Verapamil

[hocmdoug]

I am about to start on Verapamil. I have both heard and read that Verapamil can cause terrible problems with constipation.:( Are there any ways to combat that problem?

Beta blockers are out of the question for me due to a non-heart related condition I have, so it will be Verapamil and possibly disopryamide in my future.

[LindaSo]

Doug,

Verapamil can be very constipating for some. Here are my recommendations:
1. Stay well hydrated
2. Eat plenty of fiber
3. Use stool softers as needed
4. Get some daily exercise
5. Try miralax if needed. It is a laxative but can be used long term.

To quote a collegue, you don't want a "lazy colon". Keep on movin'.
L

[hocmdoug]

Thanks Linda, that all sounds very "doable".:)

[LindaSo]

And, of course, if all else fails.......dynamite.

[Eileen2345]

Yes, I take Verapamil and it causes me to have constipation.

Sometimes I take extra magnesium and that helps. I have taken Senekot in the past and that helped too, but that is supposed to be a temporary solution.

I also cannot take beta blockers because of my lungs. Verapamil makes me less tired than BBs do. But Verapamil causes some fatigue.
It's hard to know exactly if the medication makes me tired or if HCM is making me tired. Probably both.

For me, no additional side effects other than what I just mentioned.

Good luck with it Doug.

[hocmdoug]

Thanks Linda and Eileen for the information. It is encouraging indeed. :D

I think I will keep a stick of dynamite handy just in case.......

[RRKamm]

I take Verapamil and haven't had any issues with constipation. However, I'm diabetic and am on Metformin, which is supposed to cause diarrhea, so maybe the two cancel each other out.

Bob
:big_bowl::big_bowl::big_bowl:

[mbcube]

I was on it for a few months, didn't notice any difference. But then again, I wasn't looking that hard.

[LindaSo]

If this is a problem, you don't have to look very hard to find it. No pun intended.........

[Chris_in_shed]

I am on verapamil and disopyramide. And suffer with constipation, although didn't really suffer when on verapamil alone.

Just eat a bag of chocolate covered raisons every day!

[Reenie]

Now Chris, that kills two birds with one stone, chocolate and fiber at once! I like it. :)

[Gayle07]

I too have been on Verapamil for over a year now and have suffered from terrible bouts of constipation. I have tried everything and even gone as far as to have a colon hydrotherapy session at a local spa. This helped tremendously but of course it will quite likely return. I agree with the Mirilax comment above. The worst thing we can do is cause our bodies to become dependent on laxatives so anything other than laxitives is a good thing to try. My high fiber diet has not seemed to help at all. I even add extra fiber to my water twice a day. I think my doctors tend to minimize this side effect as nothing major but when it's going to continue for quite likely the rest of my life then I see it as a BIG problem that could cause further troubles down the road. I also like the idea of taking another medication that has a side effect of diarrhea such as the Multaq I now take for A-fib. I wish you the best with this issue as it's been a real "pain in the butt" hehehe for me.

[Eileen2345]

Gayle,

High fiber does not work for me either. I too added water to fiber, all kinds including oatmeal and it did not work.

Only when I take some extra magnesium (about 300 mg to 400 mg in capsule form) I get relief. But with magnesium, it can make you tired, it is not recommended to drive after taking it. I take it mostly at night.

[hocmdoug]

I'm a little discouraged so far. No symptom relief yet on verapamil. Actually, the shortness of breath is a bit worse.:( I helped my wife carry a box up the basement stairs and I thought I was about to expire.

I was hoping for some relief.:(

[Pam Alexson]

Doug.. do let your HCM specialist hear how you are doing on the Verapamil.. When I was obstructed I could not tolerate the verapamil either .. gave me the same worsening symptoms as you describe .. I had a very large gradient at rest and an over the top gradient on activity but, not an extremely thick heart. It made me feel much worse.. if that was possible cause I was really, really unable to do most anything.

Presently I do take diltiazem but that came the year following myectomy for chest pain and it works now... and I tolerate it well.

That surgical experience for you may be the best plan.

http://books.google.com/books?id=ratuo8Jzim0C&pg=PA205&lpg=PA205&dq=verapamil+with+obstructive+HCM&source=bl&ots=c1Q7n7XfL0&sig=bdWb1Eow4GeFZYiz-8tkqHAKbWY&hl=en&ei=0Dz4SrX2PIvf8Aanv5nzCQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CAgQ6AEwAA#v=onepage&q=verapamil%20with%20obstructive%20HCM&f=false

Pam

[LindaSo]

Funny, just another example of how we are all different. I did get relief from verapamil when I was obstructed. I started at 120 QD and the dose was increased every time my symptoms returned to the max dose of 240mg BID. It takes a few weeks to kick in. Then post myectomy, my symptoms got worse on the Verapamil and we switched to Diltiazem which seems to have improved things. Again, we are all unique with what works and what doesn't and it's different for everybody (unless my body just refuses to play by the rules).

