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I just started verapamil for the first time, She prescribed me 120MG pills and said to take one a day. From doing a little reading, isn't this a rediculously low dose? I am perfectly healthy(other then the HA's) and thinking that this isn't going to offer me any good results.
I know you guys are shy when it comes to giving people dosage suggestions so can you at least tell me the dosage you are taking.

Thanks
Chris

360-480mg is the break point for me. Below that, it doesn't help at all.

Allow about 10 days for it to work, after you and your doctor find the right dose for you.

Also for what it's worth, the regular release works FAR better for me than the extended or slow release versions.

Marc

Take this info to your Dr. It worked much better for me than the sustained release formulation.

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Quote:

Titre du document / Document title
Individualizing treatment with verapamil for cluster Headache patients
Auteur(s) / Author(s)
BLAU Joseph N. (1) ; ENGEL Hans O. (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) City of London Migraine Clinic, ROYAUME-UNI

Résumé / Abstract
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.
Revue / Journal Title
Headache ISSN 0017-8748 CODEN HEADAE
Source / Source
2004, vol. 44, no10, pp. 1013-1018 [6 page(s) (article)] (15 ref.)
Langue / Language
Anglais

Editeur / Publisher
Blackwell, Malden, MA, ETATS-UNIS (1961) (Revue)

Mots-clés anglais / English Keywords
Sulfonamide ; 5-HT1 Serotonine receptor ; Agonist ; Vascular disease ; Cardiovascular disease ; Calcium antagonist ; Neurological disorder ; Central nervous system disease ; Cerebral disorder ; Triptan derivatives ; Anticonvulsant ; Antimigrainous agent ; Pain ; Valproic acid ; Sumatriptan ; Cluster headache ; Chemotherapy ; Migraine ; Headache ; Chronic ; Human ; Cerebrovascular disease ; Verapamil ; Treatment ; Nervous system diseases ;
Mots-clés français / French Keywords
Sulfonamide ; Récepteur sérotoninergique 5-HT1 ; Agoniste ; Vaisseau sanguin pathologie ; Appareil circulatoire pathologie ; Antagoniste calcium ; Trouble neurologique ; Système nerveux central pathologie ; Encéphale pathologie ; Triptan dérivé ; Anticonvulsivant ; Antimigraineux ; Douleur ; Acide valproïque ; Sumatriptan ; Céphalée vasomotrice Horton ; Chimiothérapie ; Migraine ; Céphalée ; Chronique ; Homme ; Cérébrovasculaire pathologie ; Vérapamil ; Traitement ; Système nerveux pathologie ;
Mots-clés espagnols / Spanish Keywords
Sulfonamida ; Receptor serotoninérgico 5-HT1 ; Agonista ; Vaso sanguíneo patología ; Aparato circulatorio patología ; Antagonista calcio ; Trastorno neurológico ; Sistema nervosio central patología ; Encéfalo patología ; Triptán derivado ; Anticonvulsivante ; Agente antimigrañoso ; Dolor ; Acido valproico ; Sumatriptán ; Cefalea vasomotriz Horton ; Quimioterapia ; Jaqueca ; Cefalea ; Crónico ; Hombre ; Vaso sanguíneo encéfalo patología ; Verapamilo ; Tratamiento ; Sistema nervioso patología ;
Mots-clés d'auteur / Author Keywords
cluster headache ; treatment ; verapamil ;
Localisation / Location
INIST-CNRS, Cote INIST : 17409, 35400012129020.0090

Nº notice refdoc (ud4) : 16330982

-Dennis-

ClusterChris wrote on Sep 29^th, 2009 at 9:14am:

I just started verapamil for the first time, She prescribed me 120MG pills and said to take one a day.

Just starting, this could be the beginning of a short time graduating to a higher dose.

But still... even if it is sustained/extended release, I believe that lasts 12 hours. Taken once a day wouldn't seem to cover 'round the clock. She may be thinking you only get them at night or something. Check with your pharmacist and ask the effective duration of the verap you have and then keep in touch with your doc with questions about this effectiveness, perhaps 120mg twice a day will be ok for starters. Continue feedback with the doc because the dosage Marc mentioned is more in line with effective results starting.

And from the article Dennis gave:

Quote:

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.

Thanks for the info,

I realize it may be a little soon to up the dosage but I have been in cycle for 4 months now and don't want to waste time taking a small dose that would be ineffective right from the getgo. I would prefer to at least start with a mediocre dose then to risk taking it for weeks for nothing.

Chris

Relate something similar to what you just posted to your doc. Inquire if her intentions are for a graduating dosage and that at this point, 120 twice a day to accelerate slightly, getting you to 240mg/day. Go from there to inquire of her further plans if ineffective. Obviously a short talking time required. Assess what she says and about needed abortives in the meantime or referral to a neuro.

I tried around 640mg. I have heard of people taking as high as 960mg. I had an irregular heart beat caused by the verapamil and really low blood pressure so had to quit taking it. You need to go slowly up because this effects your blood pressure and if you go up to fast you could have a sudden drop in your blood pressure and you would not want that to happen. Patience is a virtue.

