Hello friends-

I need a strategy to find the proper dose of verapamil to keep the beast at bay.  I have never really confirmed that verapamil even works for me.  I am using a taper of prednisone while verapamil kicks in. I am almost done with the prednisone taper and verapamil should have already kicked in. Prednisone worked in high doses. However, the beast jumped last night with a KIP 3.

DETAILS
I have been in cycle for 3 weeks. I started prednisone and verapamil both at the beginning.
- Prednisone - week 1, 70mg per day/ week 2 taper from 70mg to 30mg/ week 3, taper from 30mg to 0mg. Currently at 10mg.
- Verapamil - week 1, 240mg per day/ week 2 360 mg per day/ week 3, 480 mg per day. Planning to start week 4 at 600 mg. I am having an ECG every change of dosage.
- Other meds: still taking vitamin D3 régimen to keep it at 150 Ng/ml. with NO CALCIUM to avoid interactions with verapamil/ Benadryl 50 mg per day. / pseudoephedrine / ibouprufen / melatonin.
- I have oxygen ready for abortions. I do not want to use triptans as they have extended my cycles in the past.

QUESTIONS
- For those ones that use prednisone taper and verapamil. How do you manage to find your dosage of verapamil each cycle?
- how do you increment your doses and what is the maximum you go to?
- Whem do you discard that verapamil and asume it didn’t work for you?
-  Is it normal that the beast might jump at the end of the prednisone taper even if verapamil is working? What is your experience?

Thanks
Rick

RickJim wrote on Nov 12^th, 2017 at 1:31pm:

Hello friends- I need a strategy to find the proper dose of verapamil to keep the beast at bay.  I have never really confirmed that verapamil even works for me.  I am using a taper of prednisone while verapamil kicks in. I am almost done with the prednisone taper and verapamil should have already kicked in. Prednisone worked in high doses. However, the beast jumped last night with a KIP 3. Hi RJ...that sounds like standard protocol...pred and verap...hopefully the verap kicks in...cuz you DON'T wanna continue with pred.......... DETAILS I have been in cycle for 3 weeks. I started prednisone and verapamil both at the beginning. - Prednisone - week 1, 70mg per day/ week 2 taper from 70mg to 30mg/ week 3, taper from 30mg to 0mg. Currently at 10mg. - Verapamil - week 1, 240mg per day/ week 2 360 mg per day/ week 3, 480 mg per day. Planning to start week 4 at 600 mg. I am having an ECG every change of dosage. - Other meds: still taking vitamin D3 régimen to keep it at 150 Ng/ml. with NO CALCIUM to avoid interactions with verapamil/ Benadryl 50 mg per day. / pseudoephedrine / ibouprufen / melatonin. - I have oxygen ready for abortions. I do not want to use triptans as they have extended my cycles in the past. Sounds like a plan!...although I'd drop the ibuprofen...lousy benefit risk profile........O2 is great....Zomig nasal spray (5 mg) has been my last resort med....never affected cycle length...YMMV. QUESTIONS - For those ones that use prednisone taper and verapamil. How do you manage to find your dosage of verapamil each cycle? Continue UP until ya get there...at some points (high cycle) I was at 1080 mg/dy. Never found complete relief...probably 70% effective....it has been reported here that 480 mg/dy is the sweet spot......... - how do you increment your doses and what is the maximum you go to? Divided doses...timed to expected hit times. Be sure it's immediate release and NOT extended.. - Whem do you discard that verapamil and asume it didn’t work for you? Can't answer that..only you can. Note that a med will work sometimes...and not other times. Give it a really good try.....I never went less than 6 months with a new med...sometimes over a year before I quit it............ -  Is it normal that the beast might jump at the end of the prednisone taper even if verapamil is working? What is your experience? Normal?...no....happens...yes................ Thanks Rick

Great info so far...


Quote:

- Verapamil - week 1, 240mg per day/ week 2 360 mg per day/ week 3, 480 mg per day. Planning to start week 4 at 600 mg. I am having an ECG every change of dosage.

Many will find relief between 360mg/day and 480mg/day (both levels worked for me for different cycles), but each person is different.

It typically takes 7-10 days for a dose change to become effective, so by changing the dose every week you're not giving the previous dose change to take effect. What I'd do is to give it at lease two weeks between dose changes, which is giving you 4-7 days to see if it is working. And a bit more time would be better as for many people the number of CHs they get per day can vary, especially as you approach the effective dose and the number of CHs drops off.

By changing every week you'll still find a level that works (if it will work), but you're likely to be at a higher dose than you need.

In addition to having an ECG, make sure your BP is checked as verapamil was originally designed to control blood pressure, so it can drop.

Some people need to go to about 1000mg a day. But what normally controls the upper limit for the dose for you will be a combination of your medical history, blood pressure,  ECG results and the side effects of the medication. So make sure you work with your doctor on any dose changes.

And when coming off it, step down like you did going up. Your doctor can give you advice on how quickly / slowly you need to come off.


Quote:

- I have oxygen ready for abortions. I do not want to use triptans as they have extended my cycles in the past.

It is really hard to show that they have increased a cycle since cycles can vary in duration even for the same person. So whilst you may not want to use them regularly, I'd have some available for when you're not near your oxygen, e.g. if flying or similar.


Quote:

-  Is it normal that the beast might jump at the end of the prednisone taper even if verapamil is working? What is your experience?

Once the taper is over, if the verapamil is not at an effective dose yet then the CH can / will return. Sometimes it can come back with a vengeance for some unlucky people.

I hope that answers your questions, but keep asking any more you have.

Are we saying we can take verapamil and steroids at same time?

Graemel wrote on Feb 5^th, 2018 at 7:15am:

Are we saying we can take verapamil and steroids at same time?

Yes

It is standard practice for someone starting a longer term preventive, like verapamil, which can take 7-10 days to build up to become effective to also take a prednisione taper dose at the same time to act as a very effective short term preventive.

Of course, this depends on a person's personal medical history.

Mike NZ wrote on Feb 5^th, 2018 at 3:00pm:

Graemel wrote on Feb 5th, 2018 at 7:15am: Are we saying we can take verapamil and steroids at same time? Yes It is standard practice for someone starting a longer term preventive, like verapamil, which can take 7-10 days to build up to become effective to also take a prednisione taper dose at the same time to act as a very effective short term preventive. Of course, this depends on a person's personal medical history.

100% my experience....methylprednisolone IV and taper...cycle BROKEN. Best wishes...It doesn't always work.... BUT worth a try..................