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Calcium Channel Blocker — Intralesional Anti-Fibrotic Pregnancy: Use with caution — verapamil crosses placenta (systemic use associated with fetal bradycardia); intralesional dose extremely low; discuss with patient.

Verapamil (Intralesional — Keloid Anti-Fibrotic)

Brand names: Securon (IV verapamil used for intralesional preparation)

Adult dose

Dose: 2.5 mg/mL verapamil solution, injected 0.5–2 mL intralesionally per session; repeat every 2–3 weeks for 6 sessions
Route: Intralesional injection (prepared from standard 2.5 mg/mL IV verapamil)
Frequency: Every 2–3 weeks for up to 6 sessions
Max: 2.5 mg per session intralesionally (well below systemic cardiac doses)
Intralesional verapamil for keloids — mechanism: calcium channel blockade in fibroblasts inhibits secretion of fibronectin and collagen; induces local fibroblast apoptosis via altered intracellular signalling. Used as alternative or adjunct to triamcinolone when steroid side effects (skin atrophy, telangiectasia) are a concern. Minimal systemic absorption at intralesional doses.

Paediatric dose

Route: Intralesional
Frequency: Every 2–3 weeks
Max: Same per-lesion dose as adult
Off-label in paediatrics — used in specialist centres for keloid treatment in adolescents. Local anaesthetic required.

Dose adjustments

Renal

Not clinically significant at intralesional doses.

Hepatic

Not clinically significant at intralesional doses.

Clinical pearls

  • Advantage over triamcinolone: verapamil does not cause skin atrophy, telangiectasia, or hypopigmentation — important consideration for facial keloids or dark skin. Preferred alternative when steroid side effects are unacceptable or have already occurred
  • Combination approach: verapamil + triamcinolone intralesional combination — several RCTs show superiority over triamcinolone alone; combination reduces steroid dose needed and therefore reduces atrophy risk
  • Evidence base: Roohaninasab et al. RCT (2021): intralesional verapamil vs triamcinolone for keloids — comparable efficacy, significantly less atrophy with verapamil. Increasingly used as first-line intralesional agent for keloids in cosmetically sensitive areas

Contraindications

  • Hypersensitivity to verapamil
  • Significant cardiac conduction abnormalities (theoretical risk if substantial systemic absorption)

Side effects

  • Injection site pain (mild — local anaesthetic pre-treatment recommended)
  • Local oedema (transient)
  • Skin atrophy (less than triamcinolone — advantage of verapamil)
  • Bradycardia (theoretical — systemic absorption from large lesions)
  • Hypotension (rare — systemic absorption)

Interactions

  • Not clinically significant at intralesional doses; theoretical cardiac interactions if systemic levels achieved

Monitoring

  • Keloid volume and texture assessment (response monitoring)
  • Skin texture and pigmentation at injection site (atrophy/hypopigmentation monitoring)
  • HR and BP (if large-lesion treatment with potential systemic absorption)

Reference: BNFc; BNF 90; Roohaninasab et al. J Cosmet Dermatol 2021; Doong et al. Ann Plast Surg 2011; BBA Scar Management Guidelines 2019; MHRA SPC Securon. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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