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Topic: Triptan & Ergotamine safety (Read 332 times) |
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Bob_Johnson
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Triptan & Ergotamine safety
« on: Aug 7th, 2004, 8:42am » |
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Triptan Use Not Linked With Increased Ischemic Events
Aug 04 - Triptan use is not associated with an increased risk of any ischemic events in migraineurs, according to a report published in the July/August issue of Headache.
"It has been speculated that the use of triptans or ergot alkaloid drugs might increase risk of ischemic events through vasoconstriction," Dr. Priscilla Velentgas of Ingenix Epidemiology, Auburndale, Massachusetts, and colleagues at Pfizer Inc. write.
To investigate, the team matched a retrospective cohort of 130,411 migraineurs with 130,411 nonmigraineurs who were members of UnitedHealthcare between 1995 and 1999.
Both migraineurs and nonmigraineurs had rates of myocardial infarction of about 1.4 per 1000 person-years.
Compared with nonmigraineurs, those with migraine were 67% more likely to have a stroke during follow-up. Migraineurs also had higher rates of unstable angina and transient ischemic attacks.
However, the risk of myocardial infarction or stroke did not increase with current or recent triptan use.
Current ergot alkaloids user were more likely to have a stroke or serious ventricular arrhythmia than other migraineurs although the relationship was not significant, the researcher note. No associations were seen between current ergot alkaloid use and risk of unstable angina or transient ischemic attack.
Headache 2004;44:642-651.
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| « Last Edit: Aug 7th, 2004, 8:44am by Bob_Johnson » |
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Bob Johnson
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Re: Triptan & Ergotamine safety
« Reply #1 on: Aug 7th, 2004, 11:09am » |
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If I take too much Imitrex ... (if I take a full dose) ... I get this really bad sunburnt feeling on the back of my neck and on the palms of my hands. Doctors from IN. and doctors from MHNI both said it is a "cardiac event' and that the day was coming when I could no longer use Imitrex. 
I don't understand how it (Triptan use) could NOT increase the likelyhood of an Ischemic event .
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miapet
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Re: Triptan & Ergotamine safety
« Reply #2 on: Aug 8th, 2004, 10:21am » |
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Someone shared this article with us, and we felt it important to share with y'all. This article is older . . .but I believe it's accurate. Thought you all might be interested in it's discussion on Imitrex.
http://www.motherjones.com/news/feature/1995/09/regush.html
(hope I did that right *g*)
If it helps anyone make a better-bad-choice, then it is a helpful read . . . we worry about everyone in their fight with the beast . . .
*positive light and energy*
D & miapet
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IndianaJohn
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Re: Triptan & Ergotamine safety
« Reply #3 on: Aug 8th, 2004, 10:42am » |
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So basically we're screwed. Either we suffer with the beast or potentially damage our hearts from using Imitrex. Am I reading that right? WTF? I gotta find a way to get some O2!!
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miapet
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Re: Triptan & Ergotamine safety
« Reply #4 on: Aug 8th, 2004, 10:47am » |
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If your doc won't write a script for o2 .. .there is the option of welders o2 . . .just need to either get a mask, or as some others here have done, suck the hose . . .
*positive light and energy*
miapet
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IndianaJohn
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Re: Triptan & Ergotamine safety
« Reply #5 on: Aug 8th, 2004, 10:55am » |
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I know...It's just my wife has a bunch of med problems too and lost her job b/c of it so cash is tight. I have to talkwith the doc next week so maybe I can get a script....was wondering which route is less expensive..I'm sure it's gotta be cheaper than the Trex, but damn!!
sorry for whining
John
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miapet
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Re: Triptan & Ergotamine safety
« Reply #6 on: Aug 8th, 2004, 11:33am » |
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You aren't whining . . . just talking *smiles*
Your doc (and your wife's) can also help you with meds, either samples, or there is a form, they fill it out (with you) and send it to the drug company . . .the drug company can then help with medications . . many times, free . . .I worked in a pediatric office, and learned about this, when we did it for a patient . . . it's an idea to try?
I think, the biggest deal with setting up the welding o2 is getting the tank and regulator . . . if you know any welders, they may be able to help out?
*positive light and energy*
miapet
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floridian
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Re: Triptan & Ergotamine safety
« Reply #7 on: Aug 8th, 2004, 2:43pm » |
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on Aug 8th, 2004, 10:42am, IndianaJohn wrote:| So basically we're screwed. Either we suffer with the beast or potentially damage our hearts from using Imitrex. Am I reading that right? WTF? I gotta find a way to get some O2!! |
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I don't think that's right. If you already have certain heart conditions, triptans are ruled out. But triptans do not seem to increase the risk of heart attack or stroke if you are heart healthy.