At this point in your treatment, prednisone is sometimes given for starters to help while gradually ramping up verap. Inquire.

Sorry to disagree with many of the above, but I am on Verapamil 160 daily. This was preceeded with Prednisone taper. I am on my third week of Verapamil and have been relatively pain free for the last 10 days. :D
If I've learnt anything from this site, It's "what works for 1, does not necessarily work for all" See how you go after 2 weeks and if no result I would recommend another appointment.

Hope this helps :)

Aussie you are so right... I started out at 120mg, and when my bp was ok I went on to 120mg in the AM, and 120mg, in the PM...That worked good for a while, but then the bp was droping too much. So back to the 120 mg in the PM. Now in my third month, and am getting by really well with only Half that! 60mg at night, and only having one managable hit per night.

So It must have taken some time to ramp up in me, and now am maintaining well at 60 mg.
Knock on Wood :-/

Wishing every one pf days and nights :)

I've been on Verapamil 360mg SR for about 2 years. After initially starting at 240 and still having shadows, we upped it to 360 and I've been 99% under control.

Lately - nearly 2 years to the day from my initial diagnosis - I've started showing signs of a relapse. I've had to resort to Imitrix a few times over the last month and have had a nagging shadow headache off and on. Not a full-blown attack- but that funny "oh crap, it's coming" shadow headache that most of us know & fear.

I'm just wondering - before I see my neuro - if Verapamil does lose effectiveness over time? Is a 2-year remission better than I could have hoped for?

It does seem to worsen in the fall when the trees start dropping.

Peace,
Marc

Marc,

In my experience, Verapamil loses effectiveness over long periods of time - again, I'm speaking of my experience only.

I've been taking it for about 12 years, but I have to take a break from it, or start increasing the dosage. This occurs roughly every two to three years for me.

After a 30-60 day break, the magic returns full blast.

One more thing: I saw a huge improvement when I switched from SR to regular release, taken three times per day - really big difference.

Marc

I have recently been given Verapamil - 40mg three times a day.

The reason for this was so I could try this for a couple of weeks and then have an ECH to make sure everything is going okay in my body regarding blood pressure and my heart and then the dose with be doubled if all is okay and then the same process starts again, waiting for a couple of weeks and waiting. I assume (and hope!) that I get to a certain daily dose which will give me some relief :)

Hope the medication helps you - wishing you PFDAN :)

Marc wrote on Oct 5^th, 2009 at 8:13am:

Sounds like me!

In high cycle 720-960 mg/dy divided doses. In low(er) cycle 120-480mg. I try to sneak in a break every once in a while...it's a gamble.

Best,

Jon

just thought I'd give ya an update

After four days of taking 3-120mg pills a day I have been PF for 4 days other then 1 small shadow last night just before bed. Pretty sure the verap has sent the beast packing for a while.(fingers crossed)

I noticed there is a "Do not consume Alcohol" sticker on my pill bottle, Has anyone had any problems with a having a beer or six ;) while taking verap?? Thanks

Chris

I just went from 120 to 240 today. I'm worried about the constipation. In my last cycle, two years ago, I was very constipated. I remember trying colace a couple times a day and that definitely didn't work. Any suggestions??

tylerb wrote on Oct 5^th, 2009 at 7:43pm:

I am on 960 mg Verap daily. I take Psyllium Seed Husk (Fiber Supplement Capsules) to ward off or combat the constipation that verap is sure to bring. It works rather well~ You can also try Flax seed capsules. Any fiber supplement should work. You just have to try to adjust the amount you take till it works for you!! ;)

Val

tylerb wrote on Oct 5^th, 2009 at 7:43pm:

An occasional problem for me too. I find that drinking LOTS of water, magnesium caps (250-1000 mg/dy), and a high fiber diet work WONDERS. Adjustments may be necessary ::)

Best,

Jon

jon019 wrote on Oct 5^th, 2009 at 8:29pm:

tylerb wrote on Oct 5^th, 2009 at 7:43pm:

An occasional problem for me too. I find that drinking LOTS of water, magnesium caps (250-1000 mg/dy), and a high fiber diet work WONDERS. Adjustments may be necessary ::)

Best,

Jon

Good advice Jon.

I suffer with IBS so Verapamil actually helps me out in that department. There was an initial adjustment period that lasted about a month where my bowel figured out how to deal with concrete ;)

Water-water-water, lots of fiber and some Miralax can't hurt.

-Dennis-

I agree with the Miralax! Our doctors like it better than any other Rx for constipation. Our gastro docs say it is safe to take for long periods of time. They like it best and so do we. No bloating, gas, etc. like with other meds.

I'm at 120mg daily and double that dosage when I am in a CH cycle.

I have the "uptodate.com" physician's paper on CH and for Verapamil it indicates that required dosages vary greatly for individual sufferers and should be started low and increased until the desired results are found. Great concern is expressed about the potential side effects from dosages above 480mg daily and frequent ECGs are recommended at such dosages.

