Question about Effexor and Verapamil together?

Hi all,

I have been on 120 mg of verapamil for about 5 weeks. It seems to have helped with my daily cluster headaches (which I never had - until MAV showed up last Nov). It has not touched the dizzies and unsteadiness I experience every day (motion triggered mostly).

I talked to my neuro last Friday and I told him about Hain’s approach and flowchart and asked if Effexor is a possibility since it seems to work well for the visual vertigo symptoms. He prescribed Effexor 37.5 mg.

(Sidebar: I had to tell him I needed the extended release capsule not the immediate release tablet, which concerned me because I would have thought he would know that ER is the way to go but I’m realizing so few know what to do with this illness).

Anyway I have not started Effexor yet but just read that there is a moderate interaction between Effexor and verapamil. It seems the verapamil can compromise (slow down) the metabolism of Effexor, where you may have an increased level of Effexor in your system.

I am frustrated because I’m wondering now if I should have started on propranolol instead of verapamil in the first place.

There is no interaction between propranolol and Effexor (which leads me to believe this is partially why Hain has this combo listed in his flowchart).

I know this forum cannot provide medical advice but anecdotally any thoughts or experiences on propranolol/ Effexor combo? I think @nin is on this combo. Does anyone take verapamil and Effexor together (in the last 5 years, feel like I’m setting parameters for a research paper :laughing:).

I’m just really bummed out because I feel like I wasted time titrating up to the ideal verapamil dose and may need to dump it?

Please note I recognize that many people on this forum have spent a lot more time on medications and had to dump them and start over for various reasons.

Wish my neuro was a little more helpful in this department. I think we held off on propranolol because of potential depressive side effects, but at this point, I just need an actual plan here.

Thanks very much in advance for your help!

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Your experience please?

Here’s one that take that combo 7 years some time back so it obviously happens. However as you say Dr Hain praises a Propranolol and Effexor combo as do others I’ve seen elsewhere. @nin takes both. She wrote recently ‘Propranolol is my friend. Venlafaxine an acquaintance’. You can follow her experiences with them through her PD or just search her posts. @mav, Karen, is another I recall who no longer posts but had great success with that combo recently. Search her likewise.

:laughing: you, me and quite a few other regulars on here I suspect. Personally I’ve kept detailed logs, diaries etc, etc all in the hope just one day somebody might find them useful for research but, long ago, gave up holding my breath in anticipation and besides these days I hear only data collected in real time can be considered valid. I’d have thought anything was better than nothing but apparently that’s not the case unfortunately.

If it’s any help I’ve taken Propranolol by the bucketload it seems for more than five years and despite that and MAV I am not depressed. I know it does make people prone to depression depressed. I think depression is much like any other illness if it sees an Achilles Heel it bites it! But then I believe more and more that predisposition and genetics must account for the development of most illnesses. People get depressed on Effexor.

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Hi Helen,

Thank you for your response and the links you posted. I saw the post from a while back about Effexor and verapamil combo.

I think I may ask my doc about switching over to propranolol before going anywhere near Effexor. I hate to spend more time switching and trialing a different med before starting Effexor but I would really like to make sure I’m avoiding any potential med interactions that may add to a possible med failure.

I’m really disappointed that I have to navigate this situation alone. I feel like I just tell my doc about my symptoms and I’m the one who proposes the next course of action. I don’t want to doctor shop but I have scheduled an appt with an NYU neuro-otologist as another option. I can’t get in with her until July though.

My family has been very supportive but they have no idea how horrible this feels very day. I liken it to being in a cage -people come visit and have very good intentions but then they can pack up easily and return to their normal lives. Just feeling very lost in this whole process - still not working (stopped in January), can’t drive, and feeling very hopeless about quality of life going forward. Sorry for all the negativity but just very hard when I’m nowhere near menopause and no clue what the heck is going to happen next.

Hi Liz, good to hear from you and I’m glad you got the script for effexor. I’m not surprised that your neuro didn’t reach for the extended release, this level of thinking through a specific medication does not seem to be present during a consultation.

