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Cluster Headache Help and Support >> Medications,  Treatments,  Therapies >> Verapamil dosage ?
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Message started by Roy on Oct 4th, 2008 at 10:31am

Title: Verapamil dosage ?
Post by Roy on Oct 4th, 2008 at 10:31am
I am currantly on.......
Fosinoprol-20 mg -1/2 tab daily for blood pr
Atenol-50 mg daily for blood pr.
Hydrochlorothiazide-25 mg- 1 tyab daily-for blood pr.
and now...
Verapamil-40 mg- 3 times a day- for cluster HA.

My ? is I don't think the verap is strong enough, as it does not seem to do much yet and been on it for about 3 weeks now. Would a higher dosage ne alright considering the other meds I am on ???
Of cpourse I would call my doc first tho. Just wanted to ask before I went that route and see if anyone else is on B/P med like I am. .............roy

Title: Re: Verapamil dosage ?
Post by Bob_Johnson on Oct 4th, 2008 at 11:30am
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.

Title: Re: Verapamil dosage ?
Post by CH-HELL on Oct 4th, 2008 at 12:38pm
HI,  I take Lisinoprol for my hbp I think its the same as Fosinoprol.  I have been on several different meds including the other meds you are taking.  I am taking Verap. sr 480mg? and have taken as high 720mg a day, verap has never had much affect on my bp.     Phil

Title: Re: Verapamil dosage ?
Post by Batch on Oct 4th, 2008 at 9:00pm
Roy,

Bob posted some great information...  Off hand I'd say you might be having a possible reaction between the diuretic (hydrochlorothiazide) and some of the other medications.  

I'm not a doctor so ask your doctor about it, then ask about oxygen therapy.

Take care,

V/R, Batch

Title: Re: Verapamil dosage ?
Post by michael on Oct 6th, 2008 at 8:30am
This is the first cycle I've used verapamil and I have been experimenting with the dosage (under the watchful eye of my doctor and an ecg at every 80mg increase).
Have found that 480mg per day just keeps it under control for me with 2 or 3 breakthroughs a week.

Mike

Title: Re: Verapamil dosage ?
Post by DennisM1045 on Oct 6th, 2008 at 1:19pm

Roy wrote on Oct 4th, 2008 at 10:31am:
I am currantly on.......
Fosinoprol-20 mg -1/2 tab daily for blood pr
Atenol-50 mg daily for blood pr.
Hydrochlorothiazide-25 mg- 1 tyab daily-for blood pr.
and now...
Verapamil-40 mg- 3 times a day- for cluster HA.

My ? is I don't think the verap is strong enough, as it does not seem to do much yet and been on it for about 3 weeks now. Would a higher dosage ne alright considering the other meds I am on ???
Of cpourse I would call my doc first tho. Just wanted to ask before I went that route and see if anyone else is on B/P med like I am. .............roy

Now that I've seen the disclaimer  ;)

Pete is on the right track.  Verapamil is a BP med too.  So I'd be very careful about mixing it with the other meds you are on.  You Dr needs to be all over this.

When I'm out of cycle I take 12.5mg of Hydrochlorothiazide.  When my cycle starts I switch to Verapamil instead.

-Dennis-

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