Propranolol ER 80 mg + capped triptan days (20 wks update): Topiramate at 50 mg caused word-finding trouble, so my prescriber moved me to propranolol... — what worked for others here?
Topiramate at 50 mg caused word-finding trouble, so my prescriber moved me to propranolol ER, titrating from 60 mg to 80 mg over 3 weeks. Because I use rizatriptan with propranolol, my pharmacist confirmed the 5 mg dose and the 15 mg daily cap on the label. I set a personal cap of 8 triptan days a month. Attack days fell from 12 to 6 by week 16, and triptan days from 10 to 6. Side effects were mild fatigue and cold hands. I check resting pulse and blood pressure weekly. Never stop propranolol abruptly. This is my experience, not a recommendation.
FDA DailyMed labeling for Maxalt recommends 5 mg per dose (max 15 mg/24 h) in patients taking propranolol, which raises rizatriptan exposure. Propranolol for migraine prevention is typically used at 80-240 mg/day.