The majority of people on this forum have had similar experience. The way through the frustration is to accept this and become your own champion and be ready and prepared to take a driving seat in these meetings. Its good you have a neuro apt July, take stock of your progress and know what you want from this new neuro. Do you want validation of your diagnosis or med plan etc…

The mix of pp and effexor works for me along with ajovy and as you mentioned hain recommends it too. I think your approach to wind down verapmil first is a logical move and a step I’d do, check to see can you swap over easier perhaps midway? Think about what you can tolerate too. Only add in effexor when you’re sure what your baseline is. When I added in effexor I was luck to get capsules with 12.5mg pillules so could move up slowly.

In terms of the negatively, I understand, mentally the first year of this was very, very hard for me and my family. It’s your new normal and it’s not normal at all. On a practical level, I can only suggest trying to distract yourself with something you might like to do, I found gardening and colouring very positive, even a little of something daily helps. It’s not good to let our thoughts wander too far ahead.

You will get better liz, you are lifting the hardest lift right now in trialing meds but you will find your combo and the right way to take it and time will help too.

Take care liz :heart:

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Hey There! I am on verapamil and effexor! I am a big guy so I am on a higher dose than most people. It works great for me! I trust you’ll have a good reaction to it as well! I’ve been on the combo for a few years and am doing really well. Starting to think about tapering down a bit just to see how I am doing!

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Hi Elaine,

Great to hear from you as well! Thank you so much for your post about the med combos. As you can see I’m really struggling with determining what to do next - dumping the verapamil and starting propranolol to perhaps set myself up for better success with Effexor? I’m basing that assessment on the success stories I’ve seen here like your and a few others who suffer from the visual vertigo symptoms like myself.

I really appreciate the support and suggestions you provided in your last post. It’s been so hard to switch gears and repurpose myself from the life I had less than a year ago. The longer this life of uncertainty continues the more I seem to lose hope that I will improve as I have zero point of reference with all of this (I know mostly everyone else on this forum experienced these same feelings).

I really hope and pray that there is more research in the future devoted to this illness, specialists that understand how to treat this illness, and that we can all have the relief and quality of life we (and our loved ones) all very much deserve. :pray::heart:

Hi Hale,

Thanks so much for your response on this med combo. Did your doc ever say whether there was a moderate interaction between these two meds (verapamil potentially causing and increase in the blood plasma levels of the Effexor)?

I wondered if it would be more challenging to taper up Effexor with this type of interaction?

Do you mind me asking how long you have been on this combination and how long did it take for you to notice some improvement?

Verapamil is helping with the daily tension headaches/ pressure but does not sort out the dizziness I feel when I try to ride a bike (more motion stimulated).

One last ? - it looked like from one of your posts that you saw a specialist in Philly at one point. Are you from that area and any recommendations for Neuro/ neuro-ent in that area?

Thanks so very much for your post again. It is really helpful to hear that people like yourself and @nin are improving on these med combos.

Liz

I’m was on Verapamil (180mg, and tapering down, currently 80mg) and am still on Effexor (112.5mg) (along with Botox and Nurtec for breakthroughs). I had gastro issues (constipation and reflux, not terrible, but occasionally not fun either), so my neuro suggested that I taper off Verapamil to see if it gets better.

Before the taper, I was in reasonably good shape on the combo. As I’m tapering down on the Verapamil, my dizziness and headaches have flared up a bit. I do think the Verapamil was helping keep things in check, but the original reason I added Effexor was that Verapamil got me to maybe 70%, and Effexor helped just that little bit extra. I remember it took me about 4+ weeks on Verapamil to see improvement in the symptoms you’re outlining (bike rides etc), and I had to go up on the dosage a couple of times as well.

FWIW, I also thought Propranolol was “better” than Verapamil based on what I read, and I asked my neuro about it: she basically said “some doctors have an impression it doesn’t help as much, but in my experience it works pretty well as a front line migraine med for most, and for a smaller fraction of the migraine population, it works exceptionally well”. In summary, everyone responds differently. :slight_smile:

hope that helps.

