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Topic: ? Imitrex & Amerge (Read 1265 times) |
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Linda T
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? Imitrex & Amerge
« on: Mar 20th, 2002, 8:39am » |
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Spoke to my neuro yesterday because this cycle just won't quit. He wants me to stay on the 500mg daily of depakote and has also prescribed 1mg tabs of amerge to be taken together with 50mg of imitrex. Also gave me 500mg of naproscin(SP?) (Aleve) to be taken daily. I was under the impression that I was to take the imitrex and amerge at the onset of my first attack (usually 10p). I was also under the impression that amerge was an abortive not a preventative. However, I did some research in the archives that suggest to me that amerge is a preventative.
Here's the question: Do I take the amerge and imitrex together at the onset of the attack? OR do I take the amerge nightly, say 1/2 hour before attack, and then the imitrex when the attack hits, OR do I take both the imitrex and the amerge 1/2 hour before?
I know that I can call the neuro with these questions and possibly wait 2 days for a call back but I think that you guys are better equiped to answer this one. I'm just trying to find a way to get some sleep at this point!
Any feedback appreciated.
PFDAN always, Linda T.
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Karla
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Re: ? Imitrex & Amerge
« Reply #1 on: Mar 20th, 2002, 12:09pm » |
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Wow, taking two triptans at one time. Are you sure that is what the dr. said? I have never heard of anyone else or myself doing it that way. Usually one does the trick. Have you tried just one yet without the other? I would try that route first before double dosing. You could end up with rebound ha. I would get second opinion. Also, take the triptan as soon as you feel the ha comming on especially if it is time for one to occur. Why wait? You know it will go full blown. You mights also want to ask your dr. for imitrix nasal spray it is fast acting 10 min. and beats the speed of the pills.
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Karla
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Ann
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Re: ? Imitrex & Amerge
« Reply #2 on: Mar 20th, 2002, 12:51pm » |
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Hi Linda!
I use both imitrex and amerge. I use imitrex injections though not the tabs. This is what I do: if under attack, jab that baby in there and kiss the beast goodbye. However, I take amerge as a preventative because it takes ages to kick in and has a half life of 6 hours. So, since I get hit at night, it prevents night attacks. The other day I had just taken an amerge and 15 minutes later was hit. I didn't want to take an imitrex shot for fear of mixing the two. I spoke with my neuro and he told me that there was not problem. I could either take imitrex and then amerge or amerge and then imitrex. But he never said to take them together. I think you should call the neuro and get a straight answer from him/her.
Good luck!
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Linda T
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Re: ? Imitrex & Amerge
« Reply #3 on: Mar 20th, 2002, 1:32pm » |
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Thanks for the replies.
I'm sure that the neuro said that I should take both imitrex and amerge together, however, I am unclear as to just how to do it - before after during??
An interesting note tho - the pharmacy did not have the correct dose of amerge yesterday and had to order some for me to pick up today. He had only 2.5mg pills. Neuro prescribed 1mg. The pharmacist called 4 other pharmacies in my neighborhood and they all had the 2.5mg doses. Pharmacist told me that 2.5mg is the usual dosage and when I questioned why the neuro would only prescribe 1mg he suggested that together with the imitrex 2.5mg would constrict the vessels too much and that 1mg would be more compatible with imitrex.
As for 2 triptans at one time??? I can only say that this cycle seems unbreakable. I'm to call the neuro again on Friday to see if I've had any success with the amerge and naproscin. If not, he'll double my dose of depakote to 1000 mg. Lucky me.
Thanks again. PFDAN always, Linda T.
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Bob P
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Re: ? Imitrex & Amerge
« Reply #4 on: Mar 20th, 2002, 3:08pm » |
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It's interesting:
I found that the pills, no matter what the mg, cost the same.
50mg Imitrex cost the same as 100mg Imitrex.
I bet the 1mg Amerge costs the same as the 2.5mg.
Why not get the higer dose and split them in half. Get twice as much for the money.
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dan
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Hi. I had been on Depakote and Amerge for previous cycles and that has worked pretty well for me. However, it was not working as well for this current cycle. Yesterday, my neuro prescribed the Imitrex injections which I have yet to try. I am absolutely positive that he told me NOT to take it with any of the other triptans. This conflicting info really confuses me.
