Doctors want to ween me off of verapamil

By kthc9j

1 min read

I had a wonderful migraine specialist for 15 years and have been migraine free using verapamil, 120MG 4 times a day for 18 years. My migraine doctor retired in 2013 and since then I've been going to my primary doctor for EKGs, which I've been told is necessary when taking this much verapamil. To make a long story shorter, she sent me to a cardiac specialist just to make sure nothing was wrong with my heart, and after the ultrasound and stress test, everything was normal. I decided to go to another headache specialist, neurologist. She was totally surprised that I've been on verapamil for so long and said if I haven't had a migraine for 18 years, chances are I won't have one again and promptly advised me off of verapamil. I'm now reduced to twice daily, then going to once and back to the neurologist for a follow-up. I also take a low dose (25mg) of Elavil each night, and she wants to get me off of that as well. I would like to go off of the meds, but I'm also scared because I suffered for 17 years with horrible migraines. I thought I'd seek out other migraine sufferers and ask if anyone has been on verapamil long term. My original doctor always told me it was very safe and effective. My new doc said if I experience symptoms again I can always go back on the meds, but I always wonder if they will work the same. Any advice is appreciated.

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jennl Member
Hi ks71974- Thank you for sharing your story here, and sorry to hear about your migraine specialist retiring! In addition to feedback you may get from the community, I thought this link might be useful, as it will take you to our articles on verapamil: <a href='https://migraine.com/?s=verapamil&submit=go' target='_blank'>http://migraine.com/?s=verapamil&submit=Go</a>. I truly hope this is helpful. We're so glad you're under the care of doctors - always feel free to look for a second opinion as well - that's another thing that many community members find helpful. Please do keep us posted on how you're doing! Best, Jenn (Community Manager, <a href='https://migraine.com' target='_blank'>Migraine.com</a>)
dragonsflight23 Member
Here is the best description I can find for verapamil: Verapamil Side Effects Overview Side Effects Dosage Interactions Professional More It is possible that some side effects of verapamil may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice. For the Consumer Applies to verapamil: oral capsule extended release, oral capsule extended release 24 hr, oral tablet, oral tablet extended release, oral tablet extended release 24 hr Other dosage forms: intravenous solution As well as its needed effects, verapamil may cause unwanted side effects that require medical attention. If any of the following side effects occur while taking verapamil, check with your doctor immediately: Less common Blue lips and fingernails blurred vision burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings chest pain confusion coughing that sometimes produces a pink frothy sputum difficult, fast, noisy breathing, sometimes with wheezing dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly increased sweating lightheadedness, dizziness, or fainting pale skin shortness of breath slow or irregular heartbeat sore throat sweating swelling in legs and ankles unusual tiredness or weakness Rare Chills cold sweats feeling of warmth redness of the face, neck, arms and occasionally, upper chest Some verapamil side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them: More common Difficulty having a bowel movement (stool) headache Less common Acid or sour stomach belching difficulty in moving heartburn indigestion joint pain muscle aching or cramping muscle pains or stiffness nausea rash stomach discomfort, upset, or pain trouble sleeping unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness swollen joints For Healthcare Professionals Applies to verapamil: compounding powder, intravenous solution, oral capsule extended release, oral tablet, oral tablet extended release Gastrointestinal Constipation due to verapamil appears to be related to a delay of colonic transit and not to an effect on upper gastrointestinal transit.[Ref] Gastrointestinal side effects have included constipation (up to 11.7%), nausea (up to 2.7%), dyspepsia (up to 2.7%), and diarrhea (up to 2.4%). Nausea (0.9%) and abdominal discomfort (0.6%) have been reported with intravenous verapamil. Nonobstructive, paralytic ileus (reversible upon discontinuation) has been reported infrequently. Diarrhea, dry mouth, gastrointestinal distress, and gingival hyperplasia have been reported during open trials/postmarketing experience.