There might be a risk from ergot alkaloids, but it was not statistically significant in this study, indicating that the risk is probably not that large if it does exist. Not sure if the people getting ergotamine had worse migraine to start with (which IS a risk factor for ischemia).
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| « Last Edit: Aug 8th, 2004, 2:46pm by floridian » |
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pubgirl
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Re: Triptan & Ergotamine safety
« Reply #8 on: Aug 8th, 2004, 2:53pm » |
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As briefly as I can!
People suffering from Basilar Arterial Migraines can actually cause strokes/Ischemic attacks with Triptans so if there is any chance you are suffering from these, get it checked out BEFORE you take any triptan as you could feasibly die.
People taking Triptans should beware (check with neuro first) taking ergotamine drugs as well as they have a similar effect on the body, and in the case of Imitrex, it is a synthesised version of one of the active parts of ergotamine. Talking both can create serious circulation problems.
There is evidence of increased risk of stroke amongst young female migraine sufferers. I haven't seen any credible research linking CH and stroke though, nor any credible research stating that triptan use is dangerous to anyone other than BAM sufferers or those with pre-existing heart or circulation problems, or older patients whose hearts are no longer healthy due to age/lifestyle.
Wendy
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| « Last Edit: Aug 8th, 2004, 2:59pm by pubgirl » |
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Pinkfloyd
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Re: Triptan & Ergotamine safety
« Reply #9 on: Aug 9th, 2004, 2:13am » |
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on Aug 8th, 2004, 2:53pm, pubgirl wrote: I haven't seen any credible research linking CH and stroke though, nor any credible research stating that triptan use is dangerous to anyone other than BAM sufferers or those with pre-existing heart or circulation problems, or older patients whose hearts are no longer healthy due to age/lifestyle.
Wendy |
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Wendy,
Did you read the linked article that was posted in this thread?
BTW, how old are these "older" patients that no longer have healthy enough hearts to use triptans
I also thought it interesting that when a person who's autopsy showed had a healthy heart, but died, her family was told she must have had one of those undetectable pre-existing heart conditions. How do we know if we have one (so we don't take triptans in the first place) if it's undetectable even after our autopsy? 
on Aug 7th, 2004, 8:42am, Bob_Johnson wrote:"It has been speculated that the use of triptans or ergot alkaloid drugs might increase risk of ischemic events through vasoconstriction," Dr. Priscilla Velentgas of Ingenix Epidemiology, Auburndale, Massachusetts, and colleagues at Pfizer Inc. write.
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You trust Pfizer telling you it's safe?
on Aug 7th, 2004, 8:42am, Bob_Johnson wrote:
Compared with nonmigraineurs, those with migraine were 67% more likely to have a stroke during follow-up. Migraineurs also had higher rates of unstable angina and transient ischemic attacks.
However, the risk of myocardial infarction or stroke did not increase with current or recent triptan use.
Headache 2004;44:642-651.
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So....Migrainers had higher rates of unstable angina and transient ischemic attacks but not myocardial infarction or stroke. Cool....all is well.
How much higher were the rates? Higher than even the 67%? Could they be referenced back to triptan use or not? Funny they didn't say.
on Aug 7th, 2004, 8:42am, Bob_Johnson wrote:
However, the risk of myocardial infarction or stroke did not increase with current or recent triptan use.
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Hmmm.... current or recent use. Didn't the Mother Jones article mention something about long term use. Did they just look at the people that had been using triptans for a month?
I'm not saying that there is any problem. I'm just waiting for a credible study to be done myself.
If I was still getting clusters, believe me, I'd most likely still be using imitrex and DHE. Just trying to find my way through all the smoke.
PF
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pubgirl
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Re: Triptan & Ergotamine safety
« Reply #10 on: Aug 9th, 2004, 3:14am » |
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PF
Sorry, you make fair points as usual  . I wanted to warn about the BAM issue which is clearly an immediate and real risk of fatality for triptan users, and also to say that all the studies I have seen don't link CH per se with increased stroke risk. Don't want to be alarmist (unless really necessary to warn people about something who are new to CH) but I do agree that there are some serious issues raised in the other article.
Still, if 02 doesn't work, what other realistic abortive option is there when ergotamine drugs are even more risky?
The age thing has never been defined anywhere I have seen (would like to know if it has been?) The experts over here often seem to advocate looking for alternative treatments to Verap and sumatriptan e.g. methysergide and 02 for people over 65 particularly for the life-long smokers who may have damaged their hearts, but there are quite a few people in their 70's that I know of taking both (with close monitoring)
I suspect that the 65 age they use is simply convenient as it is the retirement age here when we officially become 'old'.