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Hi Sonny,

Thanks for your response and the info you provided about verapamil and Effexor.

I recall you writing back to me and giving me some helpful hints before as well - really appreciate that.

How are you feeling overall lately with this combination? Are you able to drive, work, etc?

I am still taking 120 mg of immediate release verapamil (40 mg, 3x a day) and about to switch over to the ER capsules. I wanted that to settle in before I even touched Effexor.

I feel some relief with verapamil - but still at the end of the day get pretty bad break though headaches and still have the dizziness/ out of it feeling when I’ve tried to drive or ride a bike (funny bc I can be a passenger and get on just fine).

Did you switch to a 120 ER capsule and then count beads from another ER capsule to get to the 180 mg?

I was looking back at your earlier posts and looked like you stayed on 37.5 mg of Effexor for a bit. When did you notice seeing any improvement with that medication? I know some people have said higher doses (75 mg) is when they noticed a difference.

Did you find Effexor difficult to tolerate in the beginning? I’m afraid of it being super activating to start. I really want to give it a chance since this is the one many seem to have success on and Hain’s 1st choice with the visual stuff.

It sounds like overall you are doing much better and very happy to hear that.

I am still fighting my way out of bed 6 months into this and really down about this whole process and what to expect. When I mentioned riding a bike (this was last week), I had not been on one since last summer. I lasted maybe 15 min or so before I felt like total garbage. I pray for the days to return when I can do more of that again.

Thanks again for all of your help and looking forward to hearing from you.

Liz

I take 120mg ER verapamil, 75mg Venlafaxine (Effexor) and 20mg of amitriptyline. I’ve been on this combo for nearly 2 years after getting so ill I couldn’t work. I am now fully well, working and have just played a hour long field hockey match. I’ve had no issues from the drug combo. I started on 37.5mg Venlafaxine and a week later increased to 75mg.

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Hi Lindsay,

Thank you so much for your response! :blush:

I’m sure some of these questions about med combos may become a bit redundant but just trying to get a better understanding if verapamil + Effexor is something that has been used and successful for some.

Aside from the info in this forum and the guidance published by Hain, I feel like I’m really driving blindly in this set of circumstances (especially when it comes to med combos). I’ve seen some journal articles that are helpful but just not a lot of consistency.

If you don’t mind me asking, does this med mix help you through your monthly cycle as well? I realize we are straying into women’s biz now and trying to stay on topic.

It’s just that I seem to crash around ovulation and at the end of my cycle (which I think is probably from low estrogen and maybe accompanying low serotonin levels, although have not had any formal hormone testing).

Thanks so much for your help and really am so grateful for all the support on this forum. :blush::heart:

I’m just curious for those that have posted about Effexor/ verapamil or Effexor:propranolol combos… what level of exercise are you able to tolerate? Low impact weight lifting, high intensity cardio exercises, etc?

Did it take you a long time to be able to get back to a level where you could exercise regularly?

How are you feeling overall lately with this combination? Are you able to drive, work, etc?

I can drive for hours no problems (used to be a big issue), exercise (I just went for a 2 hour surf!), and I can work about 70%. Unfortunately, my major trigger is computer screens, and I’m a computer programmer, so that can be a bit of a struggle. :slight_smile: When I fly, that also tends to cause problems for a few days afterwards.

Did you switch to a 120 ER capsule and then count beads from another ER capsule to get to the 180 mg?

I’m on ER, and I just went straight from 120 to 180mg and really didn’t have any issues with doing that. I also tried 240mg, but had pretty bad constipation on 240, which is why I went back. My neuro suggested going as high as I could tolerate, particularly if the med was helping, which it was.

I was looking back at your earlier posts and looked like you stayed on 37.5 mg of Effexor for a bit. When did you notice seeing any improvement with that medication? I know some people have said higher doses (75 mg) is when they noticed a difference.

