Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
COVERA-HS vs CALAN
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Verapamil hydrochloride is a phenylalkylamine calcium channel blocker that inhibits calcium ion influx across cardiac and smooth muscle cells, thereby reducing afterload and myocardial contractility. In the heart, it slows atrioventricular conduction and prolongs the effective refractory period; in vascular smooth muscle, it causes vasodilation, reducing peripheral vascular resistance.
Verapamil inhibits calcium ion influx through voltage-gated L-type calcium channels in cardiac and vascular smooth muscle, leading to decreased myocardial contractility, slowed AV conduction, and vasodilation.
Hypertension,Angina pectoris including chronic stable angina, vasospastic (Prinzmetal's) angina, and unstable angina,Supraventricular tachyarrhythmias including atrial fibrillation/flutter and paroxysmal supraventricular tachycardia
Angina pectoris (chronic stable, vasospastic, unstable),Essential hypertension,Supraventricular tachyarrhythmias (e.g., atrial fibrillation, atrial flutter, PSVT)
180 mg orally once daily at bedtime, extended-release tablet. Maximum dose 540 mg/day.
Initial: 80-120 mg orally 3 times daily; maintenance: 240-480 mg/day in 3-4 divided doses. IV: 5-10 mg over 2 minutes, may repeat after 15-30 minutes.
Terminal elimination half-life is 6–17 hours for immediate-release; for Covera-HS (controlled-onset extended-release), the half-life is 10–20 hours, allowing once-daily bedtime dosing to achieve peak effect in the morning.
Terminal elimination half-life is 3-7 hours for immediate-release; can be prolonged to 12-16 hours with sustained-release due to slow absorption; increased in hepatic impairment.
Primarily hepatic metabolism via cytochrome P450 enzymes, including CYP3A4, CYP2C8, and CYP1A2, with extensive first-pass effect. Major metabolites include norverapamil (active) and various dealkylated and conjugated metabolites.
Extensively metabolized in the liver via CYP3A4, CYP1A2, and CYP2C8 isoenzymes; undergoes N-dealkylation and O-demethylation; first-pass metabolism results in low bioavailability (20-35%).
Primarily hepatic metabolism (oxidation and glucuronidation) with renal excretion of inactive metabolites; approximately 80% of metabolites are excreted renally and 15% fecally.
Approximately 70% renal (3-4% unchanged, remainder as metabolites) and 25% biliary/fecal.
95–98% bound to plasma proteins, primarily to albumin.
Approximately 90% bound to plasma proteins, primarily albumin.
2.0–2.5 L/kg, indicating extensive tissue distribution.
Vd 4-5 L/kg; indicates extensive tissue distribution beyond plasma volume.
Oral: 70–86% due to first-pass metabolism.
Oral bioavailability is 20-35% due to extensive first-pass hepatic metabolism; IV bioavailability is 100%.
GFR 30-80 m L/min: no adjustment; GFR <30 m L/min: start at 180 mg daily, titrate cautiously. Not dialyzable.
Cr Cl <30 m L/min: reduce dose by 50% and monitor carefully.
Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated.
Child-Pugh A: 50% of normal dose; Child-Pugh B: 25% of normal dose; Child-Pugh C: contraindicated or use with extreme caution.
Safety and efficacy not established; no recommended dosing.
Oral: 4-8 mg/kg/day in 3 divided doses; IV: 0.1-0.3 mg/kg over 2 minutes, max 5 mg.
Start at 180 mg orally once daily; titrate slowly due to increased sensitivity and reduced clearance.
Start at lowest dose (e.g., 40 mg 3 times daily) and titrate slowly; monitor for hypotension and bradycardia.
None
Contains verapamil hydrochloride. Risk of serious adverse effects including hypotension, bradycardia, AV block, and cardiac arrest. Must not be administered to patients with severe left ventricular dysfunction, cardiogenic shock, or sick sinus syndrome (unless paced).
May cause hypotension, especially in patients with ventricular dysfunction,Can precipitate heart failure or worsen pre-existing heart failure,Risk of bradycardia and heart block, especially in patients with sick sinus syndrome or pre-existing conduction defects,Caution in patients with hypertrophic cardiomyopathy due to risk of worsening obstruction and hypotension,Avoid abrupt withdrawal in patients with angina; may cause severe exacerbation,May increase serum levels of digoxin, cyclosporine, and other CYP3A4 substrates,Use with caution in patients with hepatic impairment due to reduced clearance,May cause symptomatic hypotension when administered with beta-blockers or other antihypertensives,Monitor for constipation, especially in elderly patients
May cause hypotension, bradycardia, AV block, and exacerbation of heart failure. Avoid in patients with pre-existing conduction abnormalities. Use caution with beta-blockers, digoxin, and CYP3A4 inhibitors. Abrupt withdrawal may exacerbate angina. May increase lithium and carbamazepine levels.
Severe left ventricular dysfunction (ejection fraction <30%),Hypotension (systolic blood pressure <90 mm Hg),Cardiogenic shock,Sick sinus syndrome (unless pacemaker in place),Second- or third-degree AV block (unless pacemaker in place),Atrial fibrillation/flutter with accessory bypass tract (e.g., Wolff-Parkinson-White syndrome),Known hypersensitivity to verapamil or any component of the formulation,Concurrent use of ivabradine
Severe left ventricular dysfunction, cardiogenic shock, sick sinus syndrome (without pacemaker), second- or third-degree AV block (without pacemaker), atrial flutter/fibrillation with accessory bypass tract (e.g., WPW syndrome), concurrent use of IV beta-blockers.
