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  New CH.com Forum › Cluster Headache Help and Support › Medications,  Treatments,  Therapies › ER vs Fast Verapamil
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ER vs Fast Verapamil (Read 1755 times)
Kim D
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ER vs Fast Verapamil
Dec 31st, 2009 at 12:16am  
Today I saw my h/a specialist and he wants me to try the "regular" verapamil that isn't extended release. I will have to take 3-4 80mg pills throughout the day, and he says its supposed to work A LOT better than the ER. I had no relief with the ER verapamil, as he says not many CH patients do.

Does anyone know anything about this? I started my pred today and am going to start ramping up on the verap tomorrow, but I really don't want to waste my time... and we all know time is precious when in an episode.

Thanks for any feedback.
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Bob Johnson
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Re: ER vs Fast Verapamil
Reply #1 - Dec 31st, 2009 at 6:47am  
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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Re: ER vs Fast Verapamil
Reply #2 - Dec 31st, 2009 at 10:00pm  
Kim,

Ask your doc for a prescription for oxygen therapy.  If used early and properly at flow rates that support hyperventilation, it's a lot less invasive than verapamil, just as fast or faster than imitrex and less expensive than either at $1.50/abort.

It won't prevent your attacks but it will make them manageable and  trips to the ER a thing of the past.

The following link has all the details you and your doctor will need for a proper Rx.

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Take care and have a Happy New Year,

V/R, Batch
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Re: ER vs Fast Verapamil
Reply #3 - Dec 31st, 2009 at 10:47pm  

Kim D wrote on Dec 31st, 2009 at 12:16am:
Today I saw my h/a specialist and he wants me to try the "regular" verapamil that isn't extended release. I will have to take 3-4 80mg pills throughout the day, and he says its supposed to work A LOT better than the ER. I had no relief with the ER verapamil, as he says not many CH patients do.


I wouldn't know what dosage of sustained/extended release verap was prescribed previously, but at 3-4 80mgs a day, it may all be a matter of also attaining an effective level of verap for prevention. 

You will be at 240-320mg/day of verap.  Modifying adjustments to dosage can be likely understood to be tinkered with, find out his plans for this. 

I've not attained any effective prevention at that level.  See if your doc will allow maybe 480-600mg/day if necessary to seek any improvement before determining if it is unhelpful. 

Extended release can work and does, perhaps the shorter acting verap better, but it can be a matter of reaching a threshold for effectiveness.
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E-Double
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Re: ER vs Fast Verapamil
Reply #4 - Jan 1st, 2010 at 12:58am  
Standard release or the fast acting as you put it is standard protocol.
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Re: ER vs Fast Verapamil
Reply #5 - Jan 4th, 2010 at 9:22am  
I take 540mg of ER Verapamil, daily.   When I asked my Dr. about the  the benefits of the "regular" Verap he said that as long as I was taking it in the morning and at night the ER  would work.  I take 180 in the am and then 360 in the pm. 

My cycle has come to an end.  I am in the process now, of weaning myself off of the Verap.  against my Dr's wishes.  I just don't want to be on it all of the time.

Jeannie
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