Please keep in mind that these dosages are based on treating a condition that chronic and severe.

I’m currently at 1200mg Lithium Carbonate and 960mg Verapamil daily.  And as previously documented some on-going, routine tests are important.  Mine include routing blood tests for Lithium levels and Liver function, and EKG for heart function.   
 
Something to understand about Verapamil - It comes in three forms, CR (Controlled Release), SR (Sustained Release), and ER (Extended Release).  Depending on the individual this apparently this can make a significant difference.

My Example,
I’d been taking CR for over a decade or so at 720mg daily with no side effects and able to maintain somewhat predictable CH highs and lows. 

While my original prescription was for CR, a Neurologist who I saw for a very short period of time wrote my prescription for SR and I failed to notice the change.  (For this and a variety of other reasons I decided to switch Neurologists fast).  The Pharmacy continued filling the prescription with CR like they had for over a decade but suddenly noticed the change and filled it with SR.  My dosage remained 720mg.
      
I questioned the change but the Pharmacist insisted there was no difference between the two.  Within two weeks the frequency/severity of CH attacks had gone through the roof and my ankles began swelling seriously anytime I was on my feet for a few minutes.  The Pharmacist insisted that the excessive swelling was the result of the unusually hot weather and that CR and SR are same.
    
Through my current Neurologist I had my Prescription re-written for CR.  With the significant increase in CH activity the Neurologist asked me to increase my daily dosage to 960mg, which I agreed to do.   Within two weeks CH attacks were back to normal daily levels and nearly all ankle swelling vanished.  We’ve agreed to stay at this level for another 3 weeks and monitor CH activity before reducing the dosage back to 720mg.  Note - the EKG was normal. 

I guess my point in all of this is to say that it is important to do research into the meds being prescribed, side effects, and any recommended tests.  As is apparent in my case what a Pharmacist and one Neurologist believed to be no change - was in fact a major change.  Secondly, a H/A journal is a key tool for communicating facts to good doctors.  With it I am able to quickly communicate when changes occur, the results of those changes - and quickly get a busy Neurologist to discuss options.


Best Wishes,
burnt-toast
(Tom)

Prescription meds and people's reactions to them are funny things...

I've seen people who go from brand name to generic completely lose the benefit of the medication.  I've seen people go from short to long acting or vice-versa suddenly start having wacky side effects.  I've seen people who can take a 12hr release of one med but be completely unable to take an immediate or 24hr release...

And, docs and pharmacists can change meds from one manufacturer to another depending on what's currently 'in vogue' or what the pharmacy has in stock or what manufacturer made the most recent delivery of meds.

Technically generic vs brand name and/or different length preparations are supposed to be chemically the same in terms of active ingredients.  But, the different patient reactions are there, sooooooo there you go...

If you are one of those people who tend to be sensitive to different med preparations - watch your bottles - check the name of the med, the manufacturer, and the pill shape/color/size when you pick up your meds at the pharmacy.  Have your doc be careful and specific of what she writes on the prescription - and also have her mark the 'do not substitute' box on the prescription - otherwise, pharmacy will just give you what they have on hand rather than the specific med by the specific manufacturer ordered.