120mg/day sustained release is a good starting point. It works differently for every person, and over the years Verapamil tends to need dosage increases. If you see relief at 120mg on one daily pill that is awesome. No need to take more than you need or to take 3+ pills per day compared to 1. Try it out and see. I started at 120mg per day and then 240. Sometimes 240mg/day in 1 pill works for me, and when it doesnt the immediate release of 4 pilles (320mg/day total) eventually does. You'll have to try it out and keep checking with your doctor.

My two cents! Used verapamil for many years, as high as 960-1200 mg. This was the only dosage that would help me. Ended up with cardiac arythmia and extremely low blood pressure so I had to stop. Went to hospital for standard pre testing on a kidney stone issue and the ekg turned up the arythmia. Thankfully, I knew of this possibilty and actually had the docs reading the info in my briefcase. They were ready to admit me. Be careful and monitor your pulse and pressure.
Or do what I did and try "alternative" methods.

I started at 240mg, once a day 4 years ago. In April 2006, I went to 360 mg/day, when I had my first springtime CH cycle. In Feb. 2008 during a particularly nasty cycle, I was put on 480 mg/day. 360 wasn't quite cutting it for me anymore. As my neuro told me, as would be the case for many other meds, I was probably building up a tolerance to 360/day. At the present time, I'm still at 480 mg/day.

In cycle, I'm at 540mg daily (180mg 3X daily). Out of cycle, I'm off the stuff.

For me, it's really been quite a miracle drug after many years of just dealing with the cycles. I'll take the plumbing problems over the feeling of an icepick in my eye stabbing me any day!

My husband took Verapamil a few years ago, and I seem to remember it helped, but don't remember the details. However, at the time, I knew very little about CH. We are going to the doctor today for the first time in over 5 years for these since an episode has started again. Is there reason to take the Verapamil when not in an episode if the episodes typically only happen for him once every 1-3 years?

I've recently undergone a planned Verapamil therapy trial.

My consultant started me on 80mg three times a day for two weeks. Then I had ECG and once GP had looked at it and said OK, then I went up 80mg per day (i.e 320mg in week 3). then another ECG at end of week 4 until I got to 720mg per day and the ECG showed some rhythm change - but GP happy and we went on to 960mg per day. That was the limit the consultant wanted to try and although I had some ectopics, it was fine. Trouble was it had no effect on the Cluster!
That said for many it helps a lot. Just make sure your medic keeps an eye on you for cardiac changes and it's a very good drug to try. Best of luck with it.
Andy

CH wrote on Oct 21^st, 2009 at 10:30am:

My husband took Verapamil a few years ago, and I seem to remember it helped,

Is there reason to take the Verapamil when not in an episode if the episodes typically only happen for him once every 1-3 years?

Taking the verap was for the purpose of preventing CH hits while in cycle. When the episode is over, gradually tapering off the drug a couple weeks after would seem to put him back in the state where he was before the cycle, Ch pain free. If unaffected by Ch during this off time, it wouldn't be needed preventing something that is not going to happen.

Consult your doctor on this about gradual increases when cycles start and tapering off afterwards, if he recommends staying on verapamil, I'd inquire of the purpose.

Incidently, I taper incrementally up or down as fluctuations in Ch occur as chronic, in order to use the minimum amount needed. When decreasing, results for me are felt about 48 hours after. Had an EKG last week.

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.

Kevin-
Thanks for this tip!
-Joni

"When decreasing, results for me are felt about 48 hours after."

Bob Johnson wrote on Oct 22^nd, 2009 at 2:57pm:

Well controlled studies or not, I can tell you that there is a huge beneficial difference for me.

I've had a chance to experiment with the two formulations for the last 13+ years and the regular release version provides FAR better results for me.

I would recommend that people who get "weak" results with SR, switch to regular release before giving up on Verapamil.

Marc

Thanks for the tips and responses. The doc did prescribe 120 mg Verapamil 2x/day (not SR), 9 day taper of Prednisone, and we also picked up Taurine supplements at GNC since he was finding that energy drinks helped some. He has not had a CH since he started the meds, but did feel the pulsing with no pain one night. I'm a little concerned that when the Prednisone is over, he will have more headaches. But I guess we'll wait and see.

CH wrote on Oct 26^th, 2009 at 10:31am:

but did feel the pulsing with no pain one night. I'm a little concerned that when the Prednisone is over, he will have more headaches. But I guess we'll wait and see.

May be good to schedule a follow-up appointment for soonafter ending the pred, to check progress or if adjustments may be needed.

I have been taking Verapamil for 3 years, 480mg, once per day. If I do not take it headaches come on quickly. We have tried many medications and treatments and the verapamil works great. I am currently in my sixth week of this current episode and the past few days appear to be signaling the end of this cycle...hopefully.
I take Imitrix shots which are a God send! Normally, but not always, 2-3 minutes after a shot and I can feel it melting away. What a great feeling. In January I went through this for 8 weeks. I ran out of Imitrix and had to buy it resale. What a shock when I was told $350.00 per box! I do not have insurance nor a job for 8 months now so I get a shipment from GlaxoSmithKline every 2 months. START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

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http://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Verapamil info Please http://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl?num=1254230089 Message started by ClusterChris on Sep 29^th, 2009 at 9:14am