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Topic: With what dose of verapamil do you start during cl (Read 632 times) |
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vitaliy.se
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With what dose of verapamil do you start during cl
« on: Jan 4th, 2008, 7:06pm » |
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With what dose of verapamil do you start during cluster?
How do you increase the dose?
I ask because my Dr. told me to start from 40mg per day and increase by 40 each week. My cluster usually lasts for 3 weeks so I will be only on 120 if I will follow her recommendations.
I started from 40 but I increase the dose faster. I'm on 240mg per day in 10 days.
Did someone took verapamil for prophylaxis reason outside the cluster?
What was the result?
Regards,
Vitaliy S
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Brew
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Re: With what dose of verapamil do you start durin
« Reply #1 on: Jan 4th, 2008, 8:44pm » |
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I've never been told to ramp up verapamil. My magic dose seems to be 480mg/day. Once we tried to go higher, but I got light-headed.
I've always jumped right in at 480mg, but I usually taper down to see if I'm truly out of cycle.
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George_J
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Re: With what dose of verapamil do you start durin
« Reply #2 on: Jan 5th, 2008, 1:15am » |
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I may be speaking out of turn here, since I don't take verapamil, but I understand that it may take some time to build up in your system to be effective. Since your usual cluster cycle lasts three weeks, a very short time, I wonder how effective verapamil will be as a preventive.
Has your doctor discussed abortive strategies with you? Oxygen--imitrex injectables--Zomig--etc.?
Best wishes,
George
Edited for syntax.
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| « Last Edit: Jan 5th, 2008, 1:16am by George_J » |
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Bob_Johnson
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Re: With what dose of verapamil do you start durin
« Reply #3 on: Jan 5th, 2008, 8:15am » |
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This from one of the major medical journals in the U.S.
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;44:1013-101 .
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(Dr. Goadsby one of the leading headache doctors in England and, soon, he moving to the U.S. to start practicing.)
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: Jan 5th, 2008, 8:18am by Bob_Johnson » |
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Bob Johnson
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vitaliy.se
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Re: With what dose of verapamil do you start durin
« Reply #4 on: Jan 5th, 2008, 5:14pm » |
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on Jan 5th, 2008, 8:15am, Bob_Johnson wrote:This from one of the major medical journals in the U.S.
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Thank you for the information Bob.
I may only guess why my neuro prescripts me to start from 40.
Probably she afraids of fast blood pressure decreasing (only guess).
2 all:
does someone know how verapamil dose correlates with weight?
My weight is almost 100kg (~ 220 lbs) so may be 240mg per day isn't big enough for me?
Regards,
Vitaliy S
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Kelly
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Re: With what dose of verapamil do you start durin
« Reply #5 on: Jan 6th, 2008, 1:28am » |
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I'm a biscuit short of #250 and I get away with 240 mg. Just like Brewcrew, I jump right in with the 240 when I get a cluster. That and the Pred seem to work well for me. I don't know if body weight has much to do with it or I would suspect I would be in for a MUCH LARGER DOSE! HMMM, maybe it's a mg per pound. That sound right Brewcrew?
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Brew
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Re: With what dose of verapamil do you start durin
« Reply #6 on: Jan 6th, 2008, 11:07am » |
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on Jan 6th, 2008, 1:28am, Kelly wrote:| I'm a biscuit short of #250 and I get away with 240 mg. Just like Brewcrew, I jump right in with the 240 when I get a cluster. That and the Pred seem to work well for me. I don't know if body weight has much to do with it or I would suspect I would be in for a MUCH LARGER DOSE! HMMM, maybe it's a mg per pound. That sound right Brewcrew? |
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I know some drugs are prescribed based on body weight, but I'm not sure if verapamil is. I weigh 200# and my magic dose is 480mg/day. So I suspect weight doesn't have much to do with it. Probably more about how fucked up my brain is.
All's I know is that I've never tapered UP on it. I taper down to see if I'm still in cycle.
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Bob_Johnson
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Re: With what dose of verapamil do you start durin
« Reply #7 on: Jan 6th, 2008, 8:43pm » |
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If your doctor is not experienced treating headache, please print out this article and give to her. Call her attention to Dr. Rozen's comment about dosing of medications for cluster, that is, higher than normal doses are common.
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http://www.plainboard.com/ch/chtherapy.pdf
Here is a link to read and print and take to your doctor. It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S. (2002)
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Bob Johnson
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Charlotte
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Re: With what dose of verapamil do you start durin
« Reply #8 on: Jan 7th, 2008, 8:49am » |
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One reason for starting low is heart irregularities; my neuro started me at only 20 mg and I had to stop and get the heart checked out and then continued a year ago, and went up to 320 mg a day which works very well, I have asked my neuro to up it at least 80 mg more, but he said he is concerned about the low BP at the beginning of this amount, and thinks I should stick here. I think it could be 20% better higher, but I have to respect his opinion on this since I am doing comparatively great.
I also asked the neuro if we can up the Indomethacin which I use for the paroxysmal hemicrania type hedache but we are trying for the least amount with best result which seems to be 100 mg a day - consistent results for good maintenance for now.
The thing about finding good maintenance doses is that there are times when nothing helps. To me, that is just part of the nature of the beast, and time to just struggle through that. It used to seem to me that it was caused by whatever med I was taking at the time, but over the years, some without meds, it just is consistent and also happens with no meds also. Those are the times when CH.com are most comforting and the best "medicine". Thank you DJ and everyone here, for being here.
Charlotte
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| « Last Edit: Jan 7th, 2008, 8:51am by Charlotte » |
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K-MAN
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Re: With what dose of verapamil do you start durin
« Reply #9 on: Jan 7th, 2008, 12:58pm » |
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I don't take Verapamil any more. My doctor and I had determined that 120mg/day would do the job, but it had a major side-effect of constipation. Helped some with the headaches but was terribly uncomfortable after several days.
Most people are not affected like this, but you would be better off taking the least amount needed to do the job. Otherwise you may find yourself needing to buy stock in a prune juice company!
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| « Last Edit: Jan 7th, 2008, 12:58pm by K-MAN » |
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Major_Headcase
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Re: With what dose of verapamil do you start durin
« Reply #10 on: Jan 8th, 2008, 10:09am » |
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Currently taking 840mg of verapamil a day. I take 240mg/day year round for high blood pressure, when my cycle comes I ramp up 120mg/per day until I hit 840. I seem to have needed about an extra 120mg/year since I started CH in 2000-01. Began low and adjusted up. 840mg/day seems to be working again this year, so maybe I won't have to up it again or switch to another preventitive this year (or next ... but probably soon). Prednisone is down to 30/mg today, and have had a few kip 7 breakthroughs but I can deal with that.
I've had to increase my Verapamil dosage each year to maintain PF status once the prednisone taper gets too low to quash the beast. Constipation was/is more of a problem than my BP or pulse ... two cycles ago I didn't ramp up, just jumped to full dosage and it was horrible. Now I start a metamucil regimen (3X day) at the same time as I start ramping up the verapamil, even with that I need an OTC laxative about day 4 to stay quasi-regular.
-John
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thomas
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Re: With what dose of verapamil do you start durin
« Reply #11 on: Jan 9th, 2008, 8:57am » |
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I once heard of a guy who was pf after just one dose of verapamil.  (true story)
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Religion and sex are powerplays. Manipulate the people for the money they pay. Selling skin, selling God, the numbers look the same on their credit cards. Triptans cause rebounds. Learn it, believe it, live it. I use triptans as the absolute LAST RESORT when treating my CH.
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