title: Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalaemia.
abstract: OBJECTIVE
  Treatment for hypertension with verapamil has a favourable renoprotective effect and is generally considered safe in patients with mild to moderate renal failure. In this report, we highlight the vulnerability of patients with mild to moderate renal failure to verapamil side effects especially in the presence of hyperkalaemia.
  We report two cases of junctional bradycardia with slow release (SR) verapamil therapy in the presence of mild hyperkalaemia in patients with mild to moderate chronic renal failure. Verapamil and hyperkalaemia may synergistically increase the vulnerability to atrioventricular conduction delay.
  
  
  CONCLUSIONS
  Renal failure patients with baseline mild hyperkalaemia are particularly liable to bradyarrhythmias with SR verapamil. In such cases, we would recommend verapamil dose reduction and avoidance of SR formulation. In cases of verapamil toxicity, actively treating any level of hyperkalaemia is recommended.
authors.affiliation: Medical Department, Al Adan Hospital, Hadeya, Kuwait. drosama02@gmail.com
authors.forename: M O
authors.initials: MO
authors.lastname: Hegazi
authors.forename: G
authors.initials: G
authors.lastname: Aldabie
authors.forename: S
authors.initials: S
authors.lastname: Al-Mutairi
authors.forename: A
authors.initials: A
authors.lastname: El Sayed
mesh_terms: D000368:Aged; D001919:Bradycardia / Q000139:chemically induced* / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000150:complications* / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014700:Verapamil