Verapamil: a review of its pharmacological properties and therapeutic use in coronary artery disease.

Verapamil has well proven efficacy in the treatment of patients with hypertension, and early studies indicated its efficacy in the treatment of coronary artery disease. The efficacy of verapamil relative to placebo in patients with stable angina pectoris is confirmed, and the drug is at least as effective as nifedipine, propranolol or metoprolol and of similar efficacy to bepridil and nicardipine when administered as a conventional or sustained release formulation. Verapamil is the first calcium antagonist to be shown in a double-blind study to significantly reduce mortality and reinfarction rate after acute myocardial infarction in patients without heart failure. In these patients, the reduction in mortality achieved with verapamil was similar to that reported with beta-adrenoceptor antagonists, suggesting that verapamil may be a suitable alternative to beta-blockers as secondary prevention in patients intolerant of these drugs. Recurrence of stenosis in patients who successfully undergo percutaneous transluminal coronary angioplasty (PTCA) limits the usefulness of the procedure. Verapamil has recently been shown to significantly reduce the rate of restenosis in patients with stable angina at risk of recurrence, although these initial results require confirmation. Verapamil, therefore, is effective in the treatment of patients with stable angina pectoris, appears to be an alternative to beta-blockers in selected patients as late start secondary prevention after acute myocardial infarction and has a potential role in preventing recurrent stenosis after PTCA, if initial results are confirmed.