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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> A bloody silly question for you 
        
(Message started by: mummymac on Jan 3^rd, 2008, 3:06am)

Title: A bloody silly question for you
Post by mummymac on Jan 3^rd, 2008, 3:06am

I am on Verapamil ( first time taking it), small and buxcom of mature age.

OK I am a bloody short arse, fat and 45 but otherwise in good health with good blood pressure

Is it safe to do cardio with this drug, I used to go to the gym 4/5 a weeks before this cycle.

Due to 3 virus infections in 5 weeks and and this cycle starting in November ( still not finished )i haven't been to the gym for almost 2 months.

I now feel ready to start a slow and steady return to the gym but I really do not know if Verapamil will have a bad effect on me , whilst I am huffing and puffing and turning a really nice shade of glowing red

It is two more weeks before I see the doctor to ask him.

Please does anyone have any advice on this

Tanya

Title: Re: A bloody silly question for you
Post by LeLimey on Jan 3^rd, 2008, 5:48am

I would say its a very sensible question! I just don't have an answer for you, I would have to say that since dosage of verapamil is so personal as to what works for one and not another that it would probably depend largely on your ECG - therefore ask your doc. You can always ring the surgery and ask for him/her to call you once their surgery is over that day.

Have you had an ECG yet? You're new to verap so are you increasing dosage still? Do you know you should have an ECG at every increase of dosage? Lots of factors here!
We can help with what questions to ask but I'd be leary about giving advice in this situation

Sorry I'm not more help!
Helen

edited to change sentence construction cos it sounded bloody silly!

Title: Re: A bloody silly question for you
Post by mummymac on Jan 3^rd, 2008, 6:06am

Good Morning Helen

Thanks for coming back so quickly.

I started on one tablet (I am at work so cannot remember dosage) for a week and then upped it to two tablets with no more increases. should there be? My CH have reduced in number and frequency but sadly not gone.

There was no mention of an ECG at all but I am having an MRI to-morrow

My neuro is the one who gave me Verapamil, is it all right to just phone up a consultant, or should I wait for my appointment?

Tanya

Title: Re: A bloody silly question for you
Post by LeLimey on Jan 3^rd, 2008, 6:51am

Ooh no you can ring up and ask to speak to him or his secretary, I do that all the time LOL

You should be on a higher dose but it could be that he is seeing how you get on with what you have. Ideally verap should be blocking almost all the hits for you. You're somewhere between 160mg and 240mg by my guess - 80mg tabs or 120mg tabs are most likely.

Also check if you have sustained release or ordinary verap. The ordinary stuff works much better for most of us.

Did you know not to drink grapefruit juice or eat grapefruit while on verap? It intensifies the effect which isn't good! I love grapefruit juice too so its a big hardship for me LOL

Title: Re: A bloody silly question for you
Post by LeLimey on Jan 3^rd, 2008, 6:54am

BTW most ECG's are just done at your GP's surgery by the practise nurse - its no big deal but you are being prescribed a BP drug for a non BP problem so you should be checked out. People with high BP are checked to see how it's progressin and we really need that too. It's something you could just ask our GP about though as you don't need to go to the hospital for that.

Let us know how you get on okay and good luck tomorrow! It's louder than having a houseful of kids (um actually - no it isn't!)

Title: Re: A bloody silly question for you
Post by DennisM1045 on Jan 3^rd, 2008, 8:52am

Just to add my 2 cents here ;;D

I am on Verapamil. During my spring cycle I was on a high enough dose that it significantly lowered my heart rate. What that meant was that I could do cardio, I just couldn't expect my heart rate to be as high.

At first it drove me nuts but with time and patients I found my new 75% level. Don't go by heart rate, go by your respiration rate and how your body feels. Take it easy and beware dizziness. That can also be a side effect of exercise and a lowered heart rate.

I agree with Helen on the need for EKGs.

Good luck and don't let this med, or anything else, keep you from doing what you love to do.

