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Verapamil - SR, CR, HCL ??? (Read 2721 times)
bradboy
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Verapamil - SR, CR, HCL ???
Nov 23rd, 2009 at 2:22pm
 
my neuro put me on 240mg of Verapamil HCL CR, 2 tabs once a day a few years ago.

I still get an occasional CH, and once or twice a year I get one or two a day for like 2 weeks or more.

I have seen my neuro several times, one time he recommended tapering off the verapamil when I'm not in a cycle but this always seems to bring on headaches so I told him I didn't want to stop it.

I no longer have insurance and there are two programs I can go through to get low cost meds but they only cover regular verapamil 80 and 120 mg or verapamil SR 120, 180, and 240mg.

my regular doctor writes my scripts now and wrote it out as printed on the bottle, Verapamil HCL CR 240mg CR -Tabs. Should I have her re-write it for Verapamil SR 240mg 2 x a day?

I have cut back to 1 of my 240s a day for 4 days now, so far so good. Undecided
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Bob Johnson
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Re: Verapamil - SR, CR, HCL ???
Reply #1 - Nov 23rd, 2009 at 3:52pm
 
No, use the regular. Goadsby, mentioned here, is one of our "gods", and to be taken at face value!
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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.
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Also, print out the following for your doc:

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).
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« Last Edit: Nov 23rd, 2009 at 3:54pm by Bob Johnson »  

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miikkee
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Re: Verapamil - SR, CR, HCL ???
Reply #2 - Nov 23rd, 2009 at 11:33pm
 
hi bradboy

i have been on gen-verapamil SR 240mg twice a day since april with no issues.
not sure if it will work for you

good luck
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seaworthy
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Re: Verapamil - SR, CR, HCL ???
Reply #3 - Nov 24th, 2009 at 7:12am
 
I've always been successful with the SR.
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Marc
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Re: Verapamil - SR, CR, HCL ???
Reply #4 - Nov 24th, 2009 at 7:19am
 
I started with the SR version many years ago and thought that it was good.

Then I switched to regular release (new Neuro) and found out that it works even better and at a lower dose. When I ran out of regular release, I switched back to SR and started getting more hits. Did this a few times with the same result. Now I don't let myself run out!

I'm convinced that regular release works a lot better for me.

Marc
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