Hi

I am wondering where I sit on the scale of effective/safe dosing for verapamil. I am taking 180 mg twice a day, but it's not effective in preventing the attacks. How high can we go on this med?

Thanks

Some go as high as 960mg/day. I've been at 720mg/day, but it made me lightheaded. When I was on it, my magic number was 480mg/day.

I'm on 600mg right now and 150mg Topomax still getting a few hits

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.

kika wrote on Aug 30^th, 2010 at 1:52pm:

Hi I am wondering where I sit on the scale of effective/safe dosing for verapamil. I am taking 180 mg twice a day, but it's not effective in preventing the attacks. How high can we go on this med? Thanks

This depends on body size and a little on metabolism, if you are petite a smaller dose 480mg will put you at max level.  Larger body size = larger dosage to max out.

You would need to discuss this with your Doc.

You are well under it.  DON'T increase it on your own though.

Jerry

What Jerry said! A valuable med providing relief for many....but a very powerful med, changes need to be monitored by the doc!

Joe

Thanx for the info. I am VERY tempted to up my dose, but will be a good girl and wait until I see my MD next week.

kika wrote on Aug 31^st, 2010 at 6:09pm:

Thanx for the info. I am VERY tempted to up my dose, but will be a good girl and wait until I see my MD next week.

Just make sure you print out that info Bob provided above and take it with you when you go.  Following that exact process is how I found my theraputic level - 400mg. 

I also found that the immediate release formulation worked much better than the sustained release.  It's a pain in the butt to take meds multiple times a day but it made a real difference.

Good luck...

-Dennis-

kika wrote on Aug 31^st, 2010 at 6:09pm:

Thanx for the info. I am VERY tempted to up my dose, but will be a good girl and wait until I see my MD next week.

Glad you are waiting to discuss this with your Doc.  It probably won't be fun or easy but at least you'll be safely looking after yourself by discussing it with your Doc first.

Yes, 480 mg verapamil per day (two 240 sl, one morning one evening) plus prednisone are my best preventative.  Of course, I love a cocktail and wine, so I chew a caffiine/ergotomine pill prior to the evening drink. My episodes last 10-12 weeks and during the final stages, NOTHING stops the beast from slipping thru esp 1 - 2 hr after resting or sleeping. Then another cafergot chewed and complete silence/ darkness with pressure on the temple usually subside it within 10 min. If not, inhaling steam from hot tea and ice on the tender points really helps. Looking forward to another 2+ years of freedom. Getting off the prednisone is the worst; I reduce it 5 mg per week, but sometimes I still feel as if a truck has just run over me...no energy at all. 

I'm on 960 per day and it does make me a bit forgetful / light-headed...but it seems to be the level I need (I ramped up to it). Don't increase on your own - your doc should perform an EKG on you at some point to see how you are handling the current dose. Or at least, that's what happened with me.

Anyone tried setting their alarm clock to go off approx 2 hours before an attack is due to happen and take their verapamil then? If so, was it effective?

Thanks again

I weigh 155 lbs and my magic dosage of Verapamil is 480mg daily as a preventative during a CH cycle. Approved by my neuro. :)
O2 is my #1 abortive!!! :)

kika wrote on Sep 1^st, 2010 at 8:23pm:

Anyone tried setting their alarm clock to go off approx 2 hours before an attack is due to happen and take their verapamil then? If so, was it effective? Thanks again

To answer my own question, no, this does not prevent them. Tried it last night with ZERO success.

*sigh* my forgetfulness is making me forget if I took my dose this morning! will spend the whole day terrified of another attack....  :'(

Peter B wrote on Sep 2^nd, 2010 at 9:47am:

*sigh* my forgetfulness is making me forget if I took my dose this morning! will spend the whole day terrified of another attack....  :'(

It helps if you have a med box.  You just load up your med box for the week and at a glance you can tell if you've taken your meds or not.  Can get them at any pharmacy or walmart/kmart/whatever...

Believe me, I say this from experience - too many times I've been in the same situation as you!   ;)

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGESTART PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

Instead of waiting a week, try calling your doctor's nurse, she may be able to get an answer for you and call you back.  Plus, if you are going to up the doseage, make sure to have your BP checked.

Great pic brew, on cycle the med box is the only way in hell I can remember my 4x a day dosing! ;D

Joe

Guiseppi wrote on Sep 2^nd, 2010 at 4:43pm:

Great pic brew, on cycle the med box is the only way in hell I can remember my 4x a day dosing! ;D Joe

Thanks. Do you like my photogenic hands? Some people have told me I have girlie hands.

Nonsense...you have the delicate hands of a concert pianist!!! ;D

Joe

Now increasing Verapamil going to 720mg
With 150mg Topomax thats going up too she said.
Walking moron here with all this Dope-O-Max Maxed out!
:D

boski wrote on Sep 3^rd, 2010 at 4:03am:

Now increasing Verapamil going to 720mg With 150mg Topomax thats going up too she said. Walking moron here with all this Dope-O-Max Maxed out! :D

Cool. Now you fit in perfectly! ;D lance