Verapamil

Antihypertensive (calcium channel blocker)

Mania/mixed augmentation [3]

Ultra-rapid cycling [2]
Migraines

Features

Tolerable, Generic, Non-controlled, Bipolar-Safe, Weight-Free, Sexual-free, Medication, Elderly-Safe

Handout

Dosing

90-480 mg/day, give as ER at night (IR is same price and must be divided TID).

INTERACTIONS: Lithium levels can increase or decrease on it. CYP3A4 inducers/inhibitors alter its levels (including grapefruit which raises it). Verapamil may prolong intoxication from alcohol.

Management

Possibly treats mania, rapid cycling (4 episodes per year) and ultra-rapid cycling (more frequent). Among the ca-channel blockers, verapamil has a unique mechanism, while nimodipine, isradipine, and amlodipine are similar.

TOLERABILITY: Dizziness, GI upset, rare edema.

RISKS: Get medical approval in heart disease (AV conduction delays). Monitor BP (hypotension risk).

EMR Text

Bipolar Disorder

Verapamil use based on preliminary trials as augmentation in bipolar mania (Mallinger AG et al, Bipolar Disord. 2008;10(8):856-866).

Off label use and cardiac risks (hypotension) reviewed with patient.

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