[hocmdoug]

It's only been a week on verapamil, but I didn't expect the breathing to get worse. I went for a walk, about .6 miles around our block today, and it was almost unbearable.

I will mention that to the HCM specialist and see if he has any other options like disopyrimade or diltiazam.

I had hoped I could stay a friend of the myectomy club. I might be joining after all.

It's probably not rational on my part, but the thought of a sternotomy makes me real uneasy.:o But on the other hand, if a myectomy would relive symtoms and give me my life back......

Like I told my wife, the hardest part about contemplating surgery would be the weeks of waiting time before the operation. I am pretty obsessive-complulsive about things to say the least.

Maybe they could just sneak up on me and shoot me with a tranquilizing dart, then take me away for the surgery. You know, kind of like those hunting safaris. Then I'd be okay. LOL

[Chris_in_shed]

Hi,

I found Verapamil alone made my breathing worse. I'd walk up the stairs and get in bed and feel awful. That was on anything from 240mg to 960mg per day.

I'm now on 480mg of verapamil and 3x100mg of disapyramide and it's a lot better. I did try disapyramide on it's own and it didn't do anything, both together they actually seem to help.

Chris.

[hocmdoug]

It was a strange day yesterday, the worst of days early, then better later.

While walking early in the day, you'd have thought I was carrying an invisible refrigerator on my back. The shortness of breath was crushing, maybe the worst it's ever been.

Then last night I walked up the stairs for bed, and viola! Almost no shortness of breath! It was wonderful! The first time in 20 years I wasn't gasping for air like a fish out of water.:D.

Then came this morning. Back to usual: walk ten feet, pause, gasp for air, repeat procedure until I get where I am going.....Well, for give my dramatics. I think all of you are all too familiar with this way of life.:(

I wonder if Disopyramide might help me like it did for Chris. I will have to discuss that with the HCM expert

[Pam Alexson]

It almost sounds like an issue with peak levels .. which would depend on when you are taking the verapamil and when you do your walking and if it is extended release or regular. It may have just been a better part of your HCM day and then again it may have been that the level was up there when you went up the stairs and it worked with you and your systems.

[LindaSo]

Very good. You have been on verapamil for a week and you saw some improvement. That's great. After all, its only been a week vs. 20 years. I call that a good start. Give it some time, Doug. And yes, give your cardio a report. You may want to consider keeping a log. It will provide your cardio with accurate info and it is always a good visual. Hang in there.
L

[hocmdoug]

I'm on the extended release variety. Maybe the dosage needs tweaking, different timing?

[Eileen2345]

Before my myectomy, I could not tolerate Verapamil or Beta Blockers very well at all. I felt worse, more tired, and much more short of breath.

Verapamil does not have that affect on me anymore since my surgery. I'm tired when I take it, but nothing like before the surgery, and not as much shortness of breath; but that is mostly because of the obstruction being removed.


Hope you feel better.

[hocmdoug]

I was doing a bit better in terms of side effects. Well, that is until last night. I didn't get much sleep and I feel kind of like I had a few glasses of wine---without the wine.

The improvement in shortness of breath is sporadic. I do better now in between meals, but for about 3 hours after a meal, I pretty much am disabled by shortness of breath:(.

But, there is SOME improvement overall.:)

[hocmdoug]

I raked leaves last week and got 16 full bags out to the for pick-up. Boy, did I ever pay for that!

I couldn't get my pulse under 110 until about 5 AM. When I woke up in the middle of the night, my heart felt like it was pounding out of my throat. I didn't sleep much that night, and I was fatigued for days afterward. In fact, I felt like crap and was shorter of breath than ever.

I suppose all that squatting to fill the bags---a valsalva- like maneuver--- and carrying heavy weights did me in. I was advised to avoid weightlifting......Now I can see why.

[hocmdoug]

I did much better on the follow-up echo with verapamil. At rest I had 16 mmHg, down from 44 on the initial assessment. I also did much better on the Bruce protocol exercise treadmill.

However, I still had a high gradient on provocation, 123. We are upping the dosages over the next several weeks. If that doesn't do the job, we may add disopyriamide. If all that isn't sufficient, I will be joining the myecotmy club sometime in 2010.