Avoid grapefruit and grapefruit juice; may increase verapamil serum concentrations. Limit alcohol intake; can potentiate hypotensive effects and increase risk of bradycardia. High-fat meals may delay absorption but do not significantly alter AUC; take consistently with food.
Avoid grapefruit and grapefruit juice as they inhibit CYP3A4 metabolism, increasing verapamil levels and risk of toxicity. Limit alcohol intake as it may enhance hypotensive effects. High-fat meals may delay absorption but not extent; take consistently with regard to meals.
First trimester: No increased risk of major congenital malformations based on limited human data; animal studies show fetotoxicity at high doses. Second/third trimester: Associated with fetal hypotension, oligohydramnios, intrauterine growth restriction (IUGR), and hypocalcemia. May cause preterm delivery and neonatal renal impairment.
First trimester: No increased risk of major malformations observed in human studies; animal studies show fetal toxicity at high doses. Second and third trimesters: May cause fetal bradycardia, hypotension, and impaired placental perfusion; avoid use for pregnancy-induced hypertension due to risk of fetal hypoxia.
Verapamil (active ingredient) is excreted into human breast milk at low concentrations (M/P ratio ~0.6-0.8). Estimated infant dose is <0.1% of maternal weight-adjusted dose. Considered compatible with breastfeeding, but monitor infant for hypotonia, bradycardia, and constipation.
Verapamil (CALAN) is excreted into breast milk; M/P ratio approximately 0.6. The relative infant dose is low (estimated <5% of maternal weight-adjusted dose). No adverse effects reported in breastfed infants. Caution in preterm infants or those with renal impairment.
No specific dose adjustments are routinely recommended; however, pharmacokinetic changes in pregnancy (increased plasma volume, increased renal clearance) may necessitate dose titration based on clinical response. Consider using lowest effective dose to minimize fetal hypotension and hypoperfusion.
Pregnancy may increase clearance of verapamil; monitoring of therapeutic effect advised. Dose may need adjustment based on clinical response. Avoid use in pregnancy-induced hypertension.
Covera-HS (verapamil extended-release) is formulated for bedtime dosing to maximize blood pressure control during early morning surge. Avoid use in patients with pre-excited atrial fibrillation (Wolff-Parkinson-White syndrome) due to risk of ventricular fibrillation. Monitor for constipation, especially in elderly. Adjust dose in hepatic impairment; contraindicated in severe left ventricular dysfunction and hypotension.
Calan (verapamil) is a class IV antiarrhythmic and calcium channel blocker. Use caution in patients with hepatic impairment due to reduced clearance; dose adjustment may be needed. Avoid in patients with pre-existing bradycardia, second- or third-degree AV block, or sick sinus syndrome unless a pacemaker is present. May increase digoxin levels; monitor digoxin concentrations. Use with caution in patients with hypertrophic cardiomyopathy. For IV administration, have calcium gluconate available to reverse hypotension or bradycardia. Not recommended for use in acute myocardial infarction or cardiogenic shock.
Take exactly as prescribed, usually once daily at bedtime, with food to minimize gastrointestinal irritation.,Swallow tablet whole; do not crush, chew, or break.,Do not discontinue abruptly; may cause rebound hypertension or angina.,Avoid grapefruit juice and alcohol; they can increase verapamil levels or enhance side effects.,Report symptoms such as slow heartbeat, dizziness, fainting, or swelling of ankles/feet.
Take exactly as prescribed; do not skip doses or stop abruptly without consulting your doctor.,Avoid grapefruit juice as it can increase verapamil levels and risk of side effects.,If you miss a dose, take it as soon as you remember unless it is almost time for the next dose; do not double the dose.,Avoid alcohol as it may worsen side effects like dizziness or low blood pressure.,Report symptoms of bradycardia (slow heart rate), palpitations, shortness of breath, or swelling of ankles/feet.,This medication may cause dizziness; avoid driving or operating machinery until you know how it affects you.,Do not consume grapefruit or its juice during treatment.,Keep a regular medication schedule and do not change brands without doctor approval.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about COVERA-HS vs CALAN, answered by our medical review team.
COVERA-HS is a Calcium Channel Blocker that works by Verapamil hydrochloride is a phenylalkylamine calcium channel blocker that inhibits calcium ion influx across cardiac and smooth muscle cells, thereby reducing afterload and myocardial contractility. In the heart, it slows atrioventricular conduction and prolongs the effective refractory period; in vascular smooth muscle, it causes vasodilation, reducing peripheral vascular resistance.. CALAN is a Calcium Channel Blocker that works by Verapamil inhibits calcium ion influx through voltage-gated L-type calcium channels in cardiac and vascular smooth muscle, leading to decreased myocardial contractility, slowed AV conduction, and vasodilation.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between COVERA-HS and CALAN depend on the specific clinical indication. These are both Calcium Channel Blocker agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of COVERA-HS is: 180 mg orally once daily at bedtime, extended-release tablet. Maximum dose 540 mg/day.. The standard adult dose of CALAN is: Initial: 80-120 mg orally 3 times daily; maintenance: 240-480 mg/day in 3-4 divided doses. IV: 5-10 mg over 2 minutes, may repeat after 15-30 minutes.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between COVERA-HS and CALAN in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. COVERA-HS is classified as Category C. First trimester: No increased risk of major congenital malformations based on limited human data; animal studies show fetotoxicity at high doses. Second/third trimester: Associated. CALAN is classified as Category C. First trimester: No increased risk of major malformations observed in human studies; animal studies show fetal toxicity at high doses. Second and third trimesters: May cause fetal . Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.