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        New Message Board Archives >> Medications, Treatments, Therapies 2003 >> Advice sought on tapering Verapamil
        
(Message started by: zimmy on Feb 11^th, 2003, 11:53pm)

Title: Advice sought on tapering Verapamil
Post by zimmy on Feb 11^th, 2003, 11:53pm

I finally seemed to have brought my cluster under control.

Prednisone for a week at 80 mg, and now tapering down to 0 mg, currently at 40 mg.

In combination with the steroids, I am using 720 mg Verapamil (3 x a day at 240) until I no longer am on the steroids. Then of course I will begin tapering off the Verapamil.

Does anybody have any suggestions on the rate of step down with the Verapamil? The literature is not very helpful in that regard, thus all advice and experiences welcomed.

Thanks! Mark

Title: Re: Advice sought on tapering Verapamil
Post by Ueli on Feb 12^th, 2003, 8:34am

Mark,
There a two different issues:
The Prednisone burst gives you instant relieve, it sometimes can even abort a cycle. But because of its many side effects Prednisone should not be taken for an extended time. The tapering down gives your body an opportunity to recover; Prednisone shuts down the adrenalin production.
The Verapamil is a long time preventative. It is slow to kick in (about a week or two) and hence the Prednisone burst to fill in this delay. Verapamil does not break the cycle. The attacks come anyway, but the Verapamil dampens their intensity, ideally down to zero.
So, when you have no longer attacks with Verapamil, you never know if the cycle has ended or the V. is 100% effective.
You should judge by the previous length of your cycles and when you think the cycle should be over by now start to tapper down the Verapamil. You could reduce by half a tablet per day and if after one week you don't get any signs of an attack continue to reduce at the same rate, otherwise go back to the previous dose.

BTW, my neuro sees no reason to get off the Verapamil completely during remission. The advantage of taking about half the dose during remission is that when the next cycle starts it kicks in much faster.

PFNADs
Ueli

Title: Re: Advice sought on tapering Verapamil
Post by zimmy on Feb 13^th, 2003, 8:41am

Ueli,

Thanks, this is helpful.

I Have only had three cluster attacks my whole life, this
is the third one. Thus, I am keen to get off Verapamil entirely as I don't like the side effects. I think I will begin daily tapering at 80 mg per day as you suggest once I am off the prednisone (only two more days of that).

Warm regards,

Mark

Title: Re: Advice sought on tapering Verapamil
Post by Svenn on Feb 15^th, 2003, 4:43am

Hi

My neuro advice me to use full dozage of verap at least 3 weeks after last hit.then over 2 weeks step down the verap to 2/day "Verap retard 120mg"After going on that low dozage about a week you can quit
Just an advice

Svenn

Title: Re: Advice sought on tapering Verapamil
Post by zimmy on Feb 16^th, 2003, 2:02am

Svenn,

Thanks for your email, but I did not understand you advice entirely.

I live in Kenya and the nuerologists that I have been able to see have no experience with CH, thus I am pretty much on my own.

My last headache was about 8 days ago.

I am now taking 9 tablets of verapamil that are 80 mg each, 3 X a day (240 at breakfast, lunch and dinner) for a total of 720 mg a day. I stopped the steroids
today on Feb 16. I feel great!

I decided on 720 mg simply as a guess in terms of the dosage. I read the literature and it seems the dose varied from about 360 to as much as 960.

Are you saying that your neuro says stay at 720 for three full weeks before reducing the daily dosage? And then over a 2-week period get to 120 mg per day by the end
of the 2 weeks? And then a week at 120 per day? And then scale down to zero?

Thanks for clarifying this.

Mark

Title: Re: Advice sought on tapering Verapamil
Post by Svenn on Feb 16^th, 2003, 4:49am

full dosage of Verap for 3 weeks after the last hit yess.
tapering down to 2tbs a day over a periode of 2 weeks.
My neuro say that if you dont get hit more after a month you can quit Verap.

Had a discussion with another neuro here in Norway and he`s advice was the same but never stop with verap.
He said tapering down to 1,and use that always

So it seems even the neuroes are not 100% sure what to do with us

so it has been said i`m using Verap retard 120mg.

Hope this clear out something for you

Svenn