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Verapamil question(s) (Read 1900 times)
Joshl924
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Verapamil question(s)
May 3rd, 2011 at 5:15pm
 
So...

I know that what many do is start a prednisone taper and verapamil at the same time. I have done this this time on my second taper and did not start verapamil the first time I did a prednisone taper. 

So.. how long after the taper, or in the alternative if you just started taking verapamil did you guys start to see results if any? Im worried that it could just be the prednisone giving me relief or maybe both....   

I am confident because the last time I did a taper as the dose got low my shadows and hits began to return but have not this time or at least less so (fingers crossed, knock on wood)... hoping its the verapamil....

just looking for your guy's experiences
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Judge_Smails
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Re: Verapamil question(s)
Reply #1 - May 3rd, 2011 at 6:19pm
 
Every prednisone taper I've taken was 15 days (60x5, 40x5, 20x5).  As far as the verapamil, I guess it depends on what your daily dosage is.  I take 600mg or even 720mg per day so I'll start with 240mg during the first 5 days of my prednisone, 480mg during the next 5 days and then my full verapamil dose during my last 5 days of prednisone. 

I think the key thing that we all have learned is that we are all effected by the beast differently.  What might work for me is almost certainly not going to work exactly the same for you.  It's a lot of trial and error, which can be frustrating. 

Good luck!

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Bob Johnson
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Re: Verapamil question(s)
Reply #2 - May 4th, 2011 at 12:59pm
 
This is a widely used protocol for Verapamil. Dosing is indepedent of the pred 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).

=======================================
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.

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jon019
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Re: Verapamil question(s)
Reply #3 - May 4th, 2011 at 9:23pm
 
Marc wrote on May 4th, 2011 at 8:53pm:
As an avid user of Verapamil for 13 years, I can only offer my anecdotal experience:

Me too...9 yrs



- Quick release is vastly better than SR. I can accurately control my dosage, which does need to be adjusted in response to my head. I have spent literally years on each and I quite convinced of my findings.

SR..no matter the dose...worthless. I titrate QR like mad...up and down to meet the "need". (960-1040 mg/dy in high cycle (like now)...480 as maintenance.


- 120mg x 5-6 is the sweet spot for me during peak periods of CH activity and 120mg x 4 works for the rest.

A littler higher for me...peak...same for low


- Time to become fully effective: 6-7 days with quick acting, 7-10 for SR.  This is based on starting/stopping many many times.

Have tried to stop enumerable times...always results in "higher" cycle. Some think verapamil extends or enables cycles....dunno...but something to think about.



I have to take a 30+ day vacation from it every 12-18 months as it loses effectiveness - very steep curve. The attacks come raging in, but they come under rapid control when I start again.

It just seems appropriate to have a "vacation"...just doesn't work for me....


- With my Doc's blessing, I always stop cold turkey from 600 mg without issue.

Similar to my treating neuro....she has NO problem with rapid up or down...I WOULDN'T do it without her blessing....


His position and my experience is that if you are NOT hypertensive in the first place, there is no reason for blood pressure spikes when quitting. IMPORTANT note: don't do this without medical supervision - it has been reported to be deadly.

Yup!...

Best,

Jon


Marc

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Mike NZ
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Re: Verapamil question(s)
Reply #4 - May 5th, 2011 at 3:59am
 
jon019 wrote on May 4th, 2011 at 9:23pm:
Marc wrote on May 4th, 2011 at 8:53pm:
- Quick release is vastly better than SR. I can accurately control my dosage, which does need to be adjusted in response to my head. I have spent literally years on each and I quite convinced of my findings.

SR..no matter the dose...worthless. I titrate QR like mad...up and down to meet the "need". (960-1040 mg/dy in high cycle (like now)...480 as maintenance.




Just to show how things vary, SR worked much better for me than the quick release form. We're all different so what matters is to find what works for you.
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jon019
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Re: Verapamil question(s)
Reply #5 - May 5th, 2011 at 8:32pm
 
Mike NZ wrote on May 5th, 2011 at 3:59am:
jon019 wrote on May 4th, 2011 at 9:23pm:
Marc wrote on May 4th, 2011 at 8:53pm:
- Quick release is vastly better than SR. I can accurately control my dosage, which does need to be adjusted in response to my head. I have spent literally years on each and I quite convinced of my findings.

SR..no matter the dose...worthless. I titrate QR like mad...up and down to meet the "need". (960-1040 mg/dy in high cycle (like now)...480 as maintenance.




Just to show how things vary, SR worked much better for me than the quick release form. We're all different so what matters is to find what works for you.


And THAT'S the straight skinny...I keep telling myself to include "for me" in comments like mine above. I was thinking it when I wrote it...didn't make it on the page...THANK YOU Mike...my bad....

Best,

Jon
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Joshl924
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Re: Verapamil question(s)
Reply #6 - May 8th, 2011 at 10:30am
 
yea.. Ive notice a difference with the SR that when I take it in the evening it has much more of an effect....

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