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Tag "triptan"

A new treatment for motion sickness in patients with migraines was reported by a group of doctors from Pittsburgh.  Giving migraine sufferers who are prone to motion sickness a migraine drug, rizatriptan (Maxalt) prevented motion sickness . There were 25 subjects in the study and 15 of them developed motion sickness after being rotated in the darkness. Of these 15 patients, 13 showed decreased motion sickness after being pretreated with rizatriptan. This was a small study and not all patients benefited, but this is an option that should be considered in patients who suffer from severe motion sickness.  It is likely that the effect is not specific to rizatriptan, but that sumatriptan (Imitrex), eletriptan (Relpax) and other triptans are also effective.  However, just like when treating migraine attacks, it is possible that some patients will respond better to one triptan and others to another.

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A new treatment for migraines is very effective and well tolerated, according to a paper published in Neurology.  Two years ago I mentioned on this blog that this new migraine drug did well in Phase II trial and now the results of Phase III also appear to be very positive.   The study was double-blind and placebo-controlled and involved more than 1,200 patients.  The drug’s chemical name is telcagepant and it belongs to a new family of migraine drugs, CGRP antagonists.   They work on a different receptor than the triptans (sumatriptan or Imitrex and similar drugs) and appear to be as effective.  Possible advantages of this drug are that it may work when triptans are ineffective and it does not appear to constrict coronary blood vessels, which can happen, albeit rarely, with triptans.

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Treating migraines in adolescents presents some unique challenges.  Besides difficulties, such as getting them to bed before midnight and getting them to improve their diets, we face the problem of not having any FDA-approved drugs to treat migraine attacks.  And it is not for lack of trying on the part of makers of triptans, which are drugs that work miracles for many adult headache sufferers.  The problem has been proving to the FDA that these drugs work in kids.  Because children tend to have shorter attacks, by the time we try to assess the efficacy of a particular drug two and four hours after the pill is taken, the headache is gone even if the pill was a placebo.  Many studies have shown that the triptans are safe and effective (as was observed in kids who have longer duration of attacks).   Many, but far from all headache specialists use triptans, such as Imitrex and Maxalt in adolescents.  A study just published in Headache proved that Axert, another drug in the triptan family and that was tested in 866 children, is effective in children 15 to 17 years of age.  The bottom line is that triptans can be safely used in kids who suffer from severe migraine headaches.  I am often asked by other physicians, what is the youngest age I would prescribe a triptan?  Because of a shortage of pediatric neurologists I feel compelled to see children as young as 10 and this is the youngest age at which I will prescribe triptans.

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Treximet, a new migraine treatment was approved today by the FDA.  Treximet is a combination of two old drugs – sumatriptan (Imitrex), 85 mg and naproxen (Aleve), 500 mg.  The combination is more effective than Imitrex alone because naproxen provides additional relief through its anti-inflammatory and pain relieving effects.  Imitrex is losing its patent protection and is going to be available as a generic drug in 2009.  The maker of Treximet, GlaxoSmithKline is hoping to switch most of the patients currently taking Imitrex to Treximet before patent expiration, in order to reduce its losses to generic competition.  However, it is likely that insurance companies will force physicians to prescribe generic Imitrex and generic naproxen rather than pay for Treximet.  GSK argues that the combination drug, just like Imitrex are fast-dissolving and therefore faster acting drugs than the generic naproxen is and the generic Imitrex is going to be.

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