ACUTE ASTHMA ASSOCIATED WITH SUSTAINED-RELEASE VERAPAMIL

OBJECTIVE: To describe a patient with asymptomatic bronchial asthma an d hypertension who developed an acute asthma attack after receiving su stained-release verapamil. CASE SUMMARY: A 66-year-old white woman wit h a 10-year history of hypertension and bronchial asthma was switched from immediate-release verapamil hydrocloride 40 mg rid to sustained-r elease verapamil 240 mg/d po for better hypertension control. After ta king the first tablet, she developed dyspnea, cough, and wheezing. Ant iasthmatic medications were prescribed, but the asthma symptoms did no t improve. She continued taking verapamil for 6 months, then, on her o wn, stopped all medications including the sustained-release verapamil, and her asthma symptoms disappeared. On rechallenge she developed sev ere dyspnea, cough, and wheezing 20 minutes after administration. The asthma resolved within 24 hours following three albuterol inhalations. The next day similar symptoms developed with rechallenge of the same brand of sustained-release verapamil in a 120-mg formulation, and vera pamil was discontinued. Six months later she was again prescribed sust ained-release verapamil 240 mg in another clinic where the physician w as unaware of her previous reaction. Once again, severe dyspnea, cough , and wheezing developed. DISCUSSION: On four separate occasions the p atient was challenged, advertently or inadvertently, with sustained-re lease verapamil. Similar symptoms developed after each challenge and r esolved after discontinuing this preparation. Although dyspnea associa ted with verapamil administration has been reported, this is the first report of an elderly asymptomatic asthmatic patient with hypertension who developed an acute asthma attack following sustained-release vera pamil administration. CONCLUSIONS: Sustained-release verapamil is thou ght to be the cause of the asthma attack in this patient because she w as not taking any other preparations; the symptoms started with the ad ministration of sustained-release verapamil and were relieved after it s discontinuation.