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        New Message Board Archives >> 2004 Posts >> Verapamil question
        
(Message started by: EmpressJMB on Oct 27^th, 2004, 2:29pm)

Title: Verapamil question
Post by EmpressJMB on Oct 27^th, 2004, 2:29pm

I was just reading the newbie board and a couple people mentioned not to use time release Verapamil. How come [smiley=huh.gif]. I mentioned a couple weeks ago that my neurologist put me on it and no one said anything. Thanks! Janet

Title: Re: Verapamil question
Post by Jeepgun on Oct 27^th, 2004, 2:38pm

Are you sure they weren't talking about Imitrex? Oral Imitrex (time release) is worthless for CH.

Verapamil is, by its very nature, time released. It builds up in the system to do its job as a preventative.

I didn't think there was such a thing as time release Verapamil, but I might be wrong...

[smiley=twocents.gif]

Title: Re: Verapamil question
Post by EmpressJMB on Oct 27^th, 2004, 2:49pm

Thanks for responding Jeep. :) I actually meant to put this question on the meds board. I am definitely talking about Verapamil. Pubgirl and Angel somebody (don't remember name), both mentioned it on the newbie board. That is what my neuro called it when he was writing the script. I got my first Imitrix script filled today(been using samples) and they said all my insurance will allow is ONE 6mg stat dose per purchase and only 3 of those in 23 days!!!! Can you believe it!? >:( Hope the beast knows that! Yea right. Janet

Title: Re: Verapamil question
Post by vig on Oct 27^th, 2004, 2:52pm

It's called Verapamil ER (Extended Release)
I've never heard anyone say not to use it.
I think it's probably fine.
I'd better go look at what pubgirl said....

Title: Re: Verapamil question
Post by Jeepgun on Oct 27^th, 2004, 2:56pm

Hrmmm... Interesting! What's the difference between the regular Verapamil and the "ER" form? Hrmmm....

Title: Re: Verapamil question
Post by broomhilda on Oct 27^th, 2004, 3:22pm

From what I gather from reading and what I learned is some folks are on SR and some are not, for some the SR did not work...When I was first put on verap I specifically asked not to be put on SR as I had heard more success stories...

Not sure however as to why, hope this helps :-/

Title: Re: Verapamil question
Post by TomM on Oct 27^th, 2004, 3:57pm

I used Verap one time and it plugged me up like Fat Bastards toilet.

Title: Re: Verapamil question
Post by Jeepgun on Oct 27^th, 2004, 4:10pm

Oh! No "big deposits" for you, Tom! [smiley=laugh.gif]

Title: Re: Verapamil question
Post by EmpressJMB on Oct 27^th, 2004, 4:20pm

Thanks Tom for that lovely mental picture. J.<a href='http://www.smileycentral.com/?partner=ZSzeb008_ZNxdm115XXUS' target='_blank'><img src='http://smileys.smileycentral.com/cat/10/10_4_1.gif' alt='Very Constipated' border=0></a><a

Title: Re: Verapamil question
Post by EmpressJMB on Oct 27^th, 2004, 4:21pm

Oops! J

Title: Re: Verapamil question
Post by TomM on Oct 27^th, 2004, 4:27pm

on 10/27/04 at 16:10:43, Jeepgun wrote:

Oh! No "big deposits" for you, Tom! [smiley=laugh.gif]

Not until I drank 2 bottles of Magnesium Citrate http://www.valu-rite.com/images/magnesium-citrate.jpg did I 'deposit' anything. :o

http://www.valu-rite.com/vr/magnesium-citrate.html

Title: Re: Verapamil question
Post by Ueli on Oct 27^th, 2004, 4:43pm

As this topic has been discussed so many times, I'm just gonna quote myself:

on 08/05/03 at 21:15:55, Ueli wrote:

I'd like to add some thoughts to this Verapamil discussion.

