Comprehensive Product Description Guide: Covera-HS (Verapamil Hydrochloride Extended-Release)

Covera-HS is an extended-release form of verapamil hydrochloride, used to treat high blood pressure (hypertension) and angina. It helps relax blood vessels, improving blood flow and reducing the heart’s workload, especially during early morning hours when cardiovascular risks are higher.

Covera-HS (Verapamil Hydrochloride Extended-Release Tablets)

Verapamil Hydrochloride (extended-release)

Brand Equivalent: Isoptin SR, Calan SR (International)

Generic Names: Verapamil ER, Verapamil SR, Verapamil Hydrochloride Extended-Release

Drug Class: Calcium Channel Blocker (CCB)

Formulation: Chronotherapeutic Extended-Release (designed to act overnight for early-morning control)

Therapeutic Class: Antihypertensive, Anti-anginal

Pharmacological Class: Calcium Channel Blocker (non-dihydropyridine)

Regulatory Class (Australia): Schedule 4 (S4) – Prescription Only Medicine

Covera-HS contains verapamil, a non-dihydropyridine calcium channel blocker. It inhibits the influx of calcium ions into cardiac and smooth muscle cells during depolarization. This action:

Dilates blood vessels (reduces peripheral resistance)

Lowers blood pressure

Decreases myocardial oxygen demand

Reduces heart rate and AV node conduction

Its HS (bedtime) formulation allows the drug to release overnight, targeting the early morning surge in blood pressure and cardiac workload — a time when heart attacks and strokes are more likely to occur.

Essential Hypertension (especially early morning hypertension)

Stable and Variant Angina (Prinzmetal's Angina)

Rate control in atrial fibrillation/flutter (off-label)

Cardiovascular risk management in circadian-sensitive patients

Administration:

Take once daily at bedtime to align with circadian blood pressure control.

Swallow whole; do not crush or chew.

Typical Adult Dosage:

Initial: 180 mg to 240 mg once daily at bedtime

Maintenance: 240 mg to 360 mg daily, based on patient response

Maximum: 540 mg/day (titrate gradually under supervision)

Form:

Extended-release tablets: 180 mg, 240 mg, 360 mg

Formulation: Chronotherapeutic Extended-Release Tablet

Packaging: 30 tablets per box

Storage: Store below 25°C in a dry place away from sunlight

Severe left ventricular dysfunction

Hypotension (SBP < 90 mmHg)

Sick sinus syndrome (without pacemaker)

Second- or third-degree AV block

Cardiogenic shock

Wolff-Parkinson-White (WPW) syndrome with atrial fibrillation

Use cautiously in hepatic impairment (requires dose reduction)

May worsen bradycardia and AV block

Monitor ECG in patients with arrhythmias

Not recommended in heart failure with reduced ejection fraction

Avoid grapefruit juice (affects CYP3A4 metabolism)
Constipation (most common, dose-related)

Dizziness

Headache

Fatigue

Hypotension

Bradycardia

Edema (especially ankles)

Nausea

Rash

Gingival hyperplasia (long-term use)

AV block

Hepatic enzyme elevation

Heart failure exacerbation

Stevens-Johnson syndrome (rare)

Notable Interactions:

Beta-blockers: Risk of severe bradycardia or AV block

Digoxin: Increases digoxin serum levels

Statins (simvastatin, lovastatin): Increased risk of myopathy

CYP3A4 inhibitors (e.g., erythromycin): May elevate verapamil levels

CYP3A4 inducers (e.g., rifampicin): May reduce efficacy

Antiarrhythmics (e.g., amiodarone, quinidine): Increased bradycardia risk

Food Interactions:

Avoid grapefruit juice, which can increase verapamil bioavailability
VERA Study: Demonstrated verapamil’s efficacy in reducing systolic blood pressure peaks during early morning hours.

CHRONO Trial: Bedtime dosing resulted in improved 24-hour blood pressure control with reduced cardiovascular events.

PREVENT Trial: Showed potential benefits in slowing atherosclerotic progression when combined with other cardiovascular therapies.

Frequently Asked Questions (FAQs)
Q: What is Covera-HS used to treat?
A: It is used to manage high blood pressure and angina, particularly for overnight and early-morning protection against cardiovascular events.

Q: Why is Covera-HS taken at night?
A: Its controlled-release formulation is designed to be taken at bedtime to control the early-morning rise in blood pressure and heart workload.

Q: Can I split or crush the Covera-HS tablet?
A: No. The tablet must be swallowed whole to preserve the controlled-release mechanism.

Q: How quickly does Covera-HS start working?
A: Effects begin within hours of ingestion, with peak blood pressure reduction occurring in the early morning.

Q: Is it safe to use Covera-HS with other heart medications?
A: Yes, but under medical supervision. It interacts with beta-blockers, digoxin, and some statins.
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