricular arrhythmias in patients who are more sensitive to the cardiac effects of Verapamil. It may also be combined with higher-strength tablets to achieve a precise dose.

Verapamil 80 mg Tablets

The 80 mg tablet is a standard dose unit for several indications. For hypertension and angina, the usual starting dose is 80 mg to 120 mg three times daily, with 80 mg tablets supporting three times daily administration. For supraventricular arrhythmias, 80 mg two or three times daily is within the standard dose range. The 80 mg tablet is one of the most frequently prescribed strengths.

Verapamil 120 mg Tablets

The 120 mg tablet supports twice or three times daily dosing at a higher unit strength. For hypertension, three times daily dosing may be simplified to twice daily using the 120 mg tablet. For angina, 120 mg three times daily is within the standard therapeutic range.

Verapamil 160 mg Tablets

The 160 mg tablet allows higher doses to be given less frequently. Some patients with hypertension or angina may be maintained on 160 mg two or three times daily under prescriber supervision. Higher doses require careful monitoring of heart rate and blood pressure.

Verapamil 240 mg Tablets

The 240 mg tablet is the highest available strength in this immediate-release range and is used when higher total daily doses are required under prescriber direction. The maximum recommended daily dose for hypertension and angina varies by SmPC, but is generally up to 480 mg per day in divided doses. For arrhythmias, doses above 480 mg per day are not generally recommended. All dose decisions and any changes are made by your prescriber.

Verapamil can cause side effects related to both its vascular and cardiac effects. The information below is based on the current UK SmPC. Refer to the Patient Information Leaflet for the full list.

Common Side Effects (may affect up to 1 in 10 people)

• Constipation. This is one of the most commonly reported side effects of Verapamil and is more frequent at higher doses. Maintaining adequate fluid intake and dietary fibre can help. Contact your prescriber if constipation is severe or persistent.
• Nausea or abdominal discomfort.
• Headache.
• Dizziness or lightheadedness.
• Flushing or a feeling of warmth.
• Slow heart rate (bradycardia). Contact your prescriber if your heart rate becomes significantly slow.

Uncommon Side Effects (may affect up to 1 in 100 people)

• Low blood pressure (hypotension).
• Ankle swelling (peripheral oedema).
• Fatigue.
• Skin rash or itching.

Serious Side Effects: Seek Urgent Medical Attention

Go to your nearest accident and emergency department or call 999 immediately if you experience:

• Severe slowing of the heart rate or complete heart block (very slow or irregular pulse causing dizziness, fainting, or collapse). The risk is increased if you are also taking a beta blocker or other medicine that slows the heart.
• Signs of heart failure such as increasing breathlessness, ankle swelling, or rapid unexplained weight gain.
• Signs of a severe allergic reaction such as sudden swelling of the face, lips, tongue, or throat.

Report any suspected side effect to your prescriber, pharmacist, or via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Verapamil Tablets May Be Suitable If You:

• Are an adult with a confirmed diagnosis of mild to moderate hypertension.
• Have angina pectoris and require treatment or prevention of angina episodes.
• Have a supraventricular arrhythmia or atrial fibrillation and your prescriber has determined that Verapamil is appropriate for rate control or arrhythmia management.
• Are already prescribed Verapamil and require a repeat prescription through an online prescribing service.

Verapamil Tablets Are Not Suitable If You:

• Are taking a beta blocker. Combining Verapamil with a beta blocker can cause severe bradycardia, atrioventricular block, and potentially fatal cardiac arrest. This combination is contraindicated unless under very specific specialist circumstances with close monitoring. Always tell your prescriber that you are taking Verapamil before any beta blocker is prescribed, and vice versa.
• Have severe bradycardia (a very slow heart rate), second or third degree atrioventricular block, or sick sinus syndrome (unless a pacemaker is in place).
• Have uncompensated heart failure or significantly impaired left ventricular function.
• Have atrial flutter or fibrillation with an accessory bypass tract (such as Wolff-Parkinson-White syndrome). Verapamil can accelerate conduction down the accessory pathway in this setting and trigger life threatening arrhythmias.
• Have hypotension (very low blood pressure).
• Are taking ivabradine.
• Have a known allergy or hypersensitivity to Verapamil or any excipient listed in the SmPC.
• Are under 18 years of age.

Verapamil has a number of clinically important drug interactions. Tell your prescriber about all medicines you take.