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pinksharkmark
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Re: ? Imitrex & Amerge
« Reply #6 on: Mar 21st, 2002, 4:16pm » |
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on Mar 21st, 2002, 2:40pm, dan wrote:| Yesterday, my neuro prescribed the Imitrex injections which I have yet to try. I am absolutely positive that he told me NOT to take it with any of the other triptans. This conflicting info really confuses me. |
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My neuro told me the reason the literature warns against taking two different triptans in a 24 hour period is to make sure the patient doesn't exceed the maximum recommended dose of triptans... ANY triptans.
In other words, say you have both Imitrex and Zomig pills at hand. You are getting hit every few hours, and before the day is done, you have maxed out on Imitrex, so you grab your Zomig and then take the daily max of Zomig as well. Not recommended.
But if you have taken only half the recommended daily max of Imitrex, then switch over to Zomig, you can then take half the recommended daily max of Zomig with no difficulty.
So, according to one neuro anyway, it is not the mixing of the triptans that is the issue, but the quantity taken in a given time period.
pinky
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rick
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Re: ? Imitrex & Amerge
« Reply #7 on: Mar 23rd, 2002, 9:43pm » |
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Linda T,
I would use caution and definitely question your neuro. For me, Amerge has caused some nasty rebounds when I took it by itself 3-4 days in a row. I attempted once to take it as a preventitive for three straight days. On the fourth day, I had an attack that had me heading to the ER about an hour after I woke up.
This may be due to the fact that Amerge reacted to my individual physiology in a really rough way. The only other med I was on at the time was Verapamil, which did not help me at all.
In my experience, when I have used triptans for a period of consecutive days, their effectiveness either decreases or wears off completely. I lay off them for a few days, get by the best I can, and then they begin to work again. I have also had experiences where I have taken them too many days in a row and found myself slammed with a bad rebound headache. I hope things work out for you. You might also consider seeking a second opinion from another neuro.
Rick
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Jamiegrrll
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HI...
I just wanted to clarify something about combining Imitrex injections and Amerge. My Neurologist strongly warned me not to take the two together. Is this because my Amerge is 2.5 mg, and this is too strong with the injections? Also, has anyone taken this combination, and are there any nasty side affects they've noticed?
Currently, my doctor has me taking Amerge and Topomax at night and only Midrin for pain, but no Imitrex injections, and I'm just wondering if it's really dangerous for me to take the injection if I get a bad headache...
Thanks! I appreciate all the advice I can get!
Jamie
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Linda T
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Re: ? Imitrex & Amerge
« Reply #9 on: Mar 30th, 2002, 7:32pm » |
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I don't have any info on taking amerge with imitrex injections since I've never gotten the injections before. Can't help you there.
However, with regard to side effects. I took the imitrex (50mg) and the amerge (1mg) at the onset of my 10p nightly ch, attack ended about 20 minutes later and I slept throught the whole night for the first time in about 2.5 months. I did this three nights in a row and slept all three nights. Now I'm getting attacked during the day. I don't know which is worse, sleep deprevation or not being able to cope at all during the day since the attacks are coming one right after the other. They last about 45 minutes to 1 hour and come about 1 hour apart. This goes on for about 4-5 hours. One night I didn't get the 10p ch and it came around 3a. It seems that my usually "clockwork" ch's aren't "clockwork" anymore. I don't want to take the imitrex or amerge during the day because I want to hold them off for the nite.
I'm also taking 500mg of depakote. Not working, obviously.
I'm starting to wonder if all these meds are just prolonging this cycle since I've never been in cycle this long before - just over 4 months. Don't want to whine but I can tell you that in all this time I only had about 12 days totally pf and that was when I was on pred.
Thinking that maybe it's time to cut the meds and tough it out. Maybe things will get better. Any thoughts?
Thanks. Wishing you all PFDAN always, Linda T.
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Lori
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Re: ? Imitrex & Amerge
« Reply #10 on: Mar 30th, 2002, 7:33pm » |
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I thought I've read you can't get rebounds from triptans. Only from OTC meds such as tylenol,etc.
How could one tell if a HA is a rebound or a CH anyway? Just curious so I'd know for myself.
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Blessings and PFDAN,
Lori
Psalm 23:4 ~ Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me.
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Linda T
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Re: ? Imitrex & Amerge
« Reply #11 on: Mar 30th, 2002, 7:44pm » |
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Lori:
Don't know about rebounds. There was a discussion on this board a little while back about rebounds. Some said they got rebounds from triptans and others said triptans do not cause rebounds. I left the board really confused!