Drugs whose patents are expired, like Verapamil, can be marketed by everybody. Some companies add some new 'features' to an old drug, in an attempt to grab a higher share of the market. The worst example is 'Excedrin migraine' which is exactly the same stuff as Excedrin forte, with the only difference that the leaflet contains the warning to visit a doctor if the headaches should continue. ::) In Europe 'Aspirin' is a protected trade name of Bayer; others have to invent a new name to sell acetylsalicylic acid. But nevertheless, in the last years Bayer has marketed three fancy variants of the over 100 years old stuff, duh.

Verapamil comes in different variations: regular, SR (sustained release), PM and HS (controlled onset).
Regular Verapamil takes 1-2 hours to reach maximum plasma concentration. The renal elimination half-life of Verapamil is 4.5 to 12.0 hours. It therefore seems to make sense to split the daily dosis into several parts and use a slow release version, in order to get an almost constant concentration throughout the day. I don't know anything about Verapamil usage for heart disease, could be this is an important point there.
However, experience for clusterheads shows that Verapamil takes a much longer time to show any effect, a week to 10 days. Therefore, the short time variations throughout the day are of little consequence. (A year ago I dropped my daily dosis from 560 mg to 480 mg. After about a week the attacks got worse. So after a few day I went back up to the previous dose and it took another week until the attacks were reduced again.)
In view of this, there should be no reason to prefer any variant over the other. But Dr. Peter Goadsby, the world's most knowledgeable expert on CH, recommends the regular Verapamil over the SR version, on pure empirical reasons. He doesn't know why, but suspects the different mix of the (about a dozen) metabolites for the different variants. There are quite a few testimonials on this MB on improved results from changing from SR to regular.

Now to the story of Leslie. First, I think his/her pharmacist is rather irresponsible, switching the rx on his own from HS to SR; there have been reports of very serious overdosing on doing that. :( Second, I can't believe that the difference noticed by Leslie is due to timing: The 4 - 5 hours delay of HS taken before bedtime comes too late for the nightly attacks that strike with the onset of REM sleep, usually 1.5 hours after falling asleep. Furthermore, it takes days until Verapamil brings its full effects. I guess, the HS version has yet another mix of metabolites, one more useful than from the SR version and more similar to the regular.

PFNADs
Ueli

and

on 11/17/02 at 17:01:48, Ueli wrote:

Verapamil (generic name) is an old drug, e.g. all patents have expired.

This has 2 consequences:

The same drug is marketed under different brand names: Verapamil, Isoptin, Calan, Covera, Verelan and a few dozens more.
Some manufactures add some more or less fancy properties, in an attempt to grab a larger share of the market.

There are basically 3 different forms of Verapamil:

The regular form (no additional letter after the name). This is the form most suitable for clusterheads, and recommended by Dr. Goadsby.
The sustained-release form (has usually SR after the name, e.g. Calan SR). Although they are useful for some heart conditions, there are quite a few clusterheads that got better results by changing from the SR to the regular form.
The extended-release or controlled-onset forms (with ER, PM or HS after the name, e.g. Verelan PM, Covera HS). These are designed to be taken before bed time and developing their action around wake up time. An useful feature for some heart conditions but quite contrary to what a clusterhead needs.

The SR form gives a more level serum concentration throughout the day than the regular form. But that is of minor importance for a clusterhead, it takes several days to reach the point where it does do its job. Nevertheless, it's not a bad idea to split the daily dose into 2 or 3 parts taken throughout the day.

As it is so important, I repeat: :)
Dr. Goadsby recommends the regular Verapamil. For some unknown reason it is more suitable for clusterheads. We had here quite a few reports here, confirming this. And an added benefit: regular Verapamil is usually the cheapest.

And since I'm already on the topic ;D, Goadsby says: "Up the Verapamil until the cluster attacks are suppressed, side-effects intervene or the maximum dose of 960mg daily is achieved."

PFNADs
Ueli

BTW, also the Robbins Headache Clinic (http://www.headachedrugs.com/archives/preventivemeds.html) recommends:
The "regular" verapamil pills, not the long acting, may be more effective than the long acting preparation.

