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Topic: Imitrex--Safety and large doses:encouraging news! (Read 867 times) |
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Bob_Johnson
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Imitrex--Safety and large doses:encouraging news!
« on: Jul 19th, 2003, 3:23pm » |
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: Headache. 1996 Jun;36(6):389-91.
Use of high sumatriptan dosages during episodic cluster headache: three clinical cases.
Centonze V, Polito BM, Attolini E, Cassiano MA, Sabba C, Ricchhetti G, Bassi A, Cavazzuti L, Albano O.
Unit for the Study, Diagnosis, and Treatment of Headaches, Internal Medicine Clinic, Universita degli Studi, Bari, Italy.
The authors describe three patients with episodic cluster headache whose attacks were all treated with subcutaneous sumatriptan. The patients described had a high frequency of attacks (more than two per day); therefore, far higher dosage of the drug was taken than commonly used in cluster headache. The patients did not experience any particular side effects, neither during the treatment period nor on abrupt withdrawal of the drug. Moreover, neither tachyphylaxis nor addiction were observed. The authors point out both the efficacy of sumatriptan, confirmed in all the treated attacks, and its safety even at higher dosages than recommended.
PMID: 8707559 [PubMed - indexed for MEDLINE]
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Drugs. 1994 Apr;47(4):622-51.
Sumatriptan. A reappraisal of its pharmacology and therapeutic efficacy in the acute treatment of migraine and cluster headache.
Plosker GL, McTavish D.
Adis International Limited, Auckland, New Zealand.
Sumatriptan is a potent and selective agonist at a vascular serotonin1 (5-hydroxytryptamine1; 5-HT1) receptor subtype (similar to 5-HT1D) and is used in acute treatment of migraine and cluster headache. Following administration of sumatriptan 100mg orally, relief of migraine headache (at 2 hours) was achieved in 50 to 67% of patients compared with 10 to 31% with placebo in controlled clinical trials. In a comparative study, oral administration of sumatriptan 100mg consistently achieved significantly greater response rates than a fixed combination of ergotamine 2mg plus caffeine 200mg during 3 consecutive migraine attacks (66 vs 48% for first attack). Oral sumatriptan 100mg was also more effective than aspirin 900mg plus metoclopramide 10mg orally in a similar study. In the majority of controlled clinical trials, headache relief (at 1 hour after administration) was achieved in 70 to 80% of patients with migraine receiving sumatriptan 6mg subcutaneously compared with 18 to 26% of placebo recipients. Approximately 40% of patients who initially responded to oral or subcutaneous sumatriptan experienced recurrence of their headache, usually within 24 hours, but the majority of these patients responded well to a further dose of sumatriptan. Patients with cluster headache were treated for acute attacks with sumatriptan 6mg subcutaneously or placebo in 2 crossover trials. Headache relief was achieved within 15 minutes in 74 and 75% of patients receiving sumatriptan in these studies compared with 26 and 35%, respectively, with placebo. Patients receiving sumatriptan 12mg had a similar response rate as those receiving 6mg, but the higher dose was associated with an increased incidence of adverse events. Based on extensive safety data pooled from controlled clinical trials, sumatriptan is generally well tolerated and most adverse events are transient. The most frequently reported adverse events following oral administration include nausea, vomiting, malaise, fatigue and dizziness. Injection site reactions (minor pain and redness of brief duration) occur in approximately 40% of patients receiving subcutaneous sumatriptan, although the incidence appears to be markedly reduced when patients self-administer the drug with an auto-injector. Chest symptoms (mainly tightness and pressure) occur in 3 to 5% of sumatriptan recipients, but have not been associated with myocardial ischaemia except in a few isolated cases. Sumatriptan is contraindicated in patients with ischaemic heart disease, angina pectoris including Prinzmetal (variant) angina, previous myocardial infarction and uncontrolled hypertension, but is not contraindicated in patients with migraine and asthma. Data from long term studies in acute treatment of migraine and cluster headache suggest that sumatriptan remains effective and well tolerated over several months
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| « Last Edit: Jul 20th, 2003, 9:06am by Bob_Johnson » |
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Bob Johnson
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Karla
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Re: Imitrex--Safety and large doses:encouraging!
