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Verapamil is a class IV antiarrhythmic drug which impedes calcium transport across the myocardial and vascular smooth muscle cell membrane.

Effects:

  • prolongs the slow component of the action potential and so prolongs the effective refractory period
  • acts mainly at the SA and AV nodes - impairs conduction at these points
  • negative ionotrope - diltiazem may be an alternative if this is a problem
  • causes peripheral vasodilatation in smooth muscle so reducing cardiac load
  • the combined effects of reducing cardiac load and of reducing myocardial contractility reduces myocardial oxygen requirements

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