Home Drug Guide Bepridil Hydrochloride

Drug Guide

Generic Name

Bepridil Hydrochloride

Brand Names Bepadin, Vascor

Classification

Therapeutic: Antianginal, Antiarrhythmic

Pharmacological: Calcium channel blocker

FDA Approved Indications

Chronic stable angina pectoris

Mechanism of Action

Bepridil inhibits calcium influx into cardiac and smooth muscle cells, resulting in decreased myocardial oxygen demand and vasodilation, which helps to alleviate angina. It also affects certain ion channels involved in cardiac conduction, exhibiting antiarrhythmic effects.

Dosage and Administration

Adult: Start with 50 mg three times daily; dosage may be adjusted based on response and tolerability, up to 100 mg three times daily.

Pediatric: Not typically used in pediatric patients.

Geriatric: Use with caution; start at lower doses due to increased sensitivity and potential for adverse effects.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor liver function as metabolism may be affected.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Primarily hepatic via CYP450 enzymes.

Excretion: Excreted mainly in urine and feces.

Half Life: Approximately 8-10 hours, extended with hepatic impairment.

Contraindications

Known hypersensitivity to bepridil.
Severe hypotension.
Concomitant use with quinidine, disopyramide, or other class III antiarrhythmics.

Precautions

Use cautiously in patients with congestive heart failure, hepatic or renal impairment, or electrolyte abnormalities.

Adverse Reactions - Common

Dizziness (Common)
Headache (Common)
Nausea (Common)

Adverse Reactions - Serious

QT prolongation leading to torsades de pointes (Rare)
Severe arrhythmias (Rare)
Liver function abnormalities (Uncommon)

Drug-Drug Interactions

Other QT-prolonging agents (e.g., amiodarone, quinidine)
Beta-blockers
CYP450 inhibitors or inducers

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor cardiac rhythm and blood pressure regularly. Assess for signs of arrhythmia or adverse hepatic effects.

Diagnoses:

Risk for arrhythmias
Ineffective tissue perfusion

Implementation: Administer with food to minimize gastrointestinal upset. Monitor ECG and vital signs.

Evaluation: Evaluate effectiveness in reducing angina and monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of arrhythmias (e.g., palpitations, syncope).
Avoid sudden discontinuation.
Limit intake of substances that may affect hepatic metabolism (e.g., grapefruit juice).

Special Considerations

Black Box Warnings:

Potential to cause serious arrhythmias, including torsades de pointes.
Use only under careful supervision with close cardiac monitoring.

Genetic Factors: Genetic variations in CYP450 enzymes may affect metabolism.

Lab Test Interference: May interfere with certain laboratory tests, including liver function tests.

Overdose Management

Signs/Symptoms: Severe hypotension, arrhythmias, ECG changes, altered consciousness.

Treatment: Supportive care, stabilize cardiac rhythm, administer activated charcoal if ingestion was recent, and provide invasive cardiac monitoring as needed.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable for the shelf life specified by manufacturer.