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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> FR - Verapamil: finding the right dose
        
(Message started by: floridian on Nov 22^nd, 2004, 2:29pm)

Title: FR - Verapamil: finding the right dose
Post by floridian on Nov 22^nd, 2004, 2:29pm

This sounds like a rational approach to finding the right dose of verapamil for preventing - start with 200 mg per day, and step that up until good control is obtained (or step it down if the initial 200 mg works).

The mention of Stevens-Johnson syndrome associated with verapamil made me cringe - a friend who had that from other meds spent several months in the hospital and barely made it.

Quote:

: 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: FR - Verapamil: finding the right dose
Post by sandie99 on Nov 27^th, 2004, 12:52pm

I used to take 200mg/day, now the dose is 400mg. Let's see if this one keeps the beast away!

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 27^th, 2004, 6:48pm

Thanks Floridian, that's a really useful extract!

Perhaps now people will stop telling me to shut up when I suggest that if Verapamil isn't working for them they should discuss with their doctor dropping the large dose slow release tablets, and consider multiple smaller dose normal release at regular intervals throughout the day.

Blau is the name of one of the neurologists who specialises in CH in London so I don't know if it is him, but this gives interesting detail on top of the Verapamil regime recommended over here by Goadsby's lot.

Wendy

Title: Re: FR - Verapamil: finding the right dose
Post by becky8 on Nov 27^th, 2004, 9:10pm

Because of you Wendy, I got my Dr. to give me 80mg's which I take 4 times a day and I do think its better than when I was on the time released.

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 27^th, 2004, 9:19pm

Hurrah Becky!

Thanks for the feedback. I feel a bit more vindicated now. I get so much stick on here for this, but I know a lot of people in the Uk where changing the regime and the release type has made Verapamil work where it didn't before.

Wendy

Title: Re: FR - Verapamil: finding the right dose
Post by becky8 on Nov 27^th, 2004, 9:26pm

Or maybe it just works better for me cause I'm a WENDY TOO!!!LOL!!! We need to start a Wendyclusters club, they're are so many of us, thats why I use Becky.

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 27^th, 2004, 9:28pm

How about a club called "Wendys against nasty clusters"

WANC!

Title: Re: FR - Verapamil: finding the right dose
Post by becky8 on Nov 27^th, 2004, 9:31pm

Sounds good!! whats your middle name? Isn't kinda creepy though that so many WENDYS (FEMALES) are clusterheads?? Mine's SUE of course

Title: Re: FR - Verapamil: finding the right dose
Post by Jonny on Nov 27^th, 2004, 9:32pm

I'll join.....i take verap and...well, you know.....LMAO ;;D

Title: Re: FR - Verapamil: finding the right dose
Post by becky8 on Nov 27^th, 2004, 9:46pm

Yea, Just Jonny and all the Wendys? Right???LOL!

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 28^th, 2004, 2:35am

Mine's very dull, Wendy Ann :-[

Wendy the Brit

Title: Re: FR - Verapamil: finding the right dose
Post by Jonny on Nov 28^th, 2004, 10:21am

[quote author=pubgirl link=board=meds;num=1101151777;start=0#10 date=11/28/04 at 02:35:37]Mine's very dull, Wendy Ann :-[/quote]

Im guilty of dullness also, Jon Philip :P

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 28^th, 2004, 11:46am

Philip :o :o :o :o

You ain't no Philip ;;D

We're ruining a good thread by the way

Title: Re: FR - Verapamil: finding the right dose
Post by mustang on Nov 29^th, 2004, 8:25am

I am chronic, have been pain free for 18 months.
I started taking Verapamil 80mg tablets ( 2 tablets- 4 times aday) 640mgs for about a year, have been able to taper to 480mgs now and still pf.
We have tried to taper to less but the pain comes back.
I am willing to take this dose for the rest of my life
if it continues to work. I do get light shadows, but
very lightand lasting only seconds.
:) :)

Title: Re: FR - Verapamil: finding the right dose
Post by Sylvan on Nov 29^th, 2004, 10:29pm

I just got the verapamil today. 40mg TID.

From what y'all are saying - that may be too conservative of a dose - but i guess starting low is safer.

How long do i stay on a dose to determine if it's helping at all?

Sylvan

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 30^th, 2004, 1:19pm

Sylvan
usual advice is 2 weekly increments if it hasn't worked, but the commonly prescribed start dose is 240mgs per day!
It can take a while to work though, days to weeks, but at 2 weekly increments it will take you 6 weeks to get to most people's start dosage (I'm crap at Maths though so that might be wrong)

Wendy

Title: Re: FR - Verapamil: finding the right dose
Post by Sylvan on Nov 30^th, 2004, 10:47pm

on 11/30/04 at 13:19:16, pubgirl wrote:

I'm pretty good at math - so here goes (and this is assuming that i'm interpretting the 2 weekly increments correctly)

40 mg TID = 120 mg/day

after two weeks - if not effective - double the dose

80 mg TID = 240 mg/day (most people's starting dose)

So i'm probably ok to stick with the 120/day at least until i see the neuro next thursday (which will be 10 days on the verapamil) or monday when i see my GP for a follow up.

Unless the HA's get worse again. (ah - there's always that *unless*)

Thanks for the info!

Sylvan

Title: Re: FR - Verapamil: finding the right dose
Post by pubgirl on Nov 30^th, 2004, 11:10pm

For clarity, this is the regime currently recommended over here. It isn't the Bible but is what seems to work for most. This is only followed when supervised by a Doctor and if no side effects occur. Obviously as soon as prevention is achieved, the increments stop.

For 2 weeks take 80mgs 80mgs 80mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 80mgs 80mgs 160mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 80mgs 160mgs 160mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 160mgs 160mgs 160mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 160mgs 160mgs 240mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 160mgs 240mgs 240mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 240mgs 240mgs 240mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 240mgs 240mgs 320mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 240mgs 320mgs 320mgs
Arrange to have an ECG performed – if the ECG is normal then:
For 2 weeks take 320mgs 320mgs 320mgs

Hope this helps

Wendy

Title: Re: FR - Verapamil: finding the right dose
Post by Sylvan on Nov 30^th, 2004, 11:19pm

Thanks :)