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        Cluster Headache Help and Support >> Cluster Headache Specific >> problems with inderal as well as verapamil
        
(Message started by: Stoic on Jan 13^th, 2008, 9:33am)

Title: problems with inderal as well as verapamil
Post by Stoic on Jan 13^th, 2008, 9:33am

My doctor prescribed verapamil a week ago, and I took 240 meg each of the first two days and 120 each of the next two. Each evening I felt increasing anxiety, so that by the fourth night I was jumping out of my skin. Had to take 1.5 mg ativan just to get to sleep.

So I called in and he replaced the verapamil with inderal, which I took for the first time yesterday. Last night I was able to get to sleep, but noticed that my breathing was more shallow and rapid than usual, and my heart rate seemed elevated.

I don't have high blood pressure, just headaches. Are these normal side effects of these drugs?

Title: Re: problems with inderal as well as verapamil
Post by Charlotte on Jan 13^th, 2008, 11:20am

Have you specifically talked to your doc or neuro about having what appears to be an anxiety attack each evening?

You need to tell the doc exactly what is happening and discuss exactly what is happening. It may or may not be a reaction to the meds or combination of meds, but you need help sorting it out.

Charlotte

I am not trying to shine you on. It is a real issue, and if it is panic attack/anxiety, it needs to be addressed by the doc. If it is something else, the doc may need to start you on a lower dose of med and work up the dosage, or it may be something entirely new that will require tests.

Title: Re: problems with inderal as well as verapamil
Post by Bob_Johnson on Jan 13^th, 2008, 11:43am

Have never heard of this response to Verap--but individual variation always at work. Print this out and ask your doc if starting over again on this system might resolve the issue.
-------------
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).

Title: Re: problems with inderal as well as verapamil
Post by Stoic on Jan 13^th, 2008, 11:49am

Thanks, Charlotte. I had panic attacks when I was much younger, so I know what those are like. This was far les severe, and it seemed to coincide with taking the Verapamil.

My first dose was late Monday, and my second early Tuesday morning. That evening after going to bed, I noticed that I was suddenly wide awake, although eventually I was able to get to sleep. I cut my Verapamil in half, but Wednesday evening had real difficulty getting to sleep, and by Thursday night really felt that the Ativan was all that enabled me to sleep at all. I took the next day off, and got to sleep just fine, as I did last night after taking Inderal.

I've spoken to my neurologist's nurse about this, and she's spoken with him and then called me back. Apparently he's indicated that Verapamil is an unlikely cause, but still switched me to Inderal.

My feeling now is that I've been taking so many different drugs at different times for different reasons and in different dosages, etc., that I'd like to eliminate as many as possible. I'm retired so I can lie down and just suffer for awhile if that's necessary. Perhaps I'm a candidate for oxygen.

In any case, I'll call my neurologist's nurse tomorrow to bring her up to date.

Title: Re: problems with inderal as well as verapamil
Post by Stoic on Jan 13^th, 2008, 11:56am

Thanks, Bob. Your post arrived while I was writing in response to Charlotte. :-)

This is extremely interesting information. When I arrived home with the Verapamil, I wondered if I should be taking it early in the morning, at mid-day, or before bed. But I didn't see anything in the information packet that indicated dividing it into three separate graduated doses. Perhaps if I'd done so I wouldn't have had the kind of reaction I did. Since I took the complete dose (whether 120 or 240) early in the morning, I might have been experiencing a mini-withdrawal by bedtime, which would explain a lot. And it did seem to have a prophylactic effect on the headaches -- none on Wednesday or Thursday.

I'll see if I can send your information electronically to my neurologist tomorrow.

Thanks again to you both.

Bob

Title: Re: problems with inderal as well as verapamil
Post by E-Double on Jan 13^th, 2008, 1:31pm

you appear to be taking an extended or sustained release version of verapamil.
Research suggests as do the big whigs in CH doctor land that the regular or standard release is much more effective

Title: Re: problems with inderal as well as verapamil
Post by monty on Jan 13^th, 2008, 3:23pm

Your reaction to inderal is somewhat unusual - usually it slows down the heart. But the idea that some people react the opposite way (a paradoxical reaction) is not impossible - this happens for most drugs in a few people.

Anxiety attacks could be the explanation for some of this, as Charlotte suggested. When I am in cycle, my anxiety is usually high, especially right before and during an attack (usually feel release after the attack). I don't think that this is anxiety generated by the mind - it is more of a physical reaction. Sometimes I wake up a few minutes before a hit and feel wide awake and squirmy or agitated. The balance between sympathetic and parasympathetic nerves can get really out of whack. In some ways, clusters are like seizures, and right before a hit there is that weird feeling as one part of the brain starts to wake up and go hyper, and the others switch off (or ramp up to try to counteract the other).

There have been some reports of benzodiazepines helping to turn down the clusters - nothing in the research that I am aware of. But if you have anxiety, ativan or other benzos might be useful just for that, even if they don't prevent. Ativan is good for short term control, while xanax is longer lasting, and klonipin has an even longer lasting action.

Title: Re: problems with inderal as well as verapamil
Post by Stoic on Jan 14^th, 2008, 8:23am

Thanks to all of you for your posts. I'm learning how to cope with this better each day.

Another attack late yesterday, which I fended off with Imitrex. So I decided to return to the Verapamil, taking 120 mg in the early evening. I got through the night alright, although this morning I'm feeling some of the side-effects of the medication — e.g., some confusion, difficulty concentrating, some very slight nausea, etc.

My neurologist prescribed 120 mg (extended release) each day for a week, then 240 mg per day thereafter. Is it safe to assume that some of these side-effects will diminish as my body becomes more accustomed to the Verapamil?

Title: Re: problems with inderal as well as verapamil
Post by maryo on Jan 14^th, 2008, 4:53pm

I'm inclined to side with concept of paradoxical effect. In any case, I'm finding a benzo (clonopin for me) on top of the prophylactic is making life (especially nights) much improved.

You mentioned oxygen, and I think for any clusterhead that should be one of the first things to try. Imitrex works great but it shrinks cardiac vessels, and in my case -- healthy heart, no family history of heart disease -- I developed PVCs a/k/a palpitations. Nothing dangerous, but not a direction I wanted to go in.

They started me on long-acting verapamil as well. I switched to short acting, three times a day, upping dosage 20 mg at a time. I'm at 80 mg three times a day and have had two painfree nights. Still too early for me to trust "pain free." I woke up wondering what the hell was going on, was I going to get hit or what?

Keep the faith!