Has anyone had more or less success taking Verapamil in the morning versus the afternoon or evening?  These things, for me, are at their worst in the middle of the night, and I wondered if taking the Verapamil in the evening might be more effective than the morning.  I'd appreciate any feedback.  Thanks!

er,
You should take it as prescribed. 

Most likely states X in the morning, X in the afternoon and X at night.  Usually divided into three doses. 

If hit mostly at night, more dosage before bed makes most sense providing they are immediate release form pills.

But again, take exactly as prescribed or talk to prescribing doctor for dosage revisions/clarification. 

For most current info on Verapamil, go to thread titled "Verapamil Dosage" under the Medications/Treatments board.

Good Luck! ;)

-Gregg in Las Vegas

My bet would yes, better at night. From what remember of what I read, that med takes that many hours to fade out and... more than 12 hours after, it's gone completely, but I might have read wrong. I take it twice a day and every day I can't wait for my evening pills time as I feel the effects fading out

I'm just going to throw this out there: It takes 10-14 days for verapamil to reach therapeutic serum levels. How low could it dip in half a day or less?

Brew wrote on Jan 19^th, 2012 at 5:05pm:

I'm just going to throw this out there: It takes 10-14 days for verapamil to reach therapeutic serum levels. How low could it dip in half a day or less?

Excellent point Brew ;)

oh I was just sharing one of the many readings I have done in the past days, hoping I didn't criss-crossed information. Maybe I misinterpreted this line from the Wikipedia page on Verapamil, but what I understand from it is that its action is half strong 5 to 12 hours after. Please correct me if I'm reading wrong.

Onset of action is 1–2 hours after oral dosage. Half-life is 5–12 hours (with chronic dosages)

LasVegas wrote on Jan 19^th, 2012 at 4:44pm:

er, You should take it as prescribed.  Most likely states X in the morning, X in the afternoon and X at night.  Usually divided into three doses.  If hit mostly at night, more dosage before bed makes most sense providing they are immediate release form pills. But again, take exactly as prescribed or talk to prescribing doctor for dosage revisions/clarification.  For most current info on Verapamil, go to thread titled "Verapamil Dosage" under the Medications/Treatments board. Good Luck! ;) -Gregg in Las Vegas

Totally agree with Gregg. My treating neuro emphasized "divided doses (3X/day)"...especially with immediate release type. BTW...from what I've read reported here...the extended release version is not as effective....tho not universal.  Which type are you using? Worth discussing with your Doc.

My experience that night time hits more prevalent also...I titrate the dosage and use more in the evening. Working with your Doc...you might try adjusting dosage by time of day....

Re Brew's comment...intuitively it makes sense...my experience is that missed doses result in increased hits within 24-36 hrs.  Perhaps a theraputic level is required at a steady state...and the human body...a marvel at maintaining stasis...says "ahhh" and goes back to what it "knew" before...as fast as possible...dunno.

Best,

Jon

The primary use of Verapamil is for heart related problems. I have not the slightest idea what is important for this. But one manufacturer makes a delayed release version, to take at bedtime, that starts its action in the morning. So in some cases timing seems to be critical  (if it's not just an attempt to lose customers to suppliers of generics).


The short half-life period of Verapamil gives a rather bumpy serum concentration. Example: Taking 3 daily doses at 8 hours interval gives a variation of 1 to 2, assuming a half-life of 8 hours.


But for a clusterhead, as Brew said, it takes 1 to 2 weeks until you can notice  the effect of a dosage change. Therefore, it's not the Verapamil itself, but one or more of the about a dozen metabolic products (which a much longer half-life) that do the trick for us.


Therefore, IMHO it doesn't matter much at what time you take your Verapamil.


                 [smiley=smokin.gif]

I have found that by taking Verapamil at dinner, it controls my CH's MUCH more effectively than taking it any other time.

Am now on Verapamil ER 120mg, one in the morning (8am) and one in the evening (8pm).  Working like a charm, and the ER version seems to ease the "crash" symptoms (fatigue, light-headedness, cold feet) that I had on the regular version.

Once the verap. reaches a theraputic level then it is a matter of maintaining that level so I dont see the time of day as making a differance as long as the level is maintained.

Thank you for all your advice.  I would like to report that interestingly, I started taking my Verapamil at night (I'm on once-daily extended release 240 mg) and had enjoyed nearly 3 weeks of CH free days and nights.

However, over the past 5 days (see my new post), the BEAST has returned.  It was after reading all of your advice and information (after writing my newest post) that I realized these headaches are hitting me 2-3 hours AFTER I wake up as opposed to in the middle of the night.  This may be coincidence and not related to the time of day at which I take Verapamil, but personally I prefer a mid-morning headache to an alarm clock headache.  I can hit it with an abortive immediately, and I'm still getting sleep.  Again, may be coincidence, but worth noting.

This protocol has become widely adopted because it offers a controlled, systematic approach to dosing. This give the doc time to see how your body responds to any given dose.
===
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.