Please refresh my memory.
Which is usually the better version for us..the extended release or the immediate release.
Thanks
Jayne

It ALWAYS boils down to what works best for you, but studies have indicated that the immediate release form generally works better for clusterheads.

My personal experience was that I got little relief from the sustained release formulation any substantial relief from the regular release formulation.

Of course, your mileage may vary ;)

-Dennis-

When I asked my doc about it, he said that if you are taking it morning and night, it should make no difference.  I take the extended release twice daily.

Jeannie

Hi Jayne1  Long time since I've seen you around here!  Sounds like you need to be back, and I'm sorry.

I've not used Verap in several years, so I can't say.  I just wanted to say Hi, we've missed ya!

Jerry

For me, I originally had 360mg/day of immediate release in three doses over the day but I'm now seeing much better results from 480mg/day of extended release in two doses over the day. So both can work, but the only thing that matters is what works for you.

Here's what BobJ always posts....
I see Dr. sheftell and when last taking verpamil I followed this protocol....

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;44:1013-1018).

=======================================
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.
===

Jayne wrote on Nov 15^th, 2010 at 11:27am:

Please refresh my memory. Which is usually the better version for us..the extended release or the immediate release. Thanks Jayne

Hi Jayne,

I have used Verapamil for about 17 years now. The doctor that started me put me on ER. Some years later, and living outside the US I was not able to get the ER and had to settle for IR. I felt an improvement. I went on to experiment with the IR timing the dose to coincide with my vulnerable hours (midnight to 4:00am). It seemed to help a lot.

Good Luck!

Quote:

...had to settle for IR. I felt an improvement. I went on to experiment with the IR timing the dose to coincide with my vulnerable hours (midnight to 4:00am). It seemed to help a lot.

Doesn't seem like "settling," then.

It was discussed between myself and my neuro about this but chose to stay on the immediate release as it works well for me at 480mg daily during cycle.
Out of cycle right now but I am at the ready with my Verap bottle full ( I have worked with my neuro about tapering on & off Verap, must be done slowly) and my o2 tanks are filled and good to go!
PF wishes Jayne, hope this helps in some way for you.

Brew wrote on Nov 18^th, 2010 at 3:07pm:

Quote: ...had to settle for IR. I felt an improvement. I went on to experiment with the IR timing the dose to coincide with my vulnerable hours (midnight to 4:00am). It seemed to help a lot. Doesn't seem like "settling," then.

Hi Brew,

All these years outside the US and maybe my English is less that what it should be....
I meant - at the time that I picked-up the prescription I felt I was "settling" for IR since at that point I had no idea that it would work better.

Good Day,
JB