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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Verapamil Dosage?????
        
(Message started by: ClusterChris on Aug 29^th, 2007, 8:49pm)

Title: Verapamil Dosage?????
Post by ClusterChris on Aug 29^th, 2007, 8:49pm

My doctor just prescribed me Verapamil for the second time. !st time my cycle was on its way out so i never bothered taking it, now she wants me to try it because my cycle is dragging on way too long. She prescribed me 120mg once a day. From all the reading on here I have done about Verap, It sems that this is pretty much the minimal dose. I kow your not doctors but my doctor knows shit about these and I am wondering if I should double it up for it to have some affect. Your input would be greatly appreciated.

Thanks,
Chris

Title: Re: Verapamil Dosage?????
Post by E-Double on Aug 29^th, 2007, 8:57pm

1: Headache. 2004 Nov-Dec;44(10):1013-8. Links

Individualizing treatment with verapamil for cluster headache patients.
Blau JN, Engel HO.
City of London Migraine Clinic, London, UK.

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 mgdaily. 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.

PMID: 15546265 [PubMed - indexed for MEDLINE]

Title: Re: Verapamil Dosage?????
Post by ClusterChris on Aug 29^th, 2007, 9:06pm

That was perfect! I'm going to print that and bring it to my doc!

Thank You!

Chris

Title: Re: Verapamil Dosage?????
Post by Brewcrew on Aug 29^th, 2007, 9:50pm

The most common dosage around here seems to be 480mg/day, divided into 2 doses of 240mg each. Based only on anecdotal evidence.

Title: Re: Verapamil Dosage?????
Post by ClusterChris on Aug 29^th, 2007, 11:52pm

Ok, guess i'll start with the 120 and see what happens then maybe ramp up to the 240 in a few days or so!

Thanks!

Title: Re: Verapamil Dosage?????
Post by Wayne on Aug 30^th, 2007, 1:57am

Hey Chris

I'm also at 480, in 3 doses of 160, works like a dream. There are heart related issues with this drug though, Bob J posted an article last week about possible bradycardia(sic) and iregular heart beat caused by excessive use. You may want to discuss with your doc before you ramp up. 120 is very low though.

Good luck

Title: Re: Verapamil Dosage?????
Post by UN solved on Aug 30^th, 2007, 3:06am

Chris,

Please talk to your doctor BEFORE you increase the dosage of ANY of your medications !! This medication (and many others) CAN KILL YOU if you overdo it !!

BTW ... 400 mg / day of Verapamil lowered my BP and dangerously slowed my heart rate. (24 bpm) Not everyone can handle big doses of this !!

Be careful

UNsolved

Title: Re: Verapamil Dosage?????
Post by sandie99 on Aug 30^th, 2007, 4:02am

Yes, listen to Unsolved. Verap lowered my low BP a lot as well and believe me, it's NOT nice to faint uncontrollably! :-X

Funnily, though, the fainting took place only when my dose was lower, 200mg, but when the neuro increased it to 400mg I functioned better. But talk about it with your doc before doing anything! :)

Sanna

Title: Re: Verapamil Dosage?????
Post by barry_sword on Aug 30^th, 2007, 6:46am

Chris, I am on 480mg Verap. daily, 3 doses of 160mg. This so far seems to be my dosage. I monitor my blood pressure and it is good.

As said by others, do not up your dosage without your Doc's ok. And watch those energy drinks containing torrine while taking Verap.

120mg daily is low but let your Doc know if you want to increase.

Hope you find your cocktail that works for you.

Barry

Title: Re: Verapamil Dosage?????
Post by E-Double on Aug 30^th, 2007, 9:12am

Exactly what Unsolved said!!!

Do not do anything without talking to your doctor regarding medication.
Increasing or decreasing a med (any med) without guidance can be extremely dangerous.

Title: Re: Verapamil Dosage?????
Post by ClusterChris on Aug 30^th, 2007, 12:07pm

Thanks for all the replies!

My biggest problem with my doc is she knows absolutely nothing about them, So I know if i ask her to ramp me up later she probably wont do it. She did say that she wants to see me every two weeks to check my blood pressure.

I did read the article about the heart problems but I saw that in almost all atients, the problems go away once you stop taking it, which is pretty reassuring!

I'll lets ya's know how it goes!

Chris

Title: Re: Verapamil Dosage?????
Post by birdman on Aug 30^th, 2007, 1:27pm

Chris,
Verap has been a gift from the gods for me. I currently take 840mg but I take it all at once. Starting to think I should space it out as my HR gets really really low in the afternoon. Verap has always kept me pain free except for the occasional 1 breakthrough per day. I would love to start lowering my doasge but always get breakthrough HA's whenever I try. Good luck and get the doc's okay first!
Tim

Title: Re: Verapamil Dosage?????
Post by MR_FLOOR on Aug 30^th, 2007, 5:54pm

Hey Chris,

I was at 360 and just got bumped up to 480.The 480 seems to be working pretty good,I'm getting from 3 to 5 hits a week,thats damn near cured in my book.Good luck.

Dave