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AspirinIn a few reported casescoadministration of verapamil with aspirin has led to increased bleeding time greater than observed with aspirin alone.

6Product InformationIsoptinverapamilKnoll Pharmaceutical CompanyWhippanyNJ.

Heart FailureVerapamil has a negative inotropic effect whichin most patientsis compensated by its afterload reductiondecreased systemic vascular resistanceproperties without a net impairment of ventricular performanceIn clinical experience with 4,954 patients871.8developed congestive heart failure or pulmonary edemaVerapamil should be avoided in patients with severe left ventricular dysfunctione.gejection fraction less than 30or moderate to severe symptoms of cardiac failureand in patients with any degree of ventricular dysfunction if they are receiving a beta adrenergic blockersee DRUG INTERACTIONSPatients with milder ventricular dysfunction shouldif possiblebe controlled with optimum doses of digitalis and/or diuretics before verapamil treatmentNote interactions with digoxin underPRECAUTIONS

Approximately 15of patients who had atrial flutter/fibrillation and received this drug and digoxin developed resting ventricular rates below 50 beats/minin the same trialasymptomatic hypotension occurred in approximately 5of patients.

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