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Electrical activity through the AV node dependsto a significant degreeupon calcium influx through the slow channelBy decreasing the influx of calciumISOPTIN prolongs the effective refractory period within the AV node and slows AV conduction in a rate related manner.

LithiumIncreased sensitivity to the effects of lithiumneurotoxicityhas been reported during concomitant verapamil-lithium therapylithium levels have been observed sometimes to increasesometimes to decreaseand sometimes to be unchangedPatients receiving both drugs must be monitored carefully.

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