So my last episode (5 yrs ago -see my intro) Dr prescribed Verapamil @ 240 mg /day... One 80 mg tab 3x / day. This time he Rx'd 240 mg ER once a day. Your thoughts on 3 rapid release vs 1 extended release, please?

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.
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Print a copy of the PDF file, below for your use and coinsider giving your doc a copy.


“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.

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Really good info from Bob...his library and tireless efforts much appreciated....it also reflects
my personal experience. ER vs immediate release verapamil was worthless...and on occasion went over 1000 mg/dy to achieve effectiveness. Note that some here have benefited from ER....only trial and error can confirm for YOU..............

Best

Jon

I'm one who works well with the ER, although it appears as though I'm in the minority.

The art of getting this right is to time it so that the verapamil is at its highest concentration around the time that you normally get your CH, so if you get them mainly in the night, the doses are likely to be loaded differently to if you get them during the middle of the day.

Hi Mike,
             I see the principle in the fast release variety. In fact that's what my first neurologist insisted that I go on.
6 weeks later, with no follow up blood pressure tests, I had to stop work because I was falling over and walking into things. My blood pressure was so low, I walked in to the doctors down the road and she made me stay there for about 3 hours until it rose, was horrified the nuerologist never followed up, she put me on slow release and put me on to my current nuerologist, bless her. I'm so glad, because the first nuerologist hadn't told me about imigran, O2, nothing, when my doctor rung himto say she had me in her office, he abused her when she said she was changing the med's and giving me imigran, He didn't agree with any abortives at all she called him a sadist ( in front of me )  ;D
But I do see the benefit of the fast release variety, actually targeting the period of CH hits. Slow release for me was a huge change and real benefit, probably because I have somewhat low blood pressure, but I definitely learned to have regular checkups and follow ups with the doctor while finding the right type and strength is a must.
cheers
colin

ER has never worked for me. I only use fact-acting.

:-*
jon019 wrote on Jun 18^th, 2015 at 10:48pm:

Really good info from Bob...his library and tireless efforts much appreciated.... ^^^ [smiley=thumbsup.gif] [smiley=thumbsup.gif] [smiley=applause.gif] Jon

But my next question is, if you are on RR Verapamil 3x daily and want to start the D3 regimen, how would you separate the calcium supplement from the verapamil dose by 8-12 hrs as Batch states must be done?
Should I then stay on the ER?... or stop the verapamil altogether?

Not trying to contradict, just :question [smiley=confused.gif]

Steve

Hi Steve,
With the Calcium, you don't need to take any more than
what's in the Multi Vitamin, normally around 200mg, so
if you take your last dose of verapamil in the late arvo
and you Multi Vitamin before going too bed, then their
shouldn't be a problem.

Cheers, Hoppy