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Topic: Question about Verapamil SR? (Read 270 times) |
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sue_g
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Question about Verapamil SR?
« on: Aug 25th, 2007, 6:04pm » |
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Hi Again, I've recently have joined your team. I'm just learning about Verapamil SR.
For several years I have been managing my headaches with Amitriptyline. When I am clear of all Clusters I do not take any drugs at all. The first sign I feel a HA coming on, I then start taking Amitriptyline, the pills are in 10mg doses. So at the start of a Cluster I would take 30mg, 1 hour before bedtime, it makes you dozy, helps to sleep. It use to take only about 2 weeks of taking this drug @ 30mg's and with the use of my oxygen, then the Cluster HA's would now be gone, hidden for the complete term. Eventually, After several months, I then would lower the dose, down to 10mg's and then, completely off it, guessing the Cluster is gone. However, now the amitriptyline takes longer than 2 weeks to settle in...I even increased it's dose to 40mg's/bed-time. This amount made me dozy thru out the day, which is not good for work. That's why I asked to be referred to a neuro. This summer I had quite a bit of dental work done, I've started a new Cluster this month, don't know if they are related but assuming so. With Dr. Zwicker's referral I am now taking 120mg's of Verapamil/day, I don't know much about this drug, other than reading about it on the internet. At the beginning of the Cluster, the HA's were extremely intense with 120mg's of Vern in my system, waking up at the same time of night, using the oxygen. So, what I have done is... 120mg's/Verapamil and 10 to 20mg's of the Amitriptyline just before bed. My GP said it's o.k. It seems to be working most nights, the clusters are pretty well covered up. That's my story....I can't wait until I'm out of this Cluster!
Question: Verapamil, The folks who take this drug, do you always take it, no matter if your in a bout of HA's or not? Or do you go on it and gently go off it? Thank you
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Ray
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Re: Question about Verapamil SR?
« Reply #1 on: Aug 25th, 2007, 8:06pm » |
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Dear Sue:
It's been a while, but I always tapered Verapamil. It never affected the frequency or intensity of my headaches, but for many it has been a Godsend.
Ray
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Bob_Johnson
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Re: Question about Verapamil SR?
« Reply #2 on: Aug 26th, 2007, 9:37am » |
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: Headache. 2004 Nov;44(10):1013-8.
Individualizing treatment with verapamil for cluster headache patients.
Blau JN, Engel HO.
Background.-Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses-720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved. Objective.-To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly. Methods.-Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication. Patients were followed-up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction. Chronic cluster patients were reviewed as often as necessary. Results.-Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy-lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens-Johnson syndrome, and the drug was withdrawn. Conclusions.-Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary. (Headache 2004;44:1013-101 .
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sue_g
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Re: Question about Verapamil SR?
« Reply #3 on: Aug 27th, 2007, 5:49am » |
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Thank you Bob, You are very informative. so with Verapamil as a preventive, and now it seems to be working as an abortive (my CH's are covered up). Which I'm assuming I'm episodic, will I be able to ween off of this drug?
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Wayne
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Re: Question about Verapamil SR?
« Reply #4 on: Aug 27th, 2007, 6:11am » |
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Hi Sue
Your question is a difficult one to answer ie. how do you know when to start tapering if you don't really know whether your cycle is actually over or simply being covered up by the meds. I have asked this question before and there's no definitive answer. Some folks recomend the 'beer test', ie have a few pints and if you don't get hit then you can start tapering. I tried that but is was a dismal faliure and I had to ramp up again double quick time.
Other folk reckon that if you have gone 2 full weeks completely PF then you can start tapering. You must bear in mind that most of us are on much highre doses than you are (480mg plus) so the taper would be much longer.
Incidently I also had a horrible breakthrough when I had dental work done, not sure if the anasthetic messed up the balance of the meds in my system or what, but I am convinced that there's a link between the 2.
Good luck
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Bob_Johnson
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Re: Question about Verapamil SR?
« Reply #5 on: Aug 27th, 2007, 8:03am » |
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http://www.plainboard.com/ch/chtherapy.pdf
Here is a link to read and print and take to your doctor. It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S. (2002)
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Verap does not abort attacks but works to prevent them--so both types of meds are commonly used at the same time.
When to stop? There is no test except to stop using and see what happens. My experience is to stop the preventive med when it has been several weeks since an attack. I also noticed a slight foggy sensation during active periods which cleared up when a cycle was over. A sign to stop the preventive. This is something which you will have to learn for yourself: What signals does you body reliably give you.
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Bob Johnson
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