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This document provides vital safety information and warnings about the use of Verapamil ER (Verelan). It is crucial to understand the potential risks and precautions associated with this medication. Consult your healthcare provider if you have any questions or concerns.

• Heart Failure: Verapamil ER (Verelan) may lead to heart failure and fluid accumulation in the lungs, especially if you have a history of heart disease. Symptoms include shortness of breath, fatigue, swelling in the feet, legs, or abdomen, rapid weight gain, dizziness, and a persistent cough. Discuss with your healthcare provider if you have a history of heart issues; additional medications like diuretics may be necessary.

• Low Blood Pressure: This medication can significantly lower blood pressure, though it is uncommon. Be vigilant for signs such as dizziness, lightheadedness, weakness, blurry vision, thirst, sweating, pale or cold skin, rapid breathing, or confusion. Inform your healthcare provider if you have a history of low blood pressure or are on blood pressure medications.

• Liver Issues: Verapamil ER (Verelan) might increase liver protein levels in the blood, with some cases leading to serious liver problems. Routine blood tests may be required if you have a history of liver disease. Alert your healthcare provider if you experience symptoms such as yellowing of the skin or eyes, stomach pain or swelling, appetite loss, dark urine, nausea, vomiting, fatigue, or confusion.

• Heart Rhythm Changes: The medication can alter heart rhythm, occasionally causing a decrease in heart rate or a heart block, which could be serious. Seek emergency medical assistance if you have chest pain, dizziness, shortness of breath, extreme fatigue, fainting, or an irregular heartbeat.

• Heart Rhythm Complications: Ensure your healthcare provider is informed of your complete medical history, particularly if you have heart rhythm problems like Wolff-Parkinson-White or Lown-Ganong-Levine syndrome, or hypertrophic cardiomyopathy.

Contraindications: Verapamil ER (Verelan) should not be used in the following conditions due to potential severe health risks:

• Left ventricular dysfunction
• Systolic blood pressure under 90 mmHg or cardiogenic shock
• Sick sinus syndrome
• Second- or third-degree heart block
• Atrial fibrillation or atrial flutter with congenital extra heart muscle tissue

If any of these conditions apply to you, consult your healthcare provider before using this medication.

When taking this medication, you might experience some common side effects that are generally mild. These include dizziness, constipation, nausea, headache, tiredness, and indigestion. It's important to note that dizziness and lightheadedness can be minimized by rising slowly from a sitting or lying position. If any of these symptoms persist or worsen, consulting your healthcare provider is advisable.

There are more serious side effects that, while rare, require immediate medical attention. These include severe dizziness, fainting, new or worsening symptoms of heart failure (such as shortness of breath, swelling of the ankles or feet, unusual tiredness, or sudden weight gain), and a very slow heartbeat. The medication can also cause serious liver disease, which may be indicated by persistent nausea or vomiting, loss of appetite, stomach pain, yellowing of the eyes or skin, and dark urine.

In rare cases, a severe allergic reaction may occur, characterized by rash, itching, swelling (especially of the face, tongue, or throat), severe dizziness, and difficulty breathing. It is crucial to seek medical help immediately if you notice any of these symptoms. Always communicate with your healthcare provider if you observe any side effects, whether they are listed here or not.

Verapamil ER (Verelan) can interact with various medications and supplements. It's important to inform your healthcare provider about all medicines you are taking, including prescription drugs, over-the-counter medications, vitamins, and herbal supplements.

Some drugs should not be combined with Verapamil, such as colchicine, dofetilide, eliglustat, flibanserin, and lomitapide. Your doctor might decide to avoid using Verapamil or alter your current medication regimen if you are taking these.

There are other medications that are generally not recommended to be used with Verapamil but might be necessary depending on your condition. In such cases, your physician may adjust doses or administration schedules. These include a wide range of drugs such as abametapir, acalabrutinib, and others, including erythromycin and fingolimod.

Additionally, combining Verapamil with certain drugs might increase the risk of side effects. However, if the combination is essential for your treatment, your doctor may modify the dosage or frequency. These medications include apixaban, buspirone, cyclosporine, lithium, and several others.

Verapamil can affect how other medications are removed from your body, potentially altering their effectiveness. It's crucial to discuss all your medications with your pharmacist to ensure safe use, especially those that may impact heart rate or blood pressure, like certain cough-and-cold products, diet aids, or NSAIDs such as ibuprofen and naproxen.