Clusterheadaches.com Message Board


    
      
        Clusterheadaches.com Message Board
        (http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi)
      

        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> verapamil release
        
(Message started by: tony-PA on Jan 28^th, 2008, 3:27pm)

Title: verapamil release
Post by tony-PA on Jan 28^th, 2008, 3:27pm

Ciao everybody,
I read about it some time ago in internet, and for my own experience I'm convinced that the nonsustained release formulation of verap works better than the sustained release preparation.
I tried a search in the forum, but no results (my fault for sure) :-[.
First: what you think about?
Than: can anyone tell me some internet page explaining this?
Thank you

Title: Re: verapamil release
Post by E-Double on Jan 28^th, 2008, 6:20pm

on 01/20/08 at 12:53:24, Bob_Johnson wrote:

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).
===========
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.
=====

Title: Re: verapamil release
Post by cluster on Jan 30^th, 2008, 6:30am

Hello Tony,

my very own cluster-head is not convinced that the nonsustained release formulation of verap works better than the sustained release preparation.

After my CH diagnosis in July 2005 the disease was treated successfully with 3 x 80 mg/d ordinary release verapamil. In May 2006 the medication did not seem to work any more and was changed to 2 x 120 mg/d sustained release formulation. This change improved my condition almost immediately and the treatment has been successful with acceptable side effects since then.

My opinion: Sustained release formulation verapamil should be tried to treat cluster headache patients who do not respond to ordinary release verapamil or if the side effects of ordinary release verapamil are not acceptable. - And vice versa, but never change if your medication works O.K.

Summary of a literature search:
Cardiac and extra cardiac tolerability of verapamil slow-release (SR) 240 mg was good in an open multicenter trial in 4,247 patients with hypertension.[1] Fuenmayor et al. reported that the pharmacokinetic characteristics of SR verapamil account for its more favourable side-effect profile observed with this formulation. SR was considered advantageous to instant release verapamil (IR) for the chronic treatment of hypertensive patients.[2][3] Other comparative studies with hypertensive patients did not find a difference in efficacy nor in the side effects between the SR and the IR formulation.[4][5]

The "sustained release caplets of verapamil (Calan or Isoptin)"[6] were successfully used for the treatment of cluster headache by Gabai and Spierings and by Göbel et al.[7] Both, the regular and the extended release preparations of Verapamil have been shown to be useful, but no direct comparative trials are available.[8][9]

2007 Cohen et al. reported electrocardiographic abnormalities in patients with cluster headache on verapamil therapy. These patients were using the ordinary release formulation of the medicine.[10] From a pharmacokinetic point of view it makes sense to consider using SR verapamil in order to minimize fluctuations in plasma levels.[7]

References:
1) Speders S, Sosna J, Schumacher A, Pfennigsdorf G.: Efficacy and safety of verapamil SR 240 mg in essential hypertension: results of a multicentric phase IV study. J Cardiovasc Pharmacol. 1989; 13 Suppl 4: S47-9. PMID 2475686.
2) Fuenmayor NT, Faggin BM, Cubeddu LX.: Comparative efficacy, safety, and kinetics of immediate- and slow-release verapamil in hispanic patients with essential hypertension. J Cardiovasc Pharmacol. 1989; 13 Suppl 4: S53-6. PMID 2475688.
3) Fuenmayor NT, Faggin BM, Cubeddu LX.: Comparative efficacy, safety and pharmacokinetics of verapamil SR vs verapamil IR in hypertensive patients. Drugs. 1992; 44 Suppl 1: 1-11. PMID 1283570.
4) Hilleman DE, Mohiuddin SM, Lucas BD Jr, Shinn B, Elsasser GN.: Conversion from sustained-release to immediate-release calcium entry blockers: outcome in patients with mild-to-moderate hypertension. Clin Ther. 1993 Nov-Dec; 15(6): 1002-10. PMID 8111798.
5) Midtbo K, Hals O, van der Meer J, Storstein L, Lauve O.: Instant and sustained-release verapamil in the treatment of essential hypertension. Am J Cardiol. 1986 Feb 26; 57(7): 59D-63D. PMID 3513516.
6) Gabai IJ, Spierings ELH.: Prophylactic treatment of cluster headache with verapamil. Headache. 1989; 29(3): 167–168. PMID 2708046.
7) Göbel H, Holzgreve H, Heinze A, Deuschl G, Engel C, Kuhn K.: Retarded verapamil for cluster headache prophylaxis. Cephalalgia. 1999; 19(4): 458-9.
8) Dodick DW, Rozen TD, Goadsby PJ & Silberstein SD.: Cluster headache. Cephalalgia. 2000; 20(6): 787-803. PMID 11167909.
9) A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby: EFNS guidelines on the treatment of cluster headache and other trigeminalautonomic cephalalgias. European Journal of Neurology. 2006; 13: 1066–1077. PMID 16987158.
10) Cohen AS, Matharu MS, Goadsby PJ: Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy. Neurology. (2007); 69(7): 668-75, PMID 17698788.

Here you can find a text version with links to the abstracts of these references:
http://www.ck-wissen.de/ckwiki/index.php?title=Benutzer:Friedrich_K./Verapamil

pf wishes,
Friedrich

Title: Re: verapamil release
Post by jace77 on Jan 31^st, 2008, 12:24pm

http://www.plainboard.com/ch/chtherapy.pdf

Dr Rosen touched on this ever so briefly in the "key issues" section on the above link stating that the non sustained release formulation appears to work better than sustained release, but there is no literature to support this.
Doesn't really give an explanation, but our neuro thought it would be worth trying. Hubby ended up in the Diamond headache clinic for treatment tuesday and was admitted to the hospital for approx 11 days, so we have not made the switch