I hope that everyone had a great holiday and happy new year. After getting up to 20 mg on Lexapro, I have decided to start coming off of it. It didn’t do anything positive for my constant dizziness and I was getting extremely bloated, with acid reflux issues and my ears were ringing much more so. I gave it a full 14 weeks and I am very disappointed. I am weaning off and I have been much dizzier, especially in the early part of the day, which is always my worst time anyway.

Now to my question - has anyone had any experience with Atacand? I have been on Verapamil with limited success (I was more active but still dizzy if that makes sense) but I was retaining water pretty badly. I normally have low blood pressure and the Verapamil really didn’t make it any lower, which was good and why the Dr thinks maybe Atacand could be a good next try. I cant do Propranolol due to my reactive hypoglycemia, which has become so much worse since this whole MAV stuff started, and my already low BP. I have an RX for 4 mg to take once a day in the evening, which I understand is quite low, but the thought is go low for starters. Any thoughts would be appreciated. Also, any thoughts on whether I should be off Lexapro completely prior to starting?

Thank you and I hope that some of you are having more success with treatments!


Hi Ben,

Sorry the Lexapro didn’t pan out but at least you gave it a good trial and can wipe that one off the list. Atacand? That is an interesting choice of meds. I’ve done a lot of research into the treatment of MAV and have never heard of this being used. Can you explain a bit more about your doc’s reasoning for choosing an angiotensin II blocker medication? Has your neuro had success with others on this?

As for starting Atacand while titrating off of Lexapro, there is no reason why you should wait. You are starting at such a low dose and the two have absolutely no interaction. Of course, that is just my opinion and I would always defer to your doctor.

Happy New Year to you and best of luck with Atacand!


Hi Lisa,

It was an interesting choice. The Dr essentially said that it has similar potential for success with Verapamil but since I experienced reatining water on Verapamil, he though this may be a better choice. I did a little research and found that some have used it for “normal” migraines with success. While I was in the waiting room, I spoke to someone who said she was switched from Verapamil to Atacand - this was before I saw the Dr so I didnt really ask the other patient any questions about it. She didnt have MAV, just the regualr migraine issues.

I guess it is worth a shot. I am also thinking about Cymbalta or Zoloft. I have tried Effexor and now Lexapro with limited success so I am hoping, maybe not correctly, that I will eventually hit the right SSRI/SNRI. I feel like the anxiety issues must be dealt with for me.

Thank you for the thoughts and I hope that you are doing well.


Hello Ben,
I find it interesting that you are taking Atacand and you have low blood pressure. I have read that Atacand is sometimes used for MAV (below is information from Dr. Cherchi) but I am taking it primarily for hypertension.

"Angiotensin modulators

Chemical name: Candesartan

Proprietary names: Atacand

Data: One randomized, double-blind, placebo-controlled crossover study found that candesartan decreased migraine frequency (Tronvik et al. 2003).

Class: Angiotensin modulator.

Mechanism of action: Angiotensin receptor blocker.

Pharmacokinetics: Absolute bioavailability of 14%. Peak plasma levels achieved at 3-4 hrs. Plasma protein bound >99%. Elimination half-life 9 hrs.

Metabolism: Small degree of hepatic metabolism (CYP2C9), though excreted mostly unchanged in feces (56%) and urine (26%).

Precautions: Use with caution in patients with renal artery stenosis, congestive heart failure, or hyperkalemia.

Dosing: Start at 16 mg/day.

Advantages: Reasonable choice in selected patients with comorbid hypertension.

Adverse effects: Hyperkalemia, back pain, upper respiratory tract infection.

Comments: We do not prescribe candesartan for migraine prophylaxis."

M Cherchi http://www.dizziness-and-hearing.com

Just some more info for you!


Thanks, Claudia!

Hi Ben,

Bummer about the Lexapro … hope this new one works for you. I’m attaching the full PI sheet for you from MIMS.

Best … Scott

Thanks, Scott. It looks like a fairly safe drug to try.