• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Verapress MR 240 Tablets are and what they are used for
2. What you need to know before you take Verapress MR 240 Tablets
3. How to take Verapress MR 240 Tablets
4. Possible side effects
5. How to store Verapress MR 240 Tablets
6. Contents of the pack and other information

• If you are allergic to Verapamil Hydrochloride or any of the other ingredients of this medicine (listed in section 6).
• If you have had a shock resulting from severely reduced heart function (cardiogenic shock).
• If you are having or have recently had a heart attack, particularly if a slow heart beat, low blood pressure or a type of heart failure called ‘left ventricular failure’ are involved.
• If you have second or third degree atrioventricular block (unless a permanent pacemaker is in place) or sino-atrial block. This is a disorder where parts of your heart may beat at the wrong time causing the heart not to pump blood around the body very well (unless a permanent pacemaker is in place).
• If you have sick sinus syndrome (a heart beat disorder) and do not have a pacemaker.
• If you have heart failure that is currently not under control.
• If you have a problem where your heart beats very slowly (bradycardia) at less than 50 beats per minute.
• If you have low blood pressure where the higher blood pressure reading is below 90.
• If you have certain heart rhythm disorders (atrial fibrillation/fluttering) in the presence of an extra connection between the atrium and ventricle (bypass), for example Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome.
• If you are already taking a medicine containing ivabradine for the treatment of certain heart diseases.

Talk to your doctor or pharmacist before taking Verapress MR 240 Tablets

• If you suffer or you have ever suffered in the past from kidney or liver disorders. These above mentioned medical conditions may mean that your doctor will need to monitor you more closely.
• If you are pregnant or planning to become pregnant, or you are breast-feeding.
• If you suffer or you have ever suffered from certain heart conditions (first degree AV block, too slow heart rate (bradycardia) or an irregular heart beat) or any other cardiac problem.
• If you suffer or you have ever suffered in the past from low blood pressure.
• If you are currently receiving lipid lowering agents (e.g., simvastatin, atorvastatin or lovastatin).
• If you have a condition, where the nerve to muscle transmission is affected e.g. myasthenia gravis, Lambert-Eaton syndrome, advanced Duchenne muscular dystrophy.

Take special care with Verapress MR 240 Tablets

Tell your surgeon or dentist that you are taking Verapress MR 240 Tablets if surgery is planned as it may affect the anaesthetic used.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines

• Aspirin (a non-steroidal anti-inflammatory painkiller (NSAID) used to relieve pain and reduce fever)
• quinidine, flecainide, disopyramide, digoxin and digitoxin (used to treat high blood pressure or an abnormal heart beat (arrhythmia))
• Carbamazepine, phenytoin or phenobarbital (phenobarbitone), medicines used as anticonvulsants in epilepsy)
• Medicines used to treat depression, anxiety or psychosis. These include the herbal product St John’s Wort or Imipramine, buspirone and lithium
• Glyburide (glibenclamide), medicine used to treat certain types of diabetes
• Metformin. Verapamil may decrease the glucose-lowering effect of metformin.
• Antihypertensives (used to treat hypertension)
• Diuretics (also called ‘water pills’)
• Vasodilators (open (dilate) blood vessels)
• Rifampicin (used to treat various tuberculosis (TB) and other types of infections)
• Erythromycin, clarithromycin and telithromycin (used to treat types of infection)
• Doxorubicin (an anti-cancer medicine)
• Midazolam (used as a sedative or anaesthetic)
• Beta-blockers such as atenolol, propranolol and metoprolol (used to treat high blood pressure and heart conditions)
• Colchicine or sulfinpyrazone (used to treat gout)
• Cimetidine (used to treat indigestion or stomach ulcers)
• Ritonavir (used to treat HIV)
• medicines known as immunosuppressants such as ciclosporin, sirolimus, everolimus and tacrolimus (used to prevent organ transplants rejection)
• Medicines known as ‘statins’ such as atorvastatin, lovastatin, simvastatin (used to lower cholesterol levels)
• Almotriptan (used to treat migraine)
• Theophylline (used to treat asthma)
• Dabigatran (used to thin blood)
• Ivabradine (used treat of certain heart diseases)

• Do NOT drink grapefruit juice whilst taking Verapress MR 240 Tablets as it can affect the absorption of this medicine. This does not occur with other fruit juices such as orange, apple or tomato juice.
• Verapress MR 240 Tablets will increase the time your body takes to get rid of alcohol. This means that you may not have to drink as much for your blood alcohol level to be above the legal limit to drive. It will also take you longer to sober up.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine.