-Dennis-

Title: Re: A bloody silly question for you
Post by Bob_Johnson on Jan 3^rd, 2008, 9:25am

Verap. is one of the most effective meds we have for CH but I'm sending along this information for you to print out and share with your physician. NOT to scare you--but just to have the latest data which your doc needs to be aware of. Also note that your dose is likely too low to be effective for cluster (dosing note in this maerial).
================
Verapamil warning
« on: Aug 21st, 2007, 10:38am » Quote Modify Remove

--------------------------------------------------------------------------------
I posted this information recently in the form of a news release but more details here.
__________________

Neurology. 2007 Aug 14;69(7):668-75.

Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy.

Cohen AS, Matharu MS, Goadsby PJ.

Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

BACKGROUND: High dose verapamil is an increasingly common preventive treatment in cluster headache (CH). Side effects include atrioventricular block and bradycardia, although their incidence in this population is not clear. METHOD: This audit study assessed the incidence of arrhythmias on high dose verapamil in patients with cluster headache. RESULTS: Of three hundred sixty-nine patients with cluster headache, 217 outpatients (175 men) received verapamil, starting at 240 mg daily and increasing by 80 mg every 2 weeks with a check electrocardiogram (EKG), until the CH was suppressed, side effects intervened, or to a maximum daily dose of 960 mg. One patient had 1,200 mg/day. Eighty-nine patients (41%) had no EKGs. One hundred eight had EKGs in the hospital notes, and a further 20 had EKGs done elsewhere. Twenty-one of 108 patients (19%) had arrhythmias. Thirteen (12%) had first-degree heart block (PR > 0.2 s), at 240 to 960 mg/day, with one requiring a permanent pacemaker. Four patients had junctional rhythm, and one had second-degree heart block. Four patients had right bundle branch block. There was bradycardia (HR < 60 bpm) in 39 patients (36%), but verapamil was stopped in only 4 patients. In eight patients the PR interval was lengthened, but not to >0.2 s. The incidence of arrhythmias on verapamil in this patient group is 19%, and bradycardia 36%. CONCLUSION: We therefore strongly recommend EKG monitoring in all patients with cluster headache on verapamil, to observe for the potential development of atrioventricular block and symptomatic bradycardia.

PMID: 17698788 [PubMed]

« Reply #7 on: Today at 1:01am » WITH THANKS TO "MJ" FOR POSTING THIS EXPLANATION.

--------------------------------------------------------------------------------
The article summarized in layman terms from the website below.

http://www.personalmd.com/news.jsp?nid=607285

"Cluster Headache Treatment Poses Cardiac Dangers
Off-label use of verapamil linked to heart rhythm abnormalities, study finds

By Jeffrey Perkel
HealthDay Reporter

MONDAY, Aug. 13 (HealthDay News) -- People who use a blood pressure drug called verapamil to treat cluster headaches may be putting their hearts at risk.

That's the finding from a British study that found heart rhythm abnormalities showing up in about one in five patients who took the drug in this unapproved, "off-label" way.

"The good news is, when you stop the drug, the effect wears off," said study lead author Dr. Peter Goadsby, professor of neurology at University College London. "So, as long as doctors know about it, and patients with cluster headaches on verapamil know they need EKGs [electrocardiograms] done, it is a completely preventable problem."

The study is published in the Aug. 14 issue of Neurology.

In a review of the medical records of 217 patients given verapamil to treat their cluster headaches, a team led by Goadsby found that 128 had undergone an EKG, 108 of which were available in the medical records.

Of those 108 patients, about one in five exhibited abnormalities (mostly slowing) in the heart's conduction system -- the "natural pacemaker" that causes the organ to beat. Most of these cases weren't deemed serious, although one patient did end up having a pacemaker implanted to help correct the problem. In four cases, doctors took patients off verapamil due to their EKG findings.

One in three (34 percent) developed non-cardiac side effects such as lethargy and constipation.

"It is a very nice piece of work, because it provides commentary on a boutique [that is, niche and off-label] use of the drug," said Dr. Domenic Sica, professor of medicine and pharmacology in the Virginia Commonwealth University Health System. He was not involved in the study.

Cluster headache affects about 69 in every 100,000 people, according to the Worldwide Cluster Headache Support Group Web site. Men are six times more likely than women to be afflicted, and the typical age of onset is around 30. According to Goadsby, the disease manifests as bouts of very severe pain, one or many times per day, for months at a time, usually followed by a period of remission.

