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When do you stop titrating up


#1

Hey all,

I am curious at what point do you stop titrtating your meds? It has taken me about 6 weeks to get up to 120mg on Verapamil, and it has been doing good things for me. Spinning is less, head pressure down, have even had a few days of little symptoms (those were days I also sat on the couch and did nothing but avoid triggers, but i’ll take it).

How long at a particular dose before you go up to the next dose? I am anxious to put this to bed as best as I can and I am tempted to keep titrating up by a few mg a week until I am at 100% with the medications.

What do most people do? keep going until you’ve covered up your symptoms?

Elah


#2

I stopped titrating up when I hit about 80%, then I held for a few months. I’m maybe at 90% now, and I’m calling it good right here.


#3

why not try and get to 100%?


#4

Because some people on this site have found that meds stop working or become ineffective at a dose that used to work. I’m leaving room just in case.


#5

With Verapamil, if you tolerate it, I’d just keep going up until you hit side effects or you get to maximum dose, or you get 100% recovered. This was the advice of my Neurologist. I was really worried about Verapamil tanking my blood pressure or doing something awful to my health, but no, I just kept titrating up from 0mg to 360mg over the course of about 3 months and I’ve stayed there now for about 3 months. Nothing bad has happened (well except constipation), only improvements. My Neurologist said I could even try for 480mg if I wanted to, but I decided to add topiramate instead.

Oh and I found the most improvement when I got >120mg by the way. My Neurologist said the sweet spot with Verapamil is typically in the higher range.


#6

Personally I cannot imagine that happening. Depends on what symptoms you have but I always think ‘rocking’ and general imbalance is last to settle, long after other symptoms stop so you’d be swallowing pills, packets et al, by then, way beyond safe levels, and as @flutters says it often pays to leave a little for the future. ‘Some wriggle room’ as my GP would say. Technically ideally you should tirate up to the maximum dose for migraine preventation as per consultant’s instructions, or patient info leaflet. Because of side effects some people have to settle for ‘maximum tolerated’ dose, then wait and see abd maybe add in later on a different drug or try to mop up the rest of symptoms with diet, lifestyle changes, trigger avoidance and so on. Finding when to stop is a difficult one. Helen


#7

Hey, I stopped at 75mg of Effexor, which is low for anxiety and high for MAV, and stayed there for 4 months. I was about 60%, so I decided to go up 2 more times and reached the 80% mark. I’ve been on 150mg for 3 months and I plan to stay there. Neuro said I can go up if I want but I am pretty functional here. So, it depends on your reaction to drug, how much symptoms can you handle, time. I am not sure of the 100% either. I think at 80% I started working on acceptance and keeping a healthy lifestyle.


#8

How long did you stay on a particular dose before heading up another level?


#9

About a month. But in hindsight I think once I got used to the initial dose of 120mg, I could have gone up faster, like maybe every 2-3 weeks.


#10

Thanks, how big were your jumps? I was doing about a 5mg jump a week to get to my 120mg pill ( I was shaving it down with a razor and weighing the pill).


#11

Yeah, I was using 40mg tabs until I got to 120mg (3 x 40mg) and then I switched to 120mg extended release (ER). From there I just made the jump straight from 1 x 120mg ER to 2 x 120mg ER and then eventually 3 x 120mg ER = 360mg. I definitely felt the jumps - I was tired and wanted to lay around on the couch for a week. But my blood pressure numbers really didn’t drop, I was watching them like a hawk.