I would also want to know more detail about the migraine population studied. For example, how many of the migrainers studied were middle-aged women who have used or are using HRT, have high risk lifestyles or hypertension issues-all of which are stroke contributory factors. If this was the population studied, the increased risk contributed by triptan use could be minute.
How do we know if we have an underlying heart condition and are therefore at possible risk from several of the CH treatments? God knows!
Makes me even more thankful that 02 works for me.
Wendy
Added: Just one thought. If it is the vasoconstriction that is the risk, doesn't that apply to the result of using the 02 as well.
Just worrying myself over nothing now probably
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| « Last Edit: Aug 9th, 2004, 5:25am by pubgirl » |
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Bob_Johnson
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Re: Triptan & Ergotamine safety
« Reply #11 on: Aug 9th, 2004, 8:55am » |
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While we want to find the absolute final word about safety, the reality is that it's very rare in medical research, to see such outcome reports. (This is due to the compexity of doing good research--a topic much too involved to outline here.)
"Truth" in medicine is a slow accumulation of research reports which move towards the same conclusion. That's why we are often confused by single reports which contradict other single study reports. But, we hope, over time a body of evidence will grow which gives us confidence that conclusion "x" is correct. Learning to live with ambivalence is a survival skill in this life!
Reposting another safety report, one of several I've posted along the same lines: overall, triptans have a high safety factor--not absolute--precautions are needed--but not a class of drugs for reasonably healthy people to avoid.
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Title: Triptan safety--latest statement
Post by Bob_Johnson on Jun 1st, 2004, 9:47am
------------------------------------------------------------------------ --------
Since this is a report on medications and not on the condition being treated, I believe it would be O.K. to apply these findings to folks with Cluster. NOTE: there are no comments about using triptans at the high/multiple dosing which is often done by cluster patients. (Treat everything below the line as a quotation. These are selected para. from the total report.)
------------------------------------------------------------------------ --------
Consensus Statement: Cardiovascular Safety Profile of Triptans (5-HT1B/1D Agonists) in the Acute Treatment of Migraine
Headache 44(5):414-425, 2004.
Posted 05/25/2004
Abstract
Background: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan-associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine.
Objective: To summarize the evidence reviewed by the Triptan Cardiovascular Safety Expert Panel and their recommendations for the use of triptans in clinical practice.
Participants: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology.
Evidence and Consensus Process: An exhaustive search of the relevant published literature was reviewed by each panel member in preparation for an open roundtable meeting. Pertinent issues (eg, cardiovascular pharmacology of triptans, epidemiology of cardiovascular disease, cardiovascular risk assessment, migraine) were presented as a prelude to group discussion and formulation of consensus conclusions and recommendations. Follow-up meetings were held by telephone.
Conclusions: (1) Most of the data on triptans are derived from patients without known coronary artery disease. (2) Chest symptoms occurring during use of triptans are generally nonserious and are not explained by ischemia. (3) The incidence of serious cardiovascular events with triptans in both clinical trials and clinical practice appears to be extremely low. (4) The cardiovascular risk-benefit profile of triptans favors their use in the absence of contraindications.
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These data should be interpreted in view of characteristics of the patient population in migraine clinical trials. Generally, controlled clinical trials with triptans excluded patients with cardiovascular risk factors including known ischemic heart disease, symptoms or signs consistent with ischemic heart disease, cardiac arrhythmias requiring medication, and supine diastolic blood pressure >95 mm Hg and/or systolic blood pressure >160 mm Hg. Thus, the clinical trials data cannot be generalized to migraine sufferers with cardiovascular risk factors.
Triptans are associated with a modestly elevated incidence of chest symptoms (ie, triptan sensations) relative to placebo in well-controlled clinical trials that excluded patients with significant cardiac risk factors or known ischemic heart disease. The chest symptoms in clinical trials were generally transient, mild, and nonserious.
Given the widespread use of triptans, the risk of serious cardiovascular adverse events during postmarketing surveillance appears to be very low. While the risk of a serious cardiovascular event during triptan use appears to be very small, it cannot be dismissed. Serious cardiovascular events, some of which resulted in death, have been reported in association with triptans during postmarketing surveillance. The causal association of triptan use with serious cardiovascular adverse events is difficult to determine based on the postmarketing surveillance data alone.
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| « Last Edit: Aug 9th, 2004, 8:57am by Bob_Johnson » |
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Bob Johnson
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Bob_Johnson
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Re: Triptan & Ergotamine safety
« Reply #12 on: Aug 9th, 2004, 9:17am » |
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Don't miss this message: "Drug safety under serious threat", posted 8/9/04.
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Bob Johnson
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