• Beta blockers: the combination of Verapamil and a beta blocker is contraindicated or requires extreme caution under specialist supervision. Both medicines slow the heart rate and impair atrioventricular conduction; the combination can cause severe bradycardia, heart block, and cardiac arrest.
• Simvastatin: Verapamil significantly increases simvastatin blood levels. The SmPC states that the simvastatin dose should not exceed 20 mg per day when taken with Verapamil.
• Digoxin: Verapamil increases digoxin blood levels by up to 50 to 75 per cent. Digoxin toxicity can result. Monitoring of digoxin levels is required when starting or adjusting Verapamil.
• Ivabradine: contraindicated. The combination increases the risk of excessive heart rate slowing.
• Colchicine: Verapamil may increase colchicine blood levels, potentially causing serious colchicine toxicity.
• Other antihypertensive medicines: additive blood pressure lowering effects should be considered.
• CYP3A4 inhibitors such as erythromycin, clarithromycin, and azole antifungals: these can significantly increase Verapamil blood levels.
• CYP3A4 inducers such as rifampicin, phenytoin, and carbamazepine: these can significantly reduce Verapamil blood levels and reduce its effectiveness.

Your prescriber will review all current medicines during the clinical assessment before any prescription is considered.

Verapamil is a Prescription Only Medicine. The clinical consultation is the essential first step. A prescription will only be issued if a registered prescriber concludes, based on their individual assessment of your circumstances, that Verapamil is clinically appropriate for you.

During your online consultation with Pharmacy Planet, a registered prescriber will review the information you provide. This includes your diagnosis, blood pressure and heart rate, cardiac history, current medicines, and any other relevant medical information. The prescriber will confirm whether Verapamil is appropriate, which strength and dosing schedule suit your needs, and whether online prescribing is appropriate for your situation.

The cardiac effects of Verapamil and its significant drug interaction profile, particularly with beta blockers, require careful prescriber assessment before any prescription is issued. Not all consultations will result in a prescription. The prescriber may determine that your clinical situation requires further information or that Verapamil is not appropriate through this service, and may recommend you seek review from your GP or specialist.

If you are under the care of a cardiologist, GP, or specialist for any of the conditions Verapamil is used to treat, please keep them informed of all medicines prescribed through online services. Coordinated care is particularly important with Verapamil given its cardiac effects and interaction potential.

Store below 25°C. Protect from light. Store in the original packaging. Keep out of the sight and reach of children. Do not use after the expiry date printed on the packaging. Do not dispose of medicines via household waste or wastewater. Return unused or out of date tablets to your pharmacist for safe disposal. Full storage instructions are provided in the Patient Information Leaflet supplied with your medicine.

Pharmacy Planet is a GPhC-registered online pharmacy providing access to prescription medicines through a clinically led consultation process. Our registered prescribers and pharmacists are committed to patient safety, clinical accuracy, and responsible prescribing. We follow GPhC standards, MHRA guidance, and ASA advertising regulations in all aspects of our service. Every prescription is reviewed and dispensed by qualified healthcare professionals. We provide clear, factual information to help patients understand their antihypertensive medication and make informed decisions about their blood pressure control, cardiovascular therapy, and heart rhythm management. If you have questions about Verapamil or any other medicine, our pharmacy team is available to help. We are committed to transparent, patient centred care.

References

1. Electronic Medicines Compendium (eMC). Verapamil hydrochloride tablets — Summary of Product Characteristics. https://www.medicines.org.uk/emc. Accessed May 2026.
2. National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. NICE guideline NG136. https://www.nice.org.uk/guidance/ng136. Accessed May 2026.
3. NHS. High blood pressure (hypertension). https://www.nhs.uk/conditions/high-blood-pressure-hypertension. Accessed May 2026.
4. Joint Formulary Committee. British National Formulary (BNF). Verapamil hydrochloride. BMJ Group and Pharmaceutical Press. https://bnf.nice.org.uk. Accessed May 2026.
5. Medicines and Healthcare products Regulatory Agency (MHRA). Yellow Card — report a side effect. https://yellowcard.mhra.gov.uk. Accessed May 2026.

Calcium Channel Blocker Tablets

The table below compares calcium channel blocker tablets. Dihydropyridines (such as amlodipine and nifedipine) act mainly on blood vessels. Non-dihydropyridines (Verapamil and diltiazem) also slow the heart rate and have antiarrhythmic properties.

Important: This comparison is for general information only and does not replace medical advice. A prescriber will decide which treatment is suitable for you following an online consultation.