[Ref] Cardiovascular Cardiovascular side effects have included hypotension (up to 2.5%), new or worsened congestive heart failure (CHF) or pulmonary edema (negative inotropism; 1.8%), bradycardia (heart rate less than 50/minute; 1.4%), atrioventricular (AV) block (first-degree; up to 1.7%), AV block (total first-, second-, and third-degree; 1.2%), AV block (second- and third-degree; 0.8%), and postural hypotension (up to 0.4%). Symptomatic hypotension (1.5%), bradycardia (1.2%), and severe tachycardia (1%) have been reported with intravenous verapamil. In studies related to control of ventricular response in patients taking digoxin who had atrial fibrillation or atrial flutter, ventricular rate less than 50/minute at rest (15%) and asymptomatic hypotension (5%) were reported. Dizziness, hypotension, peripheral edema, and headache are not uncommon and are related to vasodilation of vascular smooth muscle. Verapamil may accelerate conduction of anomalous AV conduction tissue, as in the Wolff-Parkinson-White syndrome, which can result in worsened tachycardia, including malignant ventricular tachyarrhythmias or accelerated junctional tachycardia. Because of this potentially fatal side effect, verapamil is not recommended in patients with atrial fibrillation and premature ventricular depolarizations. Angina pectoris, AV block (second- and third-degree), atrioventricular dissociation, CHF, pulmonary edema, abnormal ECG, chest pain, claudication, hypertension, myocardial infarction, palpitations, and purpura (vasculitis) have been reported during open trials/postmarketing experience.[Ref] CHF or pulmonary edema may be particularly important in patients with poor left ventricular function. Various conduction disturbances have been reported with verapamil therapy, including bradycardia, AV block, first-, second-, third-degree heart block, and left bundle branch block. One study of patients with the Wolff-Parkinson-White syndrome (WPW) has shown that patients with a history of WPW complicated by atrial fibrillation and a history of reciprocating tachycardias with rapid conduction over an accessory pathway during atrial fibrillation are more susceptible to ventricular fibrillation after verapamil than those without a history of a rapid ventricular response. A small series of patients with WPW complicated by atrial fibrillation and a rapid ventricular response who developed cardiac arrest within 1 to 10 minutes after receiving intravenous verapamil has been reported. The mechanism by which verapamil may enhance the ventricular rate response to atrial fibrillation is not known. Verapamil may directly shorten the refractory period of the accessory pathway or cause reflex tachycardia indirectly by causing peripheral vasodilation.[Ref] Nervous system A 70-year-old man with supraventricular tachycardia began to experience uncontrollable, irregular, and symmetrical jerking movements in his extremities and torsional movements in his trunk 10 months after beginning verapamil. Both myoclonic and dystonic movements occurred during activity and rest. An electroencephalogram was normal. The movements were not initiated by photic stimulation, hyperventilation, or acoustic stimuli. Once diltiazem was substituted, the movements gradually resolved over the ensuing three weeks. There was no rechallenge. A 28-year-old woman was treated for supraventricular tachycardia with 10 mg of intravenous verapamil for 3 days in a row. After the third dose, the patient experienced involuntary movements in the buccolingual and neck muscles which made language articulation difficult. The patient also experienced episodes of compulsory neck extension and spasmodic movements of the eyes going upwards. The patient was treated with diazepam parenterally and the symptoms disappeared after 24 hours.[Ref] Nervous system side effects have included headache (up to 12.1%), dizziness (up to 4.7%), lethargy (up to 3.2%), fatigue (up to 4.5%), sleep disturbances (up to 1.4%), paresthesia (up to 1%), and rare neurologic complaints (including paresthesias, sleeping problems, and tremors; less than 1%). Dizziness (1.2%), headache (1.2%), sleepiness, vertigo, and rare cases of seizures during injection have been reported with intravenous verapamil. Rare cases of muscle fasciculations in patients with underlying neuromuscular diseases, stroke associated with verapamil-induced hypotension, exacerbation of myasthenia gravis, and myoclonic dystonia have been reported. Cerebrovascular accident, confusion, equilibrium disorders, extrapyramidal symptoms, insomnia, paresthesia, shakiness, somnolence, syncope, and tinnitus have been reported during open trials/postmarketing experience.[Ref] Other Other side effects have included flu syndrome (up to 3.7%), peripheral edema (up to 3.7%), edema (up to 3%), pain (up to 2.4%), fatigue (1.7%), accidental injury (up to 1.5%), ankle edema (up to 1.4%), and flushing (up to 0.8%). Asthenia has been reported during open trials/postmarketing experience.