« Reply #1 on: Jul 19th, 2003, 7:44pm » |
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I have taken imtitrix ns at 60-80mg a day for a couple of years and noticed no side effects except for anxiety attacks. As soon as imitirix was stopped the anxiety attacks stopped. No damage was done and all ha were aborted up to 8 ha a day.
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Karla
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JohnM
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #2 on: Jul 21st, 2003, 8:51am » |
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the only anxiety attacks I get with the imitrex is when my store of injections gets low during an episode and it looks like I may run out of them before the CH goes.
John
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ruskus
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #3 on: Jul 22nd, 2003, 12:12pm » |
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I've been taking Imitrex just for over a week mixing between 50mg tablets and injections. My doctor has set a maximum of 4 tablets a day with an injection equalling 2 tablets. But now she is worried that its too much and is looking into the sphenopalatine block to get me off of the Imitrex. Any thoughts on this or anyone doing anything like this?
Russ
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The mad viking
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #4 on: Jul 22nd, 2003, 1:09pm » |
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up to 8 shots in a night here without any sideeffects
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ruskus
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #5 on: Jul 22nd, 2003, 1:41pm » |
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Other than the anxiety attacks, what other bad things can happen to you from too much Imitrex?
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_Binger
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #6 on: Jul 29th, 2003, 11:36am » |
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The bad things that happen with Imitrex tend to be around vascular issues, like heart attacks or stroke--but Doctor keeps telling me that if it hasn't happened yet it probably won't......we'll see. One interesting thing I read on this site was someone claiming Imitrex was a sulfonated form of the hallucinogen DMT, anyone else have any info on that?
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ruskus
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #7 on: Jul 29th, 2003, 11:53am » |
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Don't know but I get a little tipsy from Imitrex every so often. Not all the time though.
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pinksharkmark
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #8 on: Aug 1st, 2003, 6:21am » |
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on Jul 29th, 2003, 11:36am, _Binger wrote:One interesting thing I read on this site was someone claiming Imitrex was a sulfonated form of the hallucinogen DMT, anyone else have any info on that?
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That was me.
Go to Google and do an "image search" for sumatriptan, then do the same for DMT. Then do the same for psilocybin. Psilocybin is basically DMT with a phosphor group added, sumatriptan is basically DMT with a sulphur group added.
I am not saying that Glaxo starts with DMT and then sulfonates it -- I have no idea what the actual steps may be in their synthesis and what precursors are used -- I merely point out the chemical structure of the stuff.
pinky
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chanel
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #9 on: Aug 4th, 2003, 1:38pm » |
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Here is my first post, I've been reading through quite a bit of the boards today and really HAD to respond to this one.
I had a terrible headache while I was out camping with my family in 1998 and came home early because of it. I went as quickly as possible to the doctor...with a family history of "migraines", I suspected this is what was happening. The physician gave me a shot of Imitrex and sent me home. It didn't work. Later that night, as the headache progressed, I went to the emergency room and was given a second shot of Imitrex followed with a shot of Demerol/Phenergan...the Demerol worked but it didn't last and later that night I was back to laying on the couch...crying from the agony. I realized that I HAD to return to the emergency room, but when I picked up the phone to call my mother to come and take me...I no longer could remember the number. I couldn't remember my whole name and I didn't know things like the numbers to my address, my own phone number, etc. I looked my mother's number up in the phone book and she took me right away...BACK to the ER. After they'd completed the MRI/CAT scans it was found that I had had a subarachnoid hemmorage and my left internal carotid artery had dissected AND occluded. Yup, I had a disabling, life threatening Stroke at age 24...definitely due (at least in part) to the shots of Imitrex. It is a miracle that I survived this "double" stroke. It is NOT safe. I warn others currently taking it to PLEASE take into account what happened to me because or, at least in part, this medication. If it is currently working for you, I'm glad you get some relief from the pain...but PLEASE keep in mind what happened to me and that it COULD happen to you as well.
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ruskus
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #10 on: Aug 4th, 2003, 3:50pm » |
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Was the first headache you had your first stroke? If so, then did the Imitrex cause the second? When I take an Imitrex inj. I get relief within 10 minutes or so. Strange that they sent you home when the Imitrex didn't work the first time. How are you doing now?
