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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> propranolol to verapamil change -what say you?
        
(Message started by: nohandgunsallowed on Oct 20^th, 2006, 11:42pm)

Title: propranolol to verapamil change -what say you?
Post by nohandgunsallowed on Oct 20^th, 2006, 11:42pm

greetings. couldn't be newbier, i know...not new to the CH evil though. for 8 years the clusters have been well
controlled with 120mg. propranolol daily. with triptans and cafergot for break-thru... until 2 wks. ago.
then, you know the drill, every nite, every nite. started on prednisone 60mg. daily which seems to be helping. Neurologist also had me switch to verapamil 120mg for first 4 days, then 240mg thereafter. however, neuro did not seem at all worried about my stopping the propranolol that day! when i asked about a taper, she suggested 3 days! should i be as panicked as i am? how long before the verapamil picks up the slack, i wonder? frankly, i am taking both out of fear (as well as taking my pulse, i know...)

ANY advice, experience, insight for this fellow sufferer would be Greatly appreciated. Thanks.

Title: Re: propranolol to verapamil change -what say you?
Post by nani on Oct 20^th, 2006, 11:44pm

Hi and welcome. The pred will help while the verapamil kicks in. Propanolol doesn't really work well for CH, it's better for migraines. You are on a short term pred taper, right? Too much can hurt you.
pain free wishes, nani

Title: Re: propranolol to verapamil change -what say you?
Post by nohandgunsallowed on Oct 20^th, 2006, 11:47pm

thanks for responding...i will allow for the chance that the propranolol Didn't help the clusters. if that's the case, then i have been blessed with infrequent bouts without any preventative...still wonder how long verapamil might take to reach a therapeutic level though.

Title: Re: propranolol to verapamil change -what say you?
Post by BB on Oct 20^th, 2006, 11:58pm

Usually Verapamil takes about 2 days to start lowering blood pressure but no one knows what dose you will need for it to work for CH.

The mechanism for Verap against CH is more via the Ca+ channel blocks rather than just blood pressure lowering, thats why it is usually used in much higher doses for CH than when used normally just for hypertension.

Its fine to take pred taper while building up the Verap.

You may need to use Triptans OR Cafergot more in the mean time for the hits, but dont mix both though.

Take care and PFDAN

Annette

Title: Re: propranolol to verapamil change -what say you?
Post by nohandgunsallowed on Oct 21^st, 2006, 12:35am

thanks! i was afraid it'd be weeks/months for a level to build up. it is SR, which is sustained release? how high a dose of verapamil is the max, 480mg? do folks increase dosages themselves if episodes aren't being stopped with lower doses -- and does a higher dose work in that case? any experince with dose-ranges? many thanks

Title: Re: propranolol to verapamil change -what say you?
Post by BB on Oct 21^st, 2006, 1:14am

Maximum dose for Verapamil is 1000 mg per day.

The slow release version SR may not work as well as the immediate release.

You cant increase the dose yourself, as it lowers blood pressure and can cause abnormal heart beats you need to see your dr for check up and ECG with each dose increase. Usually the dose gets increased every 3 to 5 days depends on the symptoms and side effects if any.

If a lower dose helps but not that much then its worthwhile to increase the dose to see.

The problem is if you develop hypotension, ( BP too low ) or funny heartbeats then you wont be able to increase the dose any higher, then you may need to add something else like lithium.

Good luck with it all and let us know how you go.

Cheers

PFDAN to you.

Annette

Title: Re: propranolol to verapamil change -what say you?
Post by BMoneeTheMoneeMan on Oct 21^st, 2006, 1:17am

Hi there and welcome.
What is it that you were taking the propranolol for? Do you have high blood pressure or do you have another problem you take that for?
I also take propranolol for a different condition. I have never heard of propranolol helping clusters. My docs have said if you want to take them together, take small doses, but it is still not the best idea. Its good to taper off the propranolol over a few days and then taper into the verapimil.
Read up, there is lots of info here.
Again, welcome.
B$

Title: Re: propranolol to verapamil change -what say you?
Post by jon019 on Oct 21^st, 2006, 1:35am

Hi No...,

Was prescribed propanolol years ago for CH. Took it for a long time, hoping... Didn't work for me with unpleasant side effects like nightmares.

Currently taking verapamil 480mg/day and considering higher since it is losing effectiveness after years of help (perhaps a tolerance, don't know). As others have said here and in other threads, SR is NOT as effective.

