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verapamil questions (Read 1028 times)
Lucien
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verapamil questions
Apr 19th, 2009 at 10:18am
 
I'm episodic and use 10 pred taper and verapamil, 720mg/day.  Has anyone out there experienced higher pulse and what feels like a more pronounced heart beat from verapamil (720mg/day)?  Also, if you have similar med situation, could you share your schedules for ramping down from verapamil, which I am eager to do, but scared of CH's returning.  It's been two weeks since I got a headache but I do still get shadows (pulsing) and sometimes sensations of heat on the left side where I was getting CH--also heat elsewhere and stiff neck. 

One more Verap question: I'm dividing my doses 8am, 2pm, and 9pm.  I seem most vulnerable to CH's in the late afternoon and middle of night.  Any suggestions for the timing of the two doses per day, when I ramp down?  Just one in the morning, one at bedtime?

Thanks
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E-Double
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Re: verapamil questions
Reply #1 - Apr 19th, 2009 at 12:05pm
 
the palputations could be from the prednisone.
Ive experienced that many a time....

What kind of verapamil are you taking? Extended release or standard? The standard is shown to be more effective.

If you have concerns you really should talk to your doctor.

Best of luck
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Bob Johnson
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Re: verapamil questions
Reply #2 - Apr 19th, 2009 at 1:03pm
 
Mandatory that you talk with your doctor.

Print the following and give to the doc. This protocol is widely used and may help you find a useful Verap dosing.
--------

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).
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Bob Johnson
 
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DennisM1045
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Re: verapamil questions
Reply #3 - Apr 20th, 2009 at 12:12pm
 
What Bob said!!!  Get thee to thy Dr immediately.

I hope it's nothing.

-Dennis-
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Lucien
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Re: verapamil questions
Reply #4 - Apr 20th, 2009 at 6:59pm
 
many thanks all.  EKG and Echo came out fine, which is great relief.  Guess I was just anxious.
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Bob Johnson
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Re: verapamil questions
Reply #5 - Apr 21st, 2009 at 12:57pm
 
Anxiety would explain it. Forunately, as you become more knowing about your CH and meds, etc. anxiety should fall away to be replaced by quiet confidence in your ability to care for yourself.
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Bob Johnson
 
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