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ben_uk
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psilocybin success “interesting” by PG
« on: Dec 23rd, 2005, 4:53pm »
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Verapamil induced gingival enlargement in cluster headache
 
http://jnnp.bmjjournals.com/cgi/content/abstract/76/1/124  
 
Journal of Neurology Neurosurgery and Psychiatry 2005;76:124-127
M S Matharu1, J A van Vliet2, M D Ferrari2 and P J Goadsby1  
1 Headache Group, Institute of Neurology, Queen Square, London, UK
2 Department of Neurology, Leiden University Medical Centre, the Netherlands  
 
Verapamil is an effective prophylactic treatment for cluster headaches and, therefore, is widely used. This report describes four patients with cluster headache who developed gingival enlargement after initiating treatment with verapamil. In two patients, it was possible to control this side effect adequately by optimizing oral hygiene and dental plaque control. In the other two patients, lowering of the verapamil dose, in addition to optimal oral hygiene and dental plaque control, was necessary; in one patient verapamil had to be stopped completely to reverse the gingival enlargement. Doctors treating cluster headache with verapamil need to be aware of this side effect, especially as it may be preventable with good dental hygiene and dental plaque control, is reversible with reduction or cessation of verapamil, and can lead to dental loss.
 
CASE 2 of 4
 
A 40 year old man developed cluster headaches in 1992 for which he was referred in June 2001. He was diagnosed as having chronic cluster headache. His medications included subcutaneous sumatriptan 6mg prn, high dose and flow rate oxygen, Verapamil 240 mg daily, sodium valproate 600mg daily, lithium 300mg daily, ergotamine tablets 2 mg daily, methysergide 1mg daily and Prednisolone 10mg daily. Subcutaneous sumatriptan and oxygen were effective, abbreviating the attacks to 15 – 30 minutes. The combination of verapamil, Sodium valproate, lithium, ergotamine, methysergide, and prednisolone was ineffective in suppressing the cluster attacks. The patient had started verapamil in December 2000. In the past he had tried indometacin 150 mg daily and amitriptyline.
     Sodium valproate, lithium and prednisolone were discontinued.  The verapamil dose was gradually increased to 600 mg daily under regular ECG monitoring over two months; there was mild improvement in the cluster headaches.  He was then seen elsewhere and lithium 600 mg daily, methysergide 2 mg daily, and prednisolone 15 mg daily were added.  In addition, the patient was administered intravenous dihydroergotamine (IV DHE) 17.5 mg over seven days; he was rendered pain free while receiving the IV DHE but the attacks recurred within a day of stopping the infusion.  There was no added benefit with this combination of drugs.  
 He consulted again in September 2001, when he was advised to stop lithium, methysergide and prednisolone.  The verapamil dose was increased to 720 mg daily, which completely suppressed the cluster attacks.  Unfortunately, two months later the patient noticed gingival enlargement with intermittent bleeding.  We advised him to reduce the verapamil dose to 480 mg daily and to see a periodontist.  The periodontist diagnosed gingival enlargement secondary to verapamil; the patient was advised to maintain good dental hygiene and given a course of antibiotics for possible infection, although there was no evidence for this.  On reducing the verapamil dose, the cluster attacks recurred but, over the next two months, the gingival enlargement resolved completely. Interestingly, in May 2002, he took 1g of  “magic mushrooms” (containing psilocybin) which rendered him pain free for one month; since then he has been taking magic mushrooms 1g once every one to two months, which renders him pain free for two to six weeks. He continues to take Verapamil 480mg daily and has no gingival problems.  
 
 
Correspondence to:  
Professor P J Goadsby  
Institute of Neurology, Queen Square, London WC1N 3BG, UK
 
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Thank you Manjit
Thank you Peter
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Re: psilocybin success “interesting” by PG
« Reply #1 on: Dec 23rd, 2005, 6:09pm »
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on Dec 23rd, 2005, 4:53pm, ben_uk wrote:
he has been taking magic mushrooms 1g once every one to two months, which renders him pain free for two to six weeks. He continues to take Verapamil 480mg daily and has no gingival problems.  

 
 
Yes, thank you.
 
 
A noticed non-interference here continuing verap, in this case.
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Re: psilocybin success “interesting” by PG
« Reply #2 on: Dec 26th, 2005, 11:43am »
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That's serious polypharmacy at work over many years.
 
Love the phrase 'dental loss' -  read it makes your teeth drop out!
 
It's important that Psilocybin is now on record as a treatment now - is this how it enters the establishment in the UK?
 
If so that's good news - but I wonder what the progression is from interesting?
 
And how long before we have - most interesting, quite promising but totally untried, worth further serious consideration, offering genuine as yet untapped potential, a strong candidate for an alternative solution, genuine alternative option, something we're really keen to explore more fully, high risk option handicapped by a lack of clinical provenance, something we'll really consider for the future very seriously indeed any moment soon now.......we could be some time I guess.
 
Or perhaps could we be a little more radical as in 'a proven abortive for hundreds of sufferers - right now.'  
 
ps wonder if the patient has been tempted to drop the Verapamil completely yet and would that get a most interesting?
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Re: psilocybin success “interesting” by PG
« Reply #3 on: Dec 26th, 2005, 3:38pm »
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on Dec 26th, 2005, 11:43am, Beastfodder wrote:

And how long before we have - most interesting, quite promising but totally untried, worth further serious consideration, offering genuine as yet untapped potential, a strong candidate for an alternative solution, genuine alternative option, something we're really keen to explore more fully, high risk option handicapped by a lack of clinical provenance, something we'll really consider for the future very seriously indeed any moment soon now.......we could be some time I guess.

 
I fully expect to hear all of these and more, over the next 12 months.  
Feel free to keep a checklist and grade my prediction next Christmas.
 
 Grin
 
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Re: psilocybin success “interesting” by PG
« Reply #4 on: Dec 26th, 2005, 11:05pm »
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thumb
 
Step one is to prove that Psilocybin has medicinal value.
Real medicinal value....
 
the law will have to change then.
« Last Edit: Jun 11th, 2007, 8:01am by vig » IP Logged


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