Russ
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chanel
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #11 on: Aug 5th, 2003, 2:24am » |
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I only had the one stroke, after two injections of Imitrex. It was a very odd stroke, not only because of the complexity of the physiological aspects of the artery closing off and bursting AND bleed that occured simutaneously but because I had very little risk of ever having one.
No family history of strokes. No high blood pressure. My age. I was fit and healthy. Never used drugs. The risk of me having a stroke was remote if not ubsurd.
I HAD used birth control pills for 2 years while I was married (but not at the time of the stroke), and was Extremely stressed over my divorce. I had also just been at a very high altitude. All of these can contribute the the risk of a stroke, but Do Not cause them in a 24 year old at this magnitude.
I had, however, just recieved two doses of a drug that has a history of causing strokes.
How I'm doing now? I'm on disability, living with my mother at 29, broke, scared to death of having another stroke and suffering from excruciating headaches. I wish I could be more upbeat and positive on the subject but I'm a bit jaded over people repeatedly saying, "I'll pray for you" or "It COULD be worse" and getting terrible/undignified/irrespective medical care.
Does that "justify" my current situation and answer your questions?
Forgive me, it's a bad day.
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Bob_Johnson
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #12 on: Aug 5th, 2003, 2:06pm » |
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Chanel's message has left many of us with a sadness, because we can at least imagine the distress her experience and, impotence because we can do so little to help her. We are all, however, left with the question: do I change the way I live my life, considering what has happened to her.
In 1995 I had 5-hours of surgery which, it appears so far, to have cured a significant cancer. I went into the OR knowing that there was a predictable risk of dying from general anesthesia. But I can know (if I choose to!) the risks of driving, of taking any of the several medications which I use--of any aspect of living.
We are always in the position of accepting risk vs. benefit. We do NOT have the choice of risk vs. no risk. We can only be as aware as our emotional make-up will allow us to be--and then act out our lives.
I'm posting here another of several reports about the safety of Imitrex. Another report (which you can find in the archives) said that, after millions of doses of experience with Imitrex, the rate of side effects has decreased (reflecting growing knowledge of how to use it safely). Not perfect--but we know the pain and disability of cluster and few would give it up in exchange for the alternative--even in the face that experiences like Chanel's is a remote possibility.
We are still sadden by her loss.
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Drug Saf. 2003;26(2):93-107.
Tolerability of the triptans: clinical implications.
Nappi G, Sandrini G, Sances G.
University Centre for Adaptive Disorders and Headache, IRCCS C. Mondino Foundation, University of Pavia, Italy. giuseppe.nappi@mondino.it
The triptans represent a relatively new class of compounds effective in the treatment of migraine. The safety and tolerability of these drugs have been extensively investigated since the first triptan (sumatriptan) became commercially available. A report on a very large population of patients tested during clinical trials and in postmarketing studies, confirms that these drugs are safe and well tolerated when correctly used. Adverse events are frequently reported, but are usually mild and only a few patients discontinue therapy because of them. These adverse events include, in particular, the so-called 'triptan symptoms' (tingling, sensation of warmth, etc.). The exact mechanism of chest symptoms reported by 20% of patients with migraine treated with triptans remains unclear, but are exceptionally related to a cardiac mechanism. CNS adverse events (i.e. somnolence) are also reported, but it is a matter of debate whether they are related to the pharmacological properties (i.e. lipophilicity) of the drug or are symptoms of the disease itself. The potential risk for drug overuse must be taken into account when the triptans are given to patients with a high frequency of migraine attacks. Clinical interaction of triptans with other drugs metabolised in the liver may theoretically influence the incidence of adverse events, but there is little evidence to support this assumption. There is no evidence of a teratogenic risk of triptans in pregnant women taking these drugs.
Publication Types:
Review
Review, Tutorial
PMID: 12534326 [PubMed - indexed for MEDLINE]
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Bob Johnson
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ksmiggy
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #13 on: Aug 14th, 2003, 8:02am » |
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My first post, but felt this deserved mentioning, have suffered for 10 years now, i use immigran injection(imitrex i presume for those over the pond), i have used the injection for the last 4-5 years, but have limited my use when i started to feel excessive tightening in my chest, this gets worse with each use, i live on Kakape tablets, (500mg paracetomol, 30mg codiene) they only work if caught early, about a 100 every 2 weeks, no preventative treatments have worked, But my point, Although the injection is the best thing ever invented, it is to be used carefully, i was warned that at the first sign of trouble, stop, i am now at the stage where it does not always work, and at best leaves me totally drained. Also, I do believe, glaxo have made a smaller version, about half the amount as standard.
