Medication Profile - Verapamil Used Off Label for Migraine

Nancy Harris Bonk Health Guide March 07, 2012
  • There's a wide variety of medications used for Migraine, most of which are prescribed off-label. If verapamil has been prescribed for you, or if you and your doctor have been considering it, here's some information that may be helpful.

     

    Type of medication:

     

    Verapamil is a calcium channel blocker used to treat high blood pressure, angina, and specific types of heart rhythm disorders. It is also used off-label for Migraine and headache prevention. It is also used for various kidney and liver issues and those deemed necessary by your doctor.

    

     

    Precautions:

    • Patients must have regular checkups with their doctor and lab work done to verify that verapamil is working correctly.
    • Make sure your doctor knows if you've recently had a heart attack.
    • Alert your doctor to any allergies.
    • Inform your dentist or surgeon before you have surgery or dental care.
    • Verapamil should not be used in children as there is no clear data on its safety or effectiveness.
    • Caution needs to be used taken when elderly patients take verapamil because they may be more susceptible to the potential side effects.
    • Verapamil may weaken reaction time and/or thinking, use care when driving or operating machinery.
    • People with fluid in the lungs, heart conditions such as atrioveintricular block (AV block) and sick sinus syndrome, low blood pressure or are allergic to verapamil should not use this medication.
    • Alert your doctor if you have kidney or liver issues, congestive heart failure or any nerve-muscle disorder such as myasthenia gravis or muscular dystrophy.
    • Verapamil can interact with many other drugs. It is imperative to discuss all the medications you take with your doctor including prescription, vitamins, herbal supplements and any over-the-counter medications.
    • Do not stop taking this medication without discussing with your doctor first. Stopping verapamil suddenly may make your condition worse.
    • Get up slowly from sitting or lying down because verapamil may make you feel dizzy.
    • Avoid alcohol; it may increase some of the side effects.
    • The doctor may give you special instructions for certain foods like grapefruit, grapefruit juice, and ethanol and tobacco while taking verapamil. This will help avoid certain potentially dangerous side effects.
    • If you feel well when taking verapamil for high blood pressure you must continue to take this medication. High blood pressure may not have any symptoms and this is a medication you may need to take for the rest of your life.

    Pregnancy and Breastfeeding:

    • Verapamil is an FDA category C drug. This generally means there are no sufficient studies done on pregnant women OR no animal studies have been conducted. However, for verapamil, there was evidence of enbryolethality and fetotoxicity where the dose was toxic for the mother. Verapamil during pregnancy is to be used only when the benefit outweighs the risk.
    • Verapamil does cross the placenta there have been no reports of congenital defects in human pregnancy.
    • Verapamil is excreted into human milk. Side effects in the nursing infant are unlikely. However, the manufacturer recommends that due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

    Other medical conditions:

  • Be sure to let your doctor know if you have other medical problems or a history of the following:

    • Congestive heart failure
    • Muscle disease such as Duchenne's muscular dystrophy, and myasthenia gravis.
    • If you have fluid in your lungs (pulmonary edema) verapamil may make this condition worse and caution is advised when using.
    • Heart block.
    • Heart problems such as Lown-Ganong-Levine syndrome or Wolff-Parkinson-White syndrome.
    • Hypotension (low blood pressure).
    • Certain patients with heart rhythm problems such as sick sinus syndrome, unless they have a properly working pacemaker should not be using verapamil.
    • Kidney problems.
    • If you have liver problems.

     

    Other medications:

    It is not recommended to use verapamil with the following medications:

    • alpha 2 agonists/beta blockers, ophthalmic
    • dofetilide
    • beta blocker/thiazide combinations
    • beta blockers, ophthalmic
    • niacin/simvastatin
    • pimozide

    Make sure you tell your doctor ALL other medications you are taking, especially

    • aspirin
    • antipsychotics
    • buspirone (BuSpar)
    • barbiturates
    • cimetidine (Tagamet)
    • clonidine or any other blood pressure medication
    • cyclosporine
    • digoxin
    • ergots
    • lithium
    • lovastatin (Advicor) or simvastatin (Zocor, Simcor, Vytorin)
    • theophlylline (Elixophylin)
    • antibiotics such as erthromycin (Erythrocin), calrithromycin (Biaxin), rifampin (Rimacatane). and others
    • antifungal medications such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral).
    • beta blockers including metoprolol (Lopressor), propranolol (Inderal), timolol (Blocadren) and others.
    • certain cancer medications such as cisplatin (Plantinol), doxorubicin (Adriamycin), paclitaxel (Taxol).
    • heart medications including amiodarone (Cordarone), disopyramide (Norpace), quinidine (Quin-G).
    • HIV/AIDS medication including atazanavir (Reyataz), delavirdine (Rescriptor), fosamprenavir (Lexia) and others.
    • sedatives such as midazolam (Versed) or tirazolam (Halcion).
    • seizure medication including cargamazepine (Carbartrol, Equetro, Tegretol).
    • phenobarbital (Solfoton).

      

    Potential side effects:

    • Check with your doctor right away if any of these less common potential side effects occur:
      • blue lips and/or fingernails
      • blurred vision
      • burning, crawling, itching, numbness, prickling, "pins and needles "or tingling feelings
      • chest pain
      • confusion
      • coughing that may produce a pink frothy sputum
      • dark urine, clay-colored stools
      • edema in legs and/or ankles or fast weight gain
      • fast, difficult, noisy breathing, occasional wheezing, shortness of breath
      • feeling faint, dizzy or lightheaded when getting up from a sitting or lying down position.
      • general dizziness, fainting or lightheadedness
      • increased sweating
      • irregular or slow heartbeat
      • loss of appetite
      • low fever
      • pale skin
      • restless muscle movement in your neck, jaw, tongue or eyes.
      • sore throat, fever, and headache with a severe blistering, peeling and red skin rash
      • stomach pain, nausea
      • unusual fatigue or weakness
      • yellowing of the eyes or skin (jaundice)
    • Check with your doctor right away if any of these rarepotential side effects occur:
      • chills
      • cold sweats
      • feeling of warmth
      • redness of the neck, face, arms and on occasion, upper chest.

     

  •  

    The potential side effects below typically do not need medical attention and may go away as your body adjusts to verapamil. Always check with your doctor if these side effects remain a problem, he may have a way to prevent or reduce some of them.

    • More common:
      • constipation
      • headache
    • Less common:
      • abnormal tiredness, weakness, listlessness, drowsiness
      • belching, stomach discomfort, upset or pain
      • difficulty in moving
      • heartburn, indigestion, sour/ acid stomach, nausea
      • joint pain, swollen joints
      • muscle cramp or aches, muscle pain or stiffness
      • trouble sleeping

    Brand names:

    In the U.S.

    • Calan
    • Calan SR (sustained release)
    • Covera-HS (extended release)
    • Isoptin SR
    • Verelan
    • Verelen PM (sustained release)

     

    Related Information:

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    Resources:

    • Wolters Kluwer. "Verapamil." Drugs.com. Last revised March 4, 2012.  
    • Cerner Multum, Inc. "Verapamil." Epocrates.com Last revised September 12, 2011. 

     

    Material on this page is for informational purposes only, and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications.

     

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    © The HealthCentral Network, 2012
    Last Updated March 7, 2012.