Verapamil formulation for psvt

[Mascalzone]

I have experienced brief episodes of PSVT for over 30 years, and until recently was never significantly bothered by them.  Coinciding with peri-menopause (one menstrual period in past 8 months plus severe hot flashes and night sweats) at age 48, the PSVT became more problematic.  Last month I visited the ER due to 2 days of unrelenting episodes with rates 160-170 every few minutes.  My EKG was normal but they caught lots of runs of the PSVT, gave me a dose of IV Verapamil, and started me on 80mg po q8h.  I have tolerated that well except for some constipation problems, and the PSVT was pretty much exterminated.  Now my doctor has switched me to a more convenient once daily formulation, however I think what I ended up with may be wrong for me.  I have been prescribed Mylan 6201, or generic equivalent of Verelan PM 100mg.  My concern is that I work night shift and have different bedtimes on different days.  With a 4-5 hour delay in drug delivery, this Mylan 6201 seems more suited to someone with a consistent bedtime schedule.  Being aware that there are varied dosing formulations of Verapamil, I tried to communicate to my doctor and pharmacist to avoid prescribing the formulation that I nonetheless ended up with.  Would there be a more appropriate dosing form for me?  I would rather be on nothing at all chronically.  Can the short acting Verapamil be used instead as a prn "rescue"  for bothersome episodes of PSVT?   My doctor has also offered me estrogen, which I am reluctant to take, but would consider if it would eliminate the need to take the Verapamil.  Generally I am very healthy otherwise - do have some borderline high BP's at times.  I am an avid high altitude figure skater and athletic performance is a priority for me.  Thank you for providing your insights one this matter.

[Michael J. McWilliams, M.D.]

Depending on the type of SVT you are having, it might be worth talking to an electrophyiologist to see if it can be cured.  Then you wouldn't need the medication at all.  Many forms of PSVT are curable with ablation.

Once a day formulations of  medications maintain high enough concentrations of drug to be active all the time.  Without getting into the pharmacodynamics of drug dosing and frequency, a once a day formulation should do the trick.  If it does not, one option is to take it twice a day.  You could also to return to the formulation that previously worked for you.

The place I would start, however is with an electrophysiologist in case it can be cured.

I hope this helps.