Migraine and epilepsy drug Topamax is being recalled by its manufacturer, Ortho-McNeil Neurologics, a division of Johnson and Johnson. This recall affects only two lots of 100 mg tablets. This recall does not affect topiramate, generic copies of this brand. Since the generic form is much cheaper, most patients have switched to it from branded Topamax. This adds another problem to this beleaguered drug. It was recently reclassified by the FDA from pregnancy category C to category D, which means that it is much more dangerous for the fetus than originally thought. Topiramate is also associated with a high incidence of kidney stones (20%) and can cause other serious problems. This is why we always emphasize non-drug approaches (exercise, acupuncture, biofeedback magnesium, Botox, etc), which can be more effective and are much safer than drugs.
Read MoreMedications used for the preventive treatment of migraine headaches can cause weight loss, but more often cause weight gain. An interesting study by Dr. Bigal and his colleagues, just published in Cephalalgia looked at this effect of drugs in 331 patients. They found that 16% of them gained weight (5% or more of their baseline weight) and 17% lost weight. The various treatments given to these patients were equally effective in both groups. However, not surprisingly, those who gained weight had elevation of their cholesterol, blood glucose, blood pressure and pulse. Patients who have migraine headaches with aura (about 15-20% of migraine sufferers) already have an increased risk of strokes, so adding additional risk factors for both strokes and heart attacks should be especially avoided in this group. The only preventive migraine drug which consistently lowers weight in many patients is topiramate (Topamax). This drug is now available in a generic form, making it much less expensive. While topiramate does lower weight and helps prevent migraine headaches only half of the patients stay on it. For the other half it causes unpleasant side effects (memory impairment and other) or it does not work.
Read MoreImitrex and Topamax are two migraine medications that recently lost their patent protection and became available in a generic form, under the names of sumatriptan and topiramate. Many patients are concerned about the quality of generic products. A recent study published in Neurology looked at 948 patients with epilepsy who were treated with generic Topamax (it is approved for the treatment of both migraines and epilepsy). Compared to patients who used the branded Topamax, those on generic substitutions needed to have more of other medications, were admitted to the hospital more frequently and stayed in the hospital longer. The risk of head injury or fracture (presumably due to seizures) was almost three times higher after the switch to a generic drug.
Clearly, migraine patients do not run the same risk as epilepsy patients of having a seizure or being admitted to the hospital, however a small number of patients can have worsening of their migraines. The main reason is the legally permitted variation in the amount of medicine in each tablet. Taking a higher dose of the generic drug can help.
The same applies to Imitrex – a small number of patients will find that the generic sumatriptan is slightly less effective. The only, albeit significant, advantage of the generic drugs is cost savings. At this point we have only one generic substitution for Imitrex and the price difference is only 20%, but in a few months more generics will appear and the price should drop significantly, which is a very welcome development for patients with frequent migraines.
Read MoreTopamax is a popular drug for the prevention of migraine headaches. IT works for about half of the patients who try it. The main problem that makes people stop taking the drug is cognitive side effects. Patients tell us that they feel “stupid” on this drug. An article just published in the European Journal of Neurology pinpoints the main cognitive problem, which turns out to be word fluency. This means having trouble coming up with the right word.
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