[Ref] Immunologic Immunologic side effects have included infection (up to 12.1%). Respiratory A 26-year-old man with rheumatic heart disease, mitral stenosis, and supraventricular tachycardia became apneic following a 5 mg intravenous bolus of verapamil. His heart rhythm at the time was supraventricular tachycardia at 290 beats per min; his blood pressure is not reported. The patient responded to assisted ventilation, oxygen, and DC cardioversion. The authors of this case report have located two other such cases, one of which had "stable hemodynamics," but died due to intravenous verapamil-associated acute respiratory arrest. A 66-year-old woman with a 10-year history of hypertension and bronchial asthma was switched from immediate-release verapamil to sustained-release verapamil. The patient developed dyspnea, cough, and wheezing after taking the first tablet. The patient experienced similar reactions on three subsequent occasions with verapamil sustained-release administration.[Ref] Respiratory side effects have included upper respiratory infection (up to 5.4%), pharyngitis (up to 3%), sinusitis (up to 3%), rhinitis (up to 2.7%), and dyspnea (up to 1.4%). Extremely rare cases of respiratory arrest have been associated with the use of intravenous verapamil. The mechanism is unknown. An acute asthma attack associated with sustained-release verapamil has been reported. Dyspnea has also been reported during open trials/postmarketing experience.[Ref] Hepatic Hepatic side effects have included elevated liver enzymes (up to 1.4%), and elevated transaminases with or without elevated serum bilirubin and alkaline phosphatase. The mechanism of injury is not known. Verapamil-associated hepatotoxicity is considered to be idiosyncratic, although some cases indicate a probable hypersensitivity mechanism. Elevated liver enzymes have also been reported during open trials/postmarketing experience.[Ref] Transient increases in liver function tests may occur but generally resolve following discontinuation of verapamil, although these changes may abate even with continued administration. A hypersensitivity mechanism is suspected since some cases report eosinophilic infiltrations and moderate cholestasis on liver biopsy. Hepatic side effects may be more likely and more severe in patients with liver disease. It is recommended that verapamil therapy be reconsidered if this patient's liver disease is severe. Monitoring liver function tests during therapy is recommended.[Ref] Dermatologic Dermatologic side effects have included rash (up to 1.4%). Diaphoresis has been reported with intravenous verapamil. Arthralgia and rash, exanthema, hair loss, hyperkeratosis, macules, sweating, urticaria, Stevens-Johnson syndrome, and erythema multiforme have been reported during open trials/postmarketing experience.[Ref] Endocrine Endocrine side effects have rarely included interference with the release or synthesis of prolactin inhibitor factor in the hypothalamus; however, the mechanism is not known. A single case of hyperglycemic metabolic acidosis has been associated with sustained-release verapamil. Galactorrhea/hyperprolactinemia has been reported during open trials/postmarketing experience.[Ref] Due to verapamil-induced hyperprolactinemia, rare cases of galactorrhea have been reported in both sexes.[Ref] Renal Renal side effects have included rare cases of oliguria and worsened renal function in patients with preexisting chronic renal failure.[Ref] Rare cases of hypertensive patients with chronic renal failure who developed acute oliguric renal failure after receiving verapamil have been reported. These patients also developed symptomatic hypotension associated with slow cardiac arrhythmias.[Ref] Genitourinary Genitourinary side effects have included rare cases of sexual impotence and loss of libido among males. Gynecomastia, galactorrhea/hyperprolactinemia, impotence, increased urination, and spotty menstruation have been reported during open trials/postmarketing experience.[Ref] After the onset of impotence, one patient elected to discontinue verapamil. His impotence resolved upon drug discontinuation, and recurred upon rechallenge.[Ref] Musculoskeletal Musculoskeletal side effects have included myalgia (up to 1.1%) and bizarre perceptual symptoms most closely described as cold extremities. Muscle fatigue has been reported with intravenous verapamil. Arthralgia (with rash) and muscle cramps have been reported during open trials/postmarketing experience.[Ref] Three case reports have been found by one practitioner. In each case, unusual symptoms of cold extremities and paresthesias without objective evidence of a neuromuscular or cardiac etiology were described. The symptoms resolved upon discontinuation and, in each case, recurred upon drug rechallenge.