PFNADs, Ueli [smiley=smokin.gif]

Title: Re: Verapamil question
Post by kissmyglass on Oct 27^th, 2004, 5:29pm

on 10/27/04 at 14:38:16, Jeepgun wrote:

Are you sure they weren't talking about Imitrex? Oral Imitrex (time release) is worthless for CH.

[smiley=twocents.gif]

Oral Imitrex was NOT worthless for me. Took a little too long to get in the system but aborted every attack in 20-30 minutes for me. Not ideal but certainly not worthless.

Kev

Title: Re: Verapamil question
Post by broomhilda on Oct 27^th, 2004, 5:34pm

Thank you Ueli :) Clears it up for me!

Title: Re: Verapamil question
Post by Jeepgun on Oct 28^th, 2004, 11:35am

on 10/27/04 at 17:29:11, kissmyglass wrote:

Oral Imitrex was NOT worthless for me. Took a little too long to get in the system but aborted every attack in 20-30 minutes for me. Not ideal but certainly not worthless.

Kev

Interesting! My neurologist put me on oral Imitrex and it didn't do anything at all for me... Just one more example of how weird this condition is...
:-/

Title: Re: Verapamil question
Post by LeLimey on Oct 28^th, 2004, 11:43am

Same here Jeepgun, the oral imigran didn't work but the injections do which is very confusing. I would have expected the tablets to work even if they took forever. There is info about verapamil on the ouchuk website which says you shouldn't take it and drink grapefruit juice as it causes a reaction.. does that go for any other citrus fruits?

Title: Re: Verapamil question
Post by Jeepgun on Oct 28^th, 2004, 11:47am

I've never tried it with any kind of citrus juice. Grapefruit juice?? People actually drink that stuff? *shudder* [smiley=laugh.gif]

The injectable Imitrex works, but I don't like it. It gives me a massive headrush, and then I get shadows the next day, and I suspect that it lengthens my CH cycle... I never experienced shadows until I began using the injections. Next cycle, I will get the script filled, but probably keep them only as a last resort.

Title: Re: Verapamil question
Post by LeLimey on Oct 28^th, 2004, 11:56am

Quote:

Grapefruit juice?? People actually drink that stuff? *shudder*

Yeah well that's how I feel about beer !! [smiley=laugh.gif] Spirits or wine are all I like (expensive tastes sadly!) I try O2 first every time and only use the injections if I have to as I hate taking meds , really hate it. I hate hurrting more though!

Title: Re: Verapamil question
Post by Jeepgun on Oct 28^th, 2004, 11:59am

I don't care for beer too much, although I like Guinness. Most often, I far prefer 16-year old, single malt Isley scotch. (Talk about expensive tastes!) LOL

I'm not real keen on medications, either. I may try to tough this next cycle out. We'll see how it goes... :)

PFDAN to you!

Title: Re: Verapamil question
Post by StueyStu on Oct 30^th, 2004, 1:42pm

I can only add that 960 mg SR is what I was put on. It stopped my cycle within 3 days. But, and I must stress this, I was already taking 480 mg SR for at least two years prior due to high blood pressure. So perhaps since I had already been taking it for such a long period of time when I was raised to 960 it worked quickly for me. Stuey

Title: Re: Verapamil question
Post by Wendy1 on Oct 31^st, 2004, 2:54am

Gosh, I luv you guys!!! After 25 yrs I finally found something that actually broke my cycle (mega mg Verap). (1.5 yrs ago)

For the first time I'm on it as a preventative, think it may be working.

Anywho... my doc said, why don't we try SR??? I'm like umm ok. I'm almost out of the reg and I think I will stick with it. Why mess with a good thing?

Thing is, it is quite possible my profalactic (?) Verap is diverting the start of a cycle, God knows I have enough stress. But of course I can't be sure; and I'm sure as hell not going to stop taking it to see if it is!! until I hit a safety zone, say about late Nov.

Thanks again for all your great input. You are all GODSENDS!!!! I pray for all you to pfdn.