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Teranasu? (Read 1275 times)
japanzaman
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Teranasu?
Feb 24th, 2012 at 7:51am
 
Just a quick point- I'm living in Japan so some of the medicine names I am using may not correspond directly with the ones most people on this board are familiar with.

So I'm 2 months into my cluster cycle and have had both good and pretty bad moments. This is easily the most difficult cycle I've dealt with to date (5'th in 10 years). Usually I take prednisone on a 2 week taper and that usually takes care of the cycle.

Not this time. Angry Here's my usual course:

3 days at 40 mg
3 days at 30 mg
3 days at 20 mg
3 days at 10 mg

This seemed to work at first, but 2 weeks after going off pred the headaches came roaring back even nastier than before. So then my neuro put me on this:

Depakote 400mg daily
"Teranasu" 10 mg daily

Apparently Teranasu is a calcium chanel blocker along the same lines as Verapimil, but I did not do well at all on this regimen. Things got so bad (2-3 attacks daily, NASTY shadows) that I went crawling back to the neuro and demanded another pred course. Things were good until I got to about 20 mg daily and then I got rocked the other night hard.

My main concern is with this teransu CCB. I hear Verapamil numbers in the 400~600 mg range. This medication is only at 10 mg a day. Has anybody ever heard of Teranasu and if so, what are the recommended dosages? This particular dosage of Depakote and Teranasu has obviously not worked and if this last round of pred doesn't work either I'm not sure exactly where to go in terms of preventative. Verapamil doesn't appear to be widely used here in Japan, so I'm not sure I can get a hold of it.
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Bob Johnson
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Re: Teranasu?
Reply #1 - Feb 24th, 2012 at 10:56am
 
I was't able to find "Teranasu" in a major drug identification site.

In any case, you cannot compare dosing between two meds even if they are of the same type/class.

Your doc may appreciate this evaluation article. Print the whole and give him a copy (PDF file below).

Re. the modest response from the Pred cycle: Common starting dose is from 60 to 100mg, then tapering. It's common to do another cycle starting with a higher dose, of the original didn't work too well.

The following reinforces some of the information in the PDF article. This protocol is widely used in the U.S. and is authored by the doctor who first suggested this high dose approach. (If he is interested in starting this approach, get back to me for some supplemental material which he should have.)
---
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.

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« Last Edit: Feb 24th, 2012 at 11:03am by Bob Johnson »  
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japanzaman
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Re: Teranasu?
Reply #2 - Feb 25th, 2012 at 6:56am
 
Thanks. I'll give the article a look over. Smiley
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