Yep, I found an extra bit of relief with my visual symptoms at 37.5 (I had visual shimmering, and found it hard to focus/depth perception). At 75mg things were sharper, clearer in my head, and honestly, my anxiety about everything went from an 8, to like a 2. I’m at 112.5 now, but haven’t noticed much of a difference from 75. I went up very slowly, by counting beads.

Did you find Effexor difficult to tolerate in the beginning? I’m afraid of it being super activating to start. I really want to give it a chance since this is the one many seem to have success on and Hain’s 1st choice with the visual stuff.

I tried a 37.5mg tablet, and was quite sick/dizzy. I swore it off, only to come back to it later by starting with 5 beads out of 100, and going up 1-2 beads a day, until I built a tolerance, then 5 beads a day until I was at the whole tablet. The only issue I had was a bit of extra tinnitus (which I’ve had my entire life), no other issues.

I am still fighting my way out of bed 6 months into this and really down about this whole process and what to expect. When I mentioned riding a bike (this was last week), I had not been on one since last summer. I lasted maybe 15 min or so before I felt like total garbage. I pray for the days to return when I can do more of that again.

Yep, I remember this. Once I found my meds, did some regular meditation, started eating better, and slowly moving more, things improved, slowly, but they improved. I credit Verapamil for the dizzy reduction, effexor for less headaches/visual stuff, and Botox for the rest.

Take care.

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Hi Sonny,

Thanks for all of the detailed and helpful information. It seems like this has been a good combination for you. I’m happy that you have been able to find relief with these medications.

Sorry, two other questions I meant to ask prior.

(1) Are you still adhering pretty closely to the migraine diet while on this combination of medications?

(2) Was rotational vertigo (room spinning) ever one of your symptoms and if so, has this med combination seemed to help with that?

Thanks so much and sorry for the lightning round of questions.

Liz

Are you still adhering pretty closely to the migraine diet while on this combination of medications?

I tried the migraine diet, I couldn’t really tell if it was working or not. I moved to Keto diet, and that was noticeably helpful. It seems insulin spikes/blood sugar spikes aren’t fun for my brain. I’m still mostly complying with low-carb high fat, but occasionally cheat.

Was rotational vertigo (room spinning) ever one of your symptoms and if so, has this med combination seemed to help with that?

I only ever had one episode of that, and it never happened again, so I’m not sure. My dizziness is mostly in the form of feeling unstable, and when I move my head, feeling like my brain had to “catch up”. I rarely get that these days, and if I do, it’s light enough that I can ignore it.

Fingers crossed for you.

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Thanks very much for your response and maybe in the future I will try keto diet. I am pretty close to keeping in line with the migraine diet guidelines with the exception of some oatmeal cookies every now and then (exciting stuff I know, I used to have such a sweet tooth for chocolate before this :frowning:)

For now it’s going to be venlafaxine trial and then maybe adjust diet further going forward (don’t want to make too many changes at once).

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I have no noticeable symptoms around my monthly cycle but that has never been an issue for me. With regard to your question on exercise, I exercise very regularly and pretty intensely, I find it critical to my staying as well as I can be.
What I would say is that I built up very slowly. I started VRT at a very low level under the instruction of a therapist and very gradually worked my way back to full exercise. If exercise is a trigger for you then it could be you would benefit from VRT. I would consult with a therapist. Once your migraine is stable VRT should be effective. For me it was the key to my recovery. I still go back to my exercises if I have a slightly less good spell and I am quickly back to normal.

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Hi Lindsay,

Thanks again for all of the info you provided. It’s great to hear that you have been able to exercise with this med combination.

I totally agree with you - staying active and exercising is so important… Need this type of stress relief with this illness and important for recovery.

I will definitively resume with VRT when I’m more stable on a good med regimen. I tried that early on when I thought this was more of a BPPV issue and I was pretty miserable.

Thank you so much again and so glad you are doing so well :blush::pray:

Hi! Just saw Dr. Beh and I’m currently on Verapamil and he prescribed Effexor. So I don’t think you have anything to worry about!

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Thank you, have you started this combo yet? It looked like you were on a few different meds (topamax, etc) but maybe had not tried out venlafaxine?