Isoptin RR: unusually long delivery times
For the preventative treatment of cluster headaches, many patients rely on constant treatment with sustained-release verapamil. This dosage form releases the active ingredient verapamil slowly and consistently over 12 hours. Although numerous sustained-release verapamil preparations are available, many patients have found that a reliable effect can only be achieved with the preparation Isoptin RR and that attacks recur when they switch. In the last few weeks we have received numerous concerned reports from those affected that the preparation Isoptin RR is not available and that pharmacies have promised unusually long delivery times of 10 weeks or more.
Verapamil is not the same as verapamil
Cluster headache patients are repeatedly confronted with the situation where the prescribed preparation is replaced at the pharmacy. One problem with this is that instead of a sustained-release verapamil preparation, a non-sustained-release verapamil preparation is dispensed. The effect is thus drastically reduced. In particular, the effect is usually no longer present at night. Cluster headache attacks are particularly common from 2-3 a.m. onwards. With an effect of 4 hours, non-sustained-release preparations are unlikely to have any effect after midnight if taken the evening before. Those affected are then without protection. Gaps and attacks can also occur during the day.
Patients worried
In our experience, different sustained-release verapamil preparations do not have comparable release rates and durations. It is therefore impossible to predict in individual cases whether a previously tried and tested adjustment will continue to be effective by switching to another sustained-release verapamil preparation. With regard to the severity of cluster headache attacks, many patients are currently concerned because delivery delays mean that a consistent supply of Isoptin RR cannot be guaranteed. The delivery difficulties occurred without notice and stockpiling was not possible.
Reason: change of production locations
According to current consultation with the manufacturer, it was announced that the production of Isoptin RR at 240 mg was changed from Abbott to Mylan-Healthcare. This was accompanied by a change in production locations. This caused the delivery delays. However, the preparation Isoptin RR will be available on the market again. This is expected to be the case from mid-August 2015.
Alternative: Isoptin KHK will be available again from June 20, 2015
The preparation Isoptin KHK also contains identical sustained-release verapamil in a dosage of 120 mg. This will be available again from June 20, 2015. Affected patients can therefore be recommended that instead of dosing Isoptin RR with 240 mg of sustained-release verapamil, they use two capsules of Isoptin KHK containing 120 mg of sustained-release verapamil each. Isoptin RR and Isoptin KHK have the same pharmacological properties; the exchange is not expected to produce a different effect.
Every year, I've just come back from the pharmacy and unfortunately there are delivery problems again. Not only for isoptin but also for some other types of verapamil.