[Ref] Psychiatric Psychiatric side effects have included rare cases of depression. Emotional depression has been reported with intravenous verapamil. Psychotic symptoms have been reported during open trials/postmarketing experience.[Ref] Hematologic Hematologic side effects have included ecchymosis or bruising during open trials/postmarketing experience.[Ref] Hypersensitivity Hypersensitivity side effects have included aggravated allergy during open trials/postmarketing experience. In rare cases of hypersensitivity, broncho/laryngeal spasm accompanied by itch and urticaria has been reported with intravenous verapamil.[Ref] Ocular Ocular side effects have included blurred vision during open trials/postmarketing experience. Rotary nystagmus has been reported with intravenous verapamil.[Ref] References 1. Zachariah PK, Sheps SG, Oshrain C, et al "Antihypertensive efficacy of sustained-release verapamil." J Clin Hypertens 3 (1987): 536-46 2. "Product Information. Covera-HS (verapamil)." Searle, Skokie, IL. 3. Raftos J "Verapamil in the long-term treatment of angina pectoris." Med J Aust 07/26/80 (1980): 78-80 4. 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Echizen H, Vogelgesang B, Eichelbaum M "Effects of d,l-verapamil on atrioventricular conduction in relation to its stereoselective first-pass metabolism." Clin Pharmacol Ther 38 (1985): 71-6 24. Stehle G, Buss J, Eibach J, et al "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079 25. Mooy J, Schols M, Baak MV, et al "Pharmacokinetics of verapamil in patients with renal failure." Eur J Clin Pharmacol 28 (1985): 405-10 26. McGovern B, Garan H, Ruskin JN "Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome." Ann Intern Med 104 (1986): 791-4 27. Schwartz JB "Verapamil in atrial fibrillation: the expected, the unexpected, and the unknown." Am Heart J 106 (1983): 173-6 28. Hame A, Peter T, Platt M, Mandel WJ "Effects of verapamil on supraventricular tachycardia in patients with overt and concealed wolff-parkinson-white syndrome." Am Heart J 101 (1981): 600-12 29. Shimoni A, Maorkendler Y, Neuman Y "Verapamil-induced acute right heart failure." Am Heart J 132 (1996): 193-4 30. Winters SL, Schweitzer P, Kupersmith J, Gomes JA "Verapamil-induced polymorphous ventricular tachycardia." J Am Coll Cardiol 6 (1985): 257-9 31. Saikawa T, Inoue K, Ohmura I, et al "The paradoxical adverse effect of verapamil for treating clinical paroxysmal supraventricular tachycardia." Jpn Heart J 28 (1987): 107-13 32. Jacob AS, Nielsen DH, Gianelly RE "Fatal ventricular fibrillation following verapamil in Wolff-Parkinson-White syndrome with atrial fibrillation." Ann Emerg Med 14 (1985): 159-60 33. Ahmed JH, Godden J, Meredith PA, Elliott HL "R-verapamil: pharmacokinetics and effects on PR interval, blood pressure and heart rate." Br J Clin Pharmacol 36 (1993): 93-8 34. Arstall MA, Beltrame JF, Mohan P, Wuttke RD, Esterman AJ, Horowitz JD "Incidence of adverse events during treatment with verapamil for suspected acute myocardial infarction." 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dragonsflight23 Member
Here is the "typical" or "usual" dose recommendations by a pharmacist: Usual Adult Dose for Cluster Headache Oral: Initial dose: Immediate release tablets: 80 mg orally 3 to 4 times a day Sustained release tablets or capsules: 240 mg orally once a day at bedtime Extended release tablets (Covera HS (R)): 180 mg orally once a day Maintenance dose: Dosage may be adjusted at weekly intervals until optimum clinical response is obtained. Usual Adult Dose for Migraine Prophylaxis Oral: Initial dose: Immediate release tablets: 80 mg orally 3 to 4 times a day Sustained release tablets or capsules: 240 mg orally once a day at bedtime Extended release tablets (Covera HS (R)): 180 mg orally once a day Maintenance dose: Dosage may be adjusted at weekly intervals until optimum clinical response is obtained.
dragonsflight23 Member
<a href='https://www.drugs.com/verapamil.html' target='_blank' rel='noopener noreferrer ugc'>http://www.drugs.com/verapamil.html</a>
kmh Member
Ah, doctors. I, too, have been on high dose Verapamil for many years. I get an EKG every six months, as it is important to check my heart. However, if the medications are managing your migraines and there are no serious side effects, then whether to lower the dose should be YOUR decision, not your doctors. Of course,it would be wonderful if you decrease/go off the meds and you have no increase in migraine. Maybe taking that risk is completely worth it to you. On the other hand, you have a good plan now that no one should be forcing you to change. You are the one who has to live with the consequences of these choices - so try to avoid doing anything that makes you uncomfortable. Your body, your choice. If your meds are working, keep taking them.