Took about 7-14 days in my case to become effective, AFTER a medrol (similar to prednisone) taper.

Get thee some O2, read about it here. Is BEST and least side effective treatment. Also have had success with Zomig nasal spray. Others here swear by Imitrex injections. read, read, read...

Sorry you are here but welcome, you will find a family, info, and support like NOWHERE else.

Regards

Jon

Title: Re: propranolol to verapamil change -what say you?
Post by nohandgunsallowed on Oct 21^st, 2006, 1:36am

i don't know about propranolol not helping clusters generally. i only know about my own experience with it. after suffering regular 10/10 headaches that meet all CH characteristics plus photophobia, i was diagnosed with 'migraines.' propran was prescribed as a prophylaxis and within a couple months, my 'migraines,' that came 2,3,4 or more nights in a row at 2am, with me waking up screaming...stopped. since that time, every few months i pop a triptan at the first sign of a headache and rarely wake
up with one.

after my recent cluster of 16 days in a row, ended 3 days ago, i'm still partly shadowy all day and am worried. worried what'll happen when the prednisone is gone. and also worried about stopping what (i believed) had stopped so much pain for so long and starting the verapamil instead.

btw, what drove me to the docs in the first place was the fact that my triptan, that had previously stopped the attack -- now only worked for about 30 minutes and then the headache blasted back through. so i'd take another. and maybe a half hour later, another. mix in a couple cafergot because i would just as soon die at that moment, nowhere near my normal mental state. i told three different docs how much i was taking and they just sort of winked and nodded!

thanks for your response. i have a lot of questions to answer and it is a godsend that i found this board. thanks!

Title: Re: propranolol to verapamil change -what say you?
Post by nohandgunsallowed on Oct 21^st, 2006, 1:40am

much and many thanks for the advice. am presently armed with imitrex inject and sprays. tried O2 for the first time in an ER but it didn't work, or didn't work completely. do you expect O2 to completely stop the attack or just knock it down a couple notches? i am hoping i don't need the ER soon but if i do, i'll request O2 on the way in!

peace and thanks

Title: Re: propranolol to verapamil change -what say you?
Post by BMoneeTheMoneeMan on Oct 21^st, 2006, 1:46am

For me, O2 knocks it out completely. Sometimes it can take a while for it to work, but even when it isnt working perfectly it still knocks the CH down a couple notches.
Luckily for me, when I take O2, I can feel relief in minutes, but sometimes it does take up to 20 minutes to knock it out completely.

BTW, if you dont already know, it needs to be high flow O2, like 12 to 15 litres per minute, and it must be in a non-rebreather bag. Dont use the nose canules.

PF wishes
BMonee

Title: Re: propranolol to verapamil change -what say you?
Post by chopmyheadoff on Oct 23^rd, 2006, 6:22am

hi and welcome to the madhouse.

i took bloody propanalol for 7 stupid years without it doing ANYTHING.
but i was scared to stop taking it incase it really was doing something and they would get worse if i stopped.

when i finally got to see a neurologist (after nearly decking my doctor coz i was at witts end) he put me on verap and told me to stop taking the propanalol. which i did straight away, binned the lot.

iv been pretty much pain free since then my friend.
480mg a day for me - still get the odd breakthrough which i just kill with a shot of imitrex !! ;;D

Title: Re: propranolol to verapamil change -what say you?
Post by chewy on Oct 23^rd, 2006, 6:51am

Quote:

Usually Verapamil takes about 2 days to work but no one knows what dose you will need for it to work.

More like 7-10 days to reach theraputic levels.

Title: Re: propranolol to verapamil change -what say you?
Post by Charlotte on Oct 23^rd, 2006, 9:32am

on 10/21/06 at 01:40:33, nohandgunsallowed wrote:

I've read you need to use the O2 as early as possible, and not wait too long. That's probably why it didn't work very well at the ER.

Charlotte

Title: Re: propranolol to verapamil change -what say you?
Post by seasonalboomer on Oct 23^rd, 2006, 10:02am

on 10/21/06 at 01:40:33, nohandgunsallowed wrote:

For me, 80% of the time, O2 knocks it out completely and typically (again almost 80% of the time) it does so in less than 10 minutes.

The quality non-rebreather mask and 10-15 lpm is critical to the likelihood of success however. The great thing is that ER's are becoming knowledgable about O2 as a treatment for Cluster, the rest of the education is to get them to meet the administering directions. (Was even in Men's Health magazine this month as one of the preferred treatments.)

Scott