Do NOT drive, operate machinery or do anything that requires you to be alert, until you know how the tablets affect you. Verapress MR 240 Tablets can make some people feel dizzy especially when first starting to take the tablets.

This medicine contains about 35 mg sodium (main component of cooking/table salt) in each tablet. This is equivalent to 1.75% of the recommended maximum daily dietary intake of sodium for an adult.

For treatment of Hypertension (high blood pressure)

The recommended dose is one Verapress MR 240 tablet a day. Some patients may need to take two tablets per day (one in the morning and one in the evening with about 12 hours between doses). Do not take more than two tablets per day.

For the treatment and prevention of angina pectoris (chest pain)

The usual starting dose for angina is one Verapress MR 240 tablet taken twice a day. You should take one tablet in the morning and one in the evening, with a gap of about 12 hours in between them. Your doctor may prescribe a lower dose according to your symptoms.

Verapress MR 240 Tablets are NOT recommended for children under 12 years of age.

The dose will be the same as that for adults. If you have kidney or liver problem, your doctor may lower your dose.

If you take more tablets than prescribed (an overdose) you should contact a doctor or go to the nearest hospital casualty department IMMEDIATELY taking your tablets with you.

If you forget to take your tablet, take them as soon as you remember, unless it is almost time for your next dose. If it is, do not take the missed dose at all. Do not take a double dose to make up for a forgotten tablet.

If you stop taking your tablets your condition may get worse. It is important that you continue taking the tablets until your doctor tells you to stop. Do NOT stop just because you feel better.

• If you have any unexpected wheezing or difficulty in breathing, if you have Quincke's oedema (swelling of the face with itching), swelling of the mouth, lips, or tongue, or if you develop a skin rash, pruritus (itching), or severe skin rash with blistering and peeling of the skin. These are signs you are having an allergic reaction.
• If you develop yellowing of the skin or eyes, a fever or tenderness around the middle, elevated levels of liver enzymes. These are signs that your liver may not be functioning as well as usual.
• If you have bradycardia (slow heart beats), arrhythmia (irregular heart beat), palpitations (awareness of an irregular or rapid heart beat), heart failure, chest pains for the first time or chest pains that become more frequent, dizziness, weakness or confusion, swollen ankles, feeling faint or breathless or a burning pain in the feet and/or hands, which may become hot.
• Swelling of the limbs.
• Hypotension (abnormally low blood pressure).

Constipation (the most common side effect), flushing of the face or neck, headaches, feeling or being sick, abdominal pain or discomfort, a feeling of dizziness or spinning (vertigo), tinnitus (ringing or buzzing in the ears), tiredness, tremor, movement disorders, muscle weakness, aches and pains in the joints and/or muscles, a tingling or prickling feeling on the skin, numbness and hair loss. Impotence may occur rarely.

Other side effects might occur if Verapress MR 240 Tablets is used for a long time. Tell your doctor if you develop swollen gums which start to spread over your teeth, or if your breasts swell (males) or start to produce milk (males and females). These effects are rare and are resolved upon stopping taking the tablets.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is Verapamil Hydrochloride 240mg. Each tablet contains 240mg of verapamil hydrochloride, in a modified release (slow release) formulation.
• The other ingredients are Core: Sodium alginate, Microcrystalline cellulose, Povidone, Hypromellose, Colloidal anhydrous silica, Magnesium stearate.
  Coating: Hypromellose, Titanium dioxide, Macrogol, Yellow Lake E-104, Blue Lake E-132 and Carnauba wax.

This medicine can be identified as modified release, light-green film-coated, capsule-shaped, scored tablets.

Verapress MR 240 Tablets are supplied in packs of 28 tablets.