Hi there.

I have now been on Verapamil ( 480mg ) for about 6 months mostly with no ill effect.

However recently, I'm finding that on the slightest exertion, my heart beats like a drum in my chest, and I constantly feel that I'm about to fall over.

Is this a common side effect of this drug after such long term use?

Derek,

Verapamil can most certainly cause heart complications. Some can tolerate very high doses, while others can develop arrhythmias at comparatively low doses. I've been taking 480mg to 720mg (adjusted as needed) continuously for many, many years - no problems of any kind so far. Other people have reported nasty problems at lower doses.

Generally, the disturbances tend to clear up when the patient stops taking it. BUT - more and more reports are popping up indicating that higher dose patients should undergo cardiac monitoring to avoid serious complications including heart block.

It is nothing less than critical to work closely with your doctor on this!

Marc

Suggest you print this material and give to your doc.
=========

Verapamil warning
« on: Aug 21st, 2007, 10:38am »  

--------------------------------------------------------------------------------
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.

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

"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."  

Thanks for that info, however I went to a local Locum GP as my own GP who takes 2 months to see unfortunately , armed and ready with all of Professor Goadsby's data

The idiot GP I saw was not interested at all about any new info and simply stated that I was OK.

Zero ECG, Zero Blood pressure monitoring.

Derek Northcote wrote on Jul 29^th, 2009 at 4:16pm:

Thanks for that info, however I went to a local Locum GP as my own GP who takes 2 months to see unfortunately , armed and ready with all of Professor Goadsby's data The idiot GP I saw was not interested at all about any new info and simply stated that I was OK. Zero ECG, Zero Blood pressure monitoring.

Having to take time with you would have meant fewer patients through the door, and fewer fees collected from the state.

Hear that, America?

Since U.S. folks can't advise on working your health system, might contact your local support group for help:

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

I went to see a GP with regards to being asleep for 1.5 days, after my last Triptan injection, over and above the 480 mg Verapamil and 100mg Tegretol, only to be told by this GP idiot that it was out of their hands, and the responsibility of the hospital.

When I went back to work my Team leader complained that I was causing him severe grief by not turning up and he is making my life an abject misery as a direct result of this CH crap.

Who can I talk to. Who can stop, interject, help, assist.

I have contacted, OUCH.uk.org.  by phone, Email, and subscribance.

HELP.

I assume there must be a person who acts as patient advocate in the hospital. Or try the social worker there.

Hope OUCH/UK gets in touch for they are a good group.

Nope, it seems that after being stuffed on this medication by a hospital practitioner , none of them give a fig.

I have asked if I can come off it, but none of them are qualified to give me an answer.  

Apparently.

Whilst still on this crap, I still have major shadows, and passing out periods, but no one can give me an answer.

Its got to the point, I appear too healthy and sorted out.  I'm not.

I still have the sword pointing into my eye.

The madness of punching anything that comes to bear, to the extent
of breaking my hand on a wall, only to have a GP treating the hand but NOT the CH.

Colleagues who laugh at my Headache and offer aspirin.

My heart beats all over the place on the medication, to the point of collapse.

The nostril that seems to turn into a black hole, going in on itself.

The head, which I happily smash off everything in sight in order to alieviate the pain.

My partner has gave in, and seems to be tired of MY issue.

I give in.    

ENOUGH.

At least one person here was able to arrange for treatment in London at one of the leading headache operations around.

Their site is a bit confusing but you might give them a call and see if you can arrange for a visit:

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Im at the point of giving in.

Any time off work, is seen as my hindering the idiot I call my boss.

Despite explaining that if he even dares to hold me back, due to CH, I could sue the companies arse off.  This individual still does.

Which steps in the UK should I take next.?  

Derek, any response from OUCH/UK?

Do you have the energy to contact the London neurology group? (The last link I sent...)

See one of your "landsmen" messages in "getting to know you" section, Gooner by name.

You might contact him about a clinic he has just located in London which might be of benefit to you.      

City of London Migraine Clinic [and other types]  START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Bob

What I suggested in Gooner's message only applies to those living in England & Scotland, unfortunately, it doesn't apply to patients living in Wales.

I've already suggested that Derek calls our helpline. Don't know if he has yet.

Derek. Don't know if you have looked at the OUCH website, but this may help to explain your condition to your employers and workmates.

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Rod