I don't think what I have is rebounds. But then again, what do I know. LOL.
Somehow, I think messing with the imitrex and amerge shifted my attacks. I think of the beast as this living breathing evil being who can't get me during the night because of the meds so chooses to get me during the day now. Nuts huh!
Happy Easter. and may it be PF. Linda T.
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Jamiegrrll
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Linda,
First of all, I'm so sorry about your headaches right now. Secondly, I just wanted to ask you about Prednisone. I've heard it's fairly strong, and I don't like nor do I want to feel drugged during the day. Let me know what it's like please...
Jamie
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Ueli
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About Mixing Triptans
The different Triptans (Imitrex, Zomig, Maxalt, Amerge, Axert, Frova, Relpax) are all 5-HT (Serotonin) agonists. The difference is in speed and duration of action. The newer Triptans are said to be more selective to the 5-HT receptors in the vessels in the head. There is no adverse reactions between the different Triptans, but since they all have the same (or at least very similar) action the limit is on their combined dose. Therefore, you cannot take the maximum allowed dose both of Imitrex and of Amerge within one day, but taking only half of the maximum of each (with due spacing) should be ok.
Note: In the above you should include too the ergot-compounds, as these are 5-HT agonists as well.
About the Maximum Dose
As we all know, the Triptans were developed to combat migraines. In order to gain FDA approval, it had to be shown that a few times the dose needed to treat migraines has (in most cases) no adverse side effects. This is a lower limit of the save dose. In no ways does this mean that any higher dose is dangerous. A upper limit of the save dose has simply not been investigated (why should the drug companies invest in further tests if they can rake in the money of clusterheads anyway?). But sadly, many insurance companies use this "save migraine limit" as a yardstick for clusterheads too. To borrow a phrase from Lee: Fuck them!
About Rebounds
Every cluster attack (unless it's the hoped for last one in a cycle) is followed an other attack. Basta.
There is no such thing as a rebound cluster attack. Our abortives, Triptans and oxygen, are only effective for a limited time. If they wear off the next attack can hit any time. So if you are hit a few hours after an Imitrex jab with another attack, it is just that: another attack, and not a rebound. On very rare occasions, after ingesting a long lasting trigger such as MSG, the same attack my raise its ugly face again after some time, but that is only an attack lasting longer than the abortive, nothing to do with a rebound.
Ordinary pain meds and narcotics can cause a rebound headache, but these are compared to a cluster attack like a breeze to a tornado. Fact is, Triptans are used to treat rebound headaches caused by overuse of pain meds.
PFNAD's and Happy Easter,
Ueli
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Greg_A
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My Doc gave me Zomig, Imitrex Inject, Varap, and Lithium.
The Verap and Lithium are not working, i'm taking 240mg 3 times a day and lithium at 450mg a day. I'm going to see if they will raise it when i go back for a visit.
The imitrex works good, 5 min and the pain is gone.
Zomig, the doc says take one a day (5mg)
I did i used only the zomig for a while till i could get the nerve up to stick my self with a needle. I found that taking the whole 5mg at once was a little too much. So i cut the pill into quarters and take a quarter about every 6hrs.
If the pain sneaks up on me i inject myself with 1/3rd of a dose of imitrex (using the imitrex tip)
I limit myself to less than the max allowable dose which i'm guessing is 12mg a day. (thats from the imitrex directions saying to take another shot after an hour if no relief)
I do notice that if i get close to or go over the 12mg a day of triptans, i will get a dull, boring, shadow type headache that lasts most of the day. I can usually kill that one with some tylanol.
Anyways... the mix of these two hasnt killed me yet, and i at least have some way to control the pain (somewhat)
I'm going to ask about the amerge stuff. Maybe that will work mo betta.
Just thought i would add my two pennies  I gots to save my other pennies so i can get mo injections.
Greg
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rick
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Re: ? Imitrex & Amerge
« Reply #15 on: Mar 30th, 2002, 11:03pm » |
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Ueli,
As I stated above, and this actually happened to me a few times, whenever I've used Amerge multiple days in a row, I'd be slammed with a mother of a ch eventually. This monster attack would come earlier in the day then the attacks from the days prior. No such problems with Imitrex, but Imitrex would become useles after 4-5 days of consecutive use for me. I'd give it a break for a few days, and then it would work again. The only other med I was on at the time was Verapimil, and I was receiving accupuncture and chiropractic treatments. Any ideas? Thanks-Rick
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