Verapamil, a calcium-channel antagonist drug, is approved by the U.S. Food and Drug Administration for the treatment of cardiac arrhythmias and high blood pressure. The medicine is typically given in doses of 180 to 240 milligrams per day to help ease hypertension.

However, the patients in this study received more than twice that dose for the off-label treatment of their cluster headaches -- 512 milligrams per day on average, and one patient elected to take 1,200 milligrams per day. The treatment protocol involved ramping up the dose from 240 milligrams to as high as 960 milligrams per day, in 80 milligram increments every two weeks, based on EKG findings, side effects, and symptomatic relief.

Many patients may not be getting those kinds of tests to monitor heart function, however: In this study cohort, about 40 percent of patients never got an EKG.

Given the typical dosage, Sica said he was surprised so many patients were able to tolerate such high amounts of the drug.

"When used in clinical practice for hypertension, the high-end dose is 480 milligrams," said Sica. "Most people cannot tolerate 480."

Dr. Carl Pepine, chief of cardiology at the University of Florida, Gainesville, was also "amazed" at the doses that were tolerated in this study. "The highest dose I ever gave [for cardiology indications] was 680 milligrams. This might give me more encouragement to use the drug at higher dose," he said.

But Sica said he thought cardiac patients -- the typical verapamil users -- were unlikely to tolerate the drug as well as the patients in this study, because verapamil reacts differently in older individuals, who are more likely to have high blood pressure, than in younger patients. The average patient in the United Kingdom study was 44 years old.

According to Sica, two factors would conspire to make older individuals more sensitive to verapamil. First, the metabolism of the drug is age-dependent, meaning that older individuals would tend to have higher blood levels of the drug, because it is cleared more slowly than in younger individuals.

Secondly, the conduction system of the heart (the natural "pacemaker" becomes more sensitive to the effects of verapamil with age, Sica said.

"It's likely that an older population would not be able to tolerate the same dose," he concluded.

According to Goadsby, the take-home message of this study is simple: Be sure to get regular EKGs if you are taking verapamil for cluster headaches. Goadsby recommended EKGs within two weeks of changing doses, and because problems can arise over time -- even if the dose doesn't change -- to get an EKG every six months while on a constant dose.

"The tests are not expensive, and they are not invasive," he said. "They are not in any way a danger to the patient."

For the most part, Goadsby said, should a cardiac problem arise, it will typically go away once the treatment is halted."

Title: Re: A bloody silly question for you
Post by mummymac on Jan 3^rd, 2008, 2:27pm

Helen your guess was spot on

I am now on 240mg of Sustained Release Verapamil.

My so called expert who worked with Galosmithkline and another Neuro who was a CH suffer does not seem on the ball. Too low a dose of Verapamil, no ECG and no O2. I am a bit land locked to search out other specialists.

Also thanks for the grapefruit tip, I did see that somewhere on the net but had it in my head that it was for the steroids.

Bob

thank you for the information, I have printed it off right now to take with me on my next vist.

Dennis

thank you for your information on the gym, I will give it a go this weekend (slowly)

May you all be PF

Tanya

Title: Re: A bloody silly question for you
Post by Bob_Johnson on Jan 3^rd, 2008, 3:15pm

SLOW-RELEASE VERAPAMIL

Dr. Sheftell applauded the protocol for verapamil used by Dr. Goadsby and colleagues, which entailed use of short-acting verapamil in increments of 80 mg. “This method was suggested by Lee Kudrow, MD, 20 years ago as an alternative to slow-release verapamil,” Dr. Sheftell noted.

“I would agree with using short-acting verapamil, rather than the sustained-release formulation, in cluster headache,” he said. “I prefer the short-acting formulation with regard to ability to titrate more accurately and safely. My clinical experience anecdotally demonstrates improved responses when patients are switched from sustained-release verapamil to short-acting verapamil.”

Dr. Goadsby agreed that his clinical experience was similar. “There are no well-controlled, placebo-controlled, dose-ranging studies to direct treatment. This is one of those areas where clinicians who treat cluster headache have to combine what modicum of evidence is available with their own clinical experience,” Dr. Sheftell commented.