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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
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