Contact UsTransdermal Verapamil 15% Gel is a painless, non-invasive, treatment for fibrotic tissue disorders such as Dupuytren's disease that was developed and patented by PDLabs. Since 1998 PDLabs Transdermal Verapamil 15% Gel has been prescribed for over 13,000 patients. It is a prescription compounded medication that is applied directly to the skin twice a day. Verapamil belongs to the class of medications known as calcium channel blockers. The gel has been designed to carry the verapamil through the skin and deliver it to the diseased tissue. The proprietary formula allows for minimal absorption into the blood, while maximizing the concentration of verapamil in the diseased and surrounding tissue.
It is important to understand that there are no "quick fix" treatments for Dupuytren's disease. This is because remodeling tissue is a slow process. Patients should expect to use Transdermal Verapamil 15% Gel for 6 to 12 months to complete their treatment. Patients with a family history or who have an early onset of the condition are more likely to have a recurrence and may need additional treatment. Patients who are experiencing pain or discomfort typically see this as the first symptom to be significantly improved, usually within 90 days. Also by 90 days, patients typically can feel a reduction or softening of the nodules or cords. Once they have started to remodel, the contracture and dermal pits begin to decrease.
As with any medication, Transdermal Verapamil 15% Gel will not help everyone; however, PDLabs wants to make every effort to maximize the results patients receive. Patients that are not responding tend to fall into one of two categories. First are patients that do not improve at all and patients that have responded but seem to have reached a plateau and no longer improving. All patients are started on a twice a day regimen since this is effective for the majority of patients. If you are not responding at this dose, a PDLabs pharmacist will contact your doctor to discuss alternative doses that have proven effective in other patients that might be appropriate for you.
Side effects for patients treating Dupuytren's disease have been very rare. Due to the highly tolerant nature of the skin on the hands, the skin irritation seen in Peyronie's disease patients has not been seen. Since verapamil is a medication used to reduce blood pressure when it is taken orally, patients should report any dizziness, sudden rapid heart beat, or unusual irregular or rapid heart beat to PDLabs and/or their doctor.
Minimal side effects and no risk of additional damage to healthy surrounding tissue, which is a risk normally characteristic of invasive treatments.
Daily localized application enables necessary drug concentration levels to be continually maintained in the affected tissue with little systemic absorption.
Application to the entire palmar fascia allows both palpable and non-palpable fibrotic tissue to be treated, aiding in preventing reoccurrence and improving overall tissue characteristics.
Invasive treatment methods pose certain risks. Due to the density of the fibrotic tissue, injection therapy is unable to effectively dispense enough medication to the entire primary nodule or cord in one injection. Therefore, multiple injections must be made which may cause additional trauma to the surrounding tissue and worsen the condition. Additionally, since injection therapy only pinpoints the palpable nodule or cord, any non-palpable fibrosis in the fascia is left untreated, resulting in a less effective treatment.
Surgery poses risk of additional trauma to healthy fascia and is only able to remove the primary nodule or cord, not underlying fibrosis. In addition to the risks typically associated with surgery such as infection, surgery to correct Dupuytren's disease can have downfalls such as nerve damage, stiffness in the fingers, and a high recurrence rate. Long-term postoperative recurrence has been reported as high as 63%*.
Stretching devices and/or splinting only temporarily help symptoms and do not eliminate the fibrotic tissue causing the condition.
To get the most from Transdermal Verapamil 15% Gel it is critical that you use it correctly. In order to maintain a steady level of the collagenase enzyme that is responsible for remodeling the nodule or cord, the medication must be applied very consistently. Patients that skip doses or days of application, typically see very slow or no improvement in their condition. Transdermal Verapamil 15% Gel should be applied twice a day, approximately 12 hours apart. Remember to allow a few days to get your prescription refilled so that you do not run out of medication.
It is important to keep your appointments with your doctor. Since improvements in your condition occur over time with Transdermal Verapamil 15% Gel, it is often difficult to objectively determine how much your condition has improved. Your doctor will keep notes that can be objectively compared at each exam. You will also want to print out a copy of the symptom checklist for each visit so that you can talk to your doctor about the progress you are making. This will also be helpful in determining if a change in your regimen is necessary to obtain the best possible results.
As with many medications, the exact way Transdermal Verapamil 15% Gel helps Dupuytren's disease is not entirely understood. It is proposed that two different processes are taking place. The first allows for the progression of Dupuytren's disease to be slowed or stopped and second for the diseased tissue to actually be reduced, which allows for the symptoms of the condition to be reduced or eliminated. Both of these processes are effected by verapamil's ability as a calcium channel blocker to block calcium.
Cells known as fibroblasts are responsible for the production of the primary components of the nodules and cords such as collagen, fibronectin and glycosaminoglycans. Research has shown that the process by which these components are released out of the fibroblast requires calcium. It has been found that calcium channel blockers have the ability to decrease the production of collagen and fibronectin and their release from the fibroblast*. A study has also shown that the large increase of Peyronie's fibroblasts is markedly impaired by verapamil, even at low doses*. This research is the basis of why it is thought that using Transdermal Verapamil 15% Gel in the inflammatory or early stages of Dupuytren's disease, may prevent the condition from being as severe as it might have been without any treatment*.
Fibroblasts are also responsible for the production of an enzyme called collagenase. This enzyme is responsible for breaking down or remodeling the excess collagen that makes up nodules and cords. Research has demonstrated that calcium channel blockers such as verapamil have the ability to increase the activity of collagenase, which enhances the remodeling of scars in burn victims. It was also found in experiments with bovine fibroblasts that exposure to verapamil increased collagenase activity*. Dupuytren's disease is thought to be similar to other wound disorders such as keloids and hypertrophic scars*. Research on the use of verapamil in keloids has suggested that it may increase procollagenase production, meaning that verapamil may be capable of increasing collagen breakdown. Although this research was not done on fibroblasts from Dupuytren's nodules or cords, it is theorized that fibroblasts from Dupuytren's disease tissue will respond in a similar way*. The increase in collagenase activity after exposing the fibroblasts to verapamil helps to explain how Transdermal Verapamil 15% Gel can remodel an already formed nodule or cord into more healthy and elastic tissue. The remodeling of the tissue and return of the elasticity allows for the symptoms of Dupuytren's disease to be reduced or eliminated.
The illustration below shows the two proposed mechanisms of action, magnified to the level of the fibroblast.
