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Topic: Verapamil ER vs SR (Read 3177 times) |
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chbob
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Verapamil ER vs SR
« on: Jan 22nd, 2005, 12:03pm » |
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After deing episodic for 24 years I became chronic about 3 or 4 years ago. I have had good success with Verapamil SR but my druggist could not get it any more and I switched to Verapamil ER. Now the HAs are back several times a day and every 2 hours at night. Has anyone seen a difference in the ER and SR versions?
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Bob_Johnson
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Re: Verapamil ER vs SR
« Reply #1 on: Jan 22nd, 2005, 12:22pm » |
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A good overview summary follows. Notice it calls for 3-4x a day dosing which is why SR is useful--providing a more constant dose in your body.
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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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Bob Johnson
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chbob
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Re: Verapamil ER vs SR
« Reply #2 on: Jan 22nd, 2005, 12:56pm » |
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Thanks Bob.
After further research, I have concluded that the switch from SR to ER could very well explain the episode return and will try to get back to SR or even to immediate release.
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Kris_in_SJ
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Re: Verapamil ER vs SR
« Reply #3 on: Jan 22nd, 2005, 7:59pm » |
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Sorry, but now I'm confused ... Verapamil ER is Verapamil "extended release" and Verapamil SR is Verapamil "sustained release". Am I right? To me, these mean the same thing.
Can someone enlighten me here? During cycle, I always take Verap SR with good results.
Kris
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BikerBob
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Re: Verapamil ER vs SR
« Reply #4 on: Jan 24th, 2005, 3:03pm » |
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My pharmacist says that the SR (sustained release) are designed to be taken twice per day and release over 12 hours. The ER (extended release) are designed to be taken once per day and release over 24 hours. The non-SR/ER regular verapamil (immediate release) releases over about 6 hours. The above article that refers to 3-4X per day dosing is referring to the immediate release.
If you're taking verapamil twice daily (240mg am and 240mg pm for 480mg/day), it doesn't matter if you're taking the SR or ER.
If your worst hits are in the middle of the night, it would help to take some extra "immediate release" before bedtime.
Bob
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chbob
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Re: Verapamil ER vs SR
« Reply #5 on: Jan 24th, 2005, 4:13pm » |
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Thanks Biker.
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cat14
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Hi, I am also chronic and started out on the ER, I am now on the regular release and it has made a HUGE difference! I take 80mg 5 times a day. It a pain to remember but soooo worth it to me.
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BikerBob
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Re: Verapamil ER vs SR
« Reply #7 on: Jan 28th, 2005, 4:42pm » |
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Dr. Rozen's report says "The nonsustained release formulation appears to work better than the sustained release preparations, but there is no literature proving this."
I'm taking the ER at 480mg /day increasing it to 600mg /day today. It hasn't appeared to have any effect yet. I'm going to get the script changed and transition to the nonsustained release formulation.
Bob
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