A new inhaled migraine drug
Trials of an inhaled version of an old migraine drug show surprisingly good results. The drug is dihydroergotamine and in injectable from is considered to be one of the strongest migraine medications. It is often used intravenously to treat severe migraines that do not respond to other therapies and for medication overuse headaches. It can be also injected into the muscle, under the skin or sprayed into the nose. The main problem with this drug is that it often makes nausea worse or even causes severe nausea in patient who do not have it. What is surprising about the new product being developed by MAP Pharmaceuticals (to be called Levadex if and when FDA approves it) is not that is is very effective, but that it causes significantly less nausea than the same drug in an injectable form. Another advantage is that inhaling the medicine into the lungs results in a very quick delivery of the drug into the circulation – as quick as an injection but without a needle. A similar product, Ergotamine Medihaler was available until about 15 years ago, but was withdrawn because of manufacturing difficulties and limited demand. The demand for this new product will also be limited because it will be more expensive than a tablet of any migriane drug, it will be more bulky to carry around, and will be mostly utilized by patients who cannot take oral medications due to nausea or by those who need very quick onset of action to abort an attack.
It will be useful for people with chronic daily headaches who have spikes of pain and need some short-term relief – the effect of this drug lasts about 8 hours.
Does this drug have any relevance for chronic daily headache? How long do the benefits last?
BTW, the name of this new drug, if and when it becomes available, will be Levadex. The reason I am saying if, is because the FDA may question the safety of inhaling a medication into the lungs. The only way to prove that it is safe and will not cause any lung damage after long-term use is to have many patients exposed to this treatment for a long time. It is possible that the FDA will approve it with the provision that the company monitors patients for several years. On the other hand they may delay approval pending the results of long-term studies.
I find that dihydroergotamine initiates the worst rebound
headaches I have ever had–would have to describe them as
crushing– fast onset and very severe pain. Rebounds occurred
about a week after dose. Have used it IV and IM. It is very unfortunate
because I found it to be very effective immediately.
Interesting. Lately I’m finding the triptans are not working well but migranal is. I found the migranal to be almost as effective as DHE IV.
Migranal contains the same medication – dihydroergotamine – but it is sprayed into the nose, while this new product is inhaled into the lungs. Inhaled drugs are usually much more effective than nasal sprays and Migranal has not been that helpful for many of my patients.
What is the difference between this new drug and Migranal?