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“New” Migraine Drugs

I’m so tired of seeing articles announcing a new migraine drug is in development, then discovering it’s an old drug with a different delivery system. These are not new drugs, even though press releases pretend that they are.

The investigation and marketing of these new routes will help patients. Gastric stasis and vomiting can impair the efficacy of a swallowed medication, so being able to bypass these complications is beneficial. Some people who have never gotten relief from a triptan before may find that they suddenly work when taking as an injection, nasal spray, patch or oral film. These are important points, but they don’t add up to something being a new drug.

If new migraine abortives were also being developed and reported, the investigation into new delivery routes for old drugs probably would not bother me. The problem is that I so desperately want new migraine drugs to be in development that these announcements always raise my hopes.

I know better, I really do. And knowing that — what the migraine research landscape looks like — may be the bleakest part of it all.

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Save Money on Sumatriptan (Imitrex/Imigran/Treximet)

I’ve been debating posting this for months. I hesitate because I doubt getting triptans without a prescription from another country by mail order is legal, even though the drug is available over-the-counter in that country. On the other hand,  knowing of a resource for inexpensive triptans and not sharing it seems unfair to readers who delay or avoid treating migraines because of the high cost of abortive drugs. I’m sharing this with the caveat that the legality is fuzzy, so you’ll have to make that ethical decision for yourself. Here’s the FDA’s stance on drug importation.

Imitrex (Imigran in the UK) and Treximet are expensive. Even though sumatriptan, the main ingredient in both, is available as a generic, it’s still tough to find it for less than $3 for a 50 mg pill. Prices for higher doses or injections skyrocket from there. If you’re looking to save on Imitrex or Treximet, check into pricing at Inhouse Pharmacy Europe, which has 50 mg tablets of sumatriptan for $1.10 each. Higher doses and injections are also available for less than in the US. Because sumatriptan is available over-the-counter in the UK, which is the jurisdiction this pharmacy operates under, you don’t need a prescription to order it.

I can’t vouch for the company directly because I don’t use sumatriptan and haven’t ordered from them myself, but this recommendation comes from a friend and longtime reader who has been ordering from the company for at least five years without a problem. She says the company is very reliable and medications are never close to their expiration date. In fact, the website tells you the expiration date of the meds they are currently shipping. Shipping is free to the US and they provide package tracking information.

If you use Imitrex, you can substitute these directly according to the strength you are usually prescribed. They are the same thing.

If you use Treximet, you can try taking sumatriptan with 500 mg of the OTC painkiller naproxen sodium (Aleve) to approximate the drug. Treximet contains 85 mg of sumatriptan, while sumatriptan only comes in 50 mg and 100 mg, so you’ll have to choose which you prefer. GSK’s marketing materials say that having the two drugs combined into one tablet is more effective than taking each one separately. But if you’re holding off on taking triptans because they’re too expensive, you may be more likely to take them early in an attack (when they’re most effective) if they don’t cost an arm and a leg.

Not needing a prescription is a double-edged sword, of course. You still need to take them judiciously and watch out for medication overuse headache. Be sure you tell your doctor how frequently you’re taking them, even though you can get them without a prescription.

If you place an order with Inhouse Pharmacy Europe, please leave a comment letting readers know what your experience is. I hope it turns out to be a helpful source for helping readers afford these pricy meds.

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Migraine Abortives (Triptans) & Serotonin Syndrome

Migraine abortive drugs called triptans can cause the potentially serious serotonin syndrome in rare cases, according to a study in the May 15 issue of the New England Journal of Medicine. Serotonin syndrome is a known risk when combining antidepressants and triptans. The new study shows that triptans alone can cause serotonin syndrome.

Serotonin syndrome is most likely to happen when you first start taking the medication. It is very rare and, even if it does happen, the remedy is to stop taking the medication. According to Migraine Medications May Cause ‘Serotonin Syndrome’ in the Washington Post:

The average age for someone experiencing serotonin syndrome associated only with triptan therapy was 39.9 years, and the most common symptoms included tremor, stiffness, palpitations, high blood pressure and agitation, according to the study.

Five people required hospitalization, and two cases were classified as “life-threatening.” Four of the 11 cases cleared up within an hour of treatment.

“It’s very rare and not likely to happen,” said Soldin of serotonin syndrome. “And, you just need to stop taking the drugs when it does happen. If you’re taking these medications and you have strange muscular, mental or hyperactivity symptoms, contact your doctor.”

Not sure if you’re taking a triptan? The seven available are:

  • Imitrex or Imigran (sumatriptan)
  • Maxalt (rizatriptan)
  • Amerge or Naramig (naratriptan)
  • Zomig (zolmitriptan)
  • Relpax (eletriptan)
  • Axert or Almogran (almotriptan)
  • Frova or Migard (frovatriptan)

Read more about serotonin syndrome in these posts:

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Type of Magnesium Affects Absorbtion Rate, Reaction

After I stopped taking magnesium, the severe nausea diminished over several days. And the after-eating headaches that had ceased, slowly increased over those few days. Then I learned from a reader that the dose may not have caused nausea, but the type of magnesium. There are many different kinds; turns out I was taking one of the most difficult to absorb.

I planned to let my my system “flush” it all before I started again, but didn’t want to lose the progress I had made. Especially after I learned it can take three months to get the full effect. So I tried again with a lower dose of an easier-to-absorb type. On my new dose of 150 mg of magnesium glycinate chelate, the nausea is manageable and the after-eating headaches have yet to return.

Although about magnesium before I started taking it the first time, I was apparently unable to absorb the information until I was too sick to move. I have since re-read The Magnesium Solution for Migraine Headaches, a highly informative book. In addition to explaining the connection between migraine (and cluster headache) and magnesium, it shares the history of and evidence for using supplements of the mineral. Guidelines for taking magnesium are also included. If you’re thinking about taking magnesium, consider reading this short book, which is only $5.95 new and about $2.50 used.

The National Institutes of Health also has an excellent (and free!) overview of magnesium, including dietary sources, absorbtion rates and drug interations.

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Generic Form of Migraine Abortive Imitrex Available By December 2008

Sumatriptan, the generic form of Imitrex, is scheduled to be available by the end of 2008. Although Imitrex is available as a tablet, nasal spray and injection, sumatriptan will only be available in tablets of 25, 50 or 100 mg. It will be distributed by Ranbaxy.

GlaxoSmithKline no longer offers coupons for Imitrex. In the meantime, you can save on the pricey prescription by signing up for $25 off Imitrex coupons from GlaxoSmithKline. I was skeptical because your mailing address is required to receive the coupons. I signed up a couple years ago and it hasn’t been intrusive. Mailings are about four times a year and there’s no indication they’ve sold my address.

[via Dealing With Headaches]

Update: Other posts on sumatriptan availability: