Timothy C. Hain, MD
October 20, 2014
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The usual dose is 120 to 240mg, SR, once per day. SR means sustained release. This drug is an dihydropyridine L-channel calcium channel blocker, similar to other dihydropyridine drugs like nifedipine, nimodipine and diltiazem. Verapamil is generally effective for migraine but it takes about 2 weeks to work. Verapamil is effective in migraine variants such as hemiplegic migraine (Yu and Horowitz, 2003). It also may be helpful in Menieres disease, although this has not yet been documented by a controlled study. A close relative to verapamil, Nimodipine has been reported to be helpful for Meniere's disease.
About 50% of users develop mild constipation. Sometimes verapamil lowers blood pressure but this is generally not a big problem if it is started gradually. About 1% of users develop palpitations (fluttering feeling in chest). Stop taking this drug if you develop palpitations. A few individuals develop swelling of the ankles. Verapamil is safe in patients with asthma, and especially good in patients who also have high blood pressure. Should start with dose mg. roughly = weight of patient. Verapamil has no cognitive side effects and no effect on weight.
There are several concerns about verapamil that should limit its use. Because of studies suggesting increased mortality from heart disease, verapamil and related drugs in the calcium channel blocker family are not favored in individuals aged 55 and older.
One study suggested an increased risk of cancer (about 2 fold) in persons taking verapamil in Rotterdam (Biederbeck-Noll et al, 2003). However, the study of Dong et al (1997) included 11,000 patients in all published trials at the time and found "There is no statistically significant increased risk of cancer or deaths with verapamil compared with active controls or placebo." We think the much larger and more geographically diverse study of Dong is more likely to be correct than a smaller study done in a single country. As verapamil is often associated with constipation, and constipation increases the risk of colon cancer, one could speculate that verapamil might increase the risk of colon cancer. However, if one keeps the constipation under control with diet or appropriate laxatives, this risk should be nonexistent.
Verapamil increases blood levels of simvistatin (Kantola et al, 1998). Doses of simvistatin should be reduced to 10mg when verapamil is also prescribed. Statins also increase the bioavailability of verapamil (Choi et al, 2010), and when a statin and verapamil are combined, doses of verapamil should also be decreased.
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