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kbbogo1
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #14 on: Aug 16th, 2003, 6:28pm » |
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I certainly feel for Chanel and I also agree with exercising caution when using Imitrex. (I'll never forget how scared I was when I gave myself the first full dose of an Imitrex injection and felt my chest/neck tighten.) I just wanted to mention that I have had several mini strokes when I get severe migraines, but not with my clusters. Slurred speech, incoherent, can't remember anything, can't walk, can't even write my own name. So far, all of these problems go away shortly after my migraine does. ( I use Imitrex for my migraines also, sometimes 2 doses are needed) This is how it was explained to me by my Neuro. - that the migraine and stroke symptoms could be caused by lack of oxygen to the brain. So I guess what I am wondering is, if Chanel's stoke was already in progress before the Imitrex injections were administered. I have read articles about people having strokes with migraines and not recovering. I am not, however, doubting that the Imitrex could have had something to do with the stroke.
Curious,
Kim B
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Bob_Johnson
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #15 on: Aug 17th, 2003, 8:57am » |
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The experience of tightness in the chest appears--although research is still inconclusive--to NOT be related to a heart disorder.
Having said that, several folks have noted previous, well diagnosed, heart conditons or history of stroke, etc. They must be very, very cautious--there is broad medical agreement on this issue. The evidence is growing: people without pre-existing heart related problems can safely use Imitrex.
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"Cardiovascular and safety concerns in using triptans in migraine patients", Timothy R. Smith, M.D., R.Ph., in HEADACHE QUARTERLY, V. XII, 2001, Supplement 1.
There has been widely published concern about the use of triptans in patients with cardiovascular disease or uncontrolled hypertension. "Overall, serious cardiac or cerebrovascular events are uncommon--and are extremely rare when the triptans are used appropriately." Supporting this statement is a study indicating, "...the general decline in serious adverse events during the period since Sumatriptan was first marketed. This decline is observed against a backdrop of steadily increasing use of Sumatriptan. We can conclude that physicians are learning to prescribe Sumatriptan more safely and appropriately."
Clinical evidence on triptans other than Sumatriptan are not yet available because they have come on the market relatively recently.
Reports of chest symptoms associated with Sumatriptan turn out not to be signs of heart attack, etc. in most instances. There is some evidence that the cause arises from the esophagus: more work is needed to understand this symptom.
The published concerns about the use of SSRIs (a class of anti-depressants) along with triptans appears to be a theoretical concern not supported by clinical experience. One study followed 1,784 patients using such combinations for one year and found side effects of only 0.8 percent, none of which occurred within 24-hours of receiving Sumatriptan.
The use of MAOs (another class of anti-depressants) and triptans is still an unresolved question. Bottom line: don't mix them. (In general, MAOs are effective anti-depressants but should only be used by a physician with experience. I should never accept them from a family practice/generalist physician.)
The use of triptans along with ergot compounds should be avoided. There are very few clinical studies of the interaction to guide use and there is theoretical reasons to be concerned about mixing them.
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Bob Johnson
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zanychef
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #16 on: Aug 18th, 2003, 7:25am » |
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took 14 injections in one day once felt like shit but then didn't have a ha for 24 hours
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plenty of time to sleep now me headaches aint too bad
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notseinfeld
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Re: Imitrex--Safety and large doses:encouraging ne
« Reply #17 on: Aug 18th, 2003, 1:47pm » |
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Additional Horror:
Went on a ten day retreat in Calif last week and met a girl who had chronic migraines and was serving in the military. The Mil. doc put her on DHE to try to give her a breather.
While on DHE an attack slipped through and he (doc) advised she take some Imitrex. At 44 years old, she's now completely blind as the constriction cut off blood to both of her eyeballs. She didn't mention any other areas effected and there is no recourse financially against the military doctor.
Careful--
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