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Bob_Johnson
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Intranasal meds--overview
« on: Aug 23rd, 2004, 6:42am » |
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CNS Drugs. 2004;18(10):671-85.
Intranasal medications for the treatment of migraine and cluster headache.
Rapoport AM, Bigal ME, Tepper SJ, Sheftell FD.
Columbia University College of Physicians & Surgeons, New York, New York, USAThe New England Center for Headache, Stamford, Connecticut, USA.
Intranasal medications for the treatment of headache have recently received increased attention. This paper reviews intranasal formulations of a variety of available medications (dihydroergotamine mesylate [dihydroergotamine mesilate], sumatriptan, zolmitriptan, butorphanol, capsaicin and lidocaine [lignocaine]) and one experimental medication (civamide, a cis-isomer of capsaicin) for the treatment of migraine and cluster headache.Although the efficacy of intranasal agents varies with the product used, intranasal delivery may be both convenient and more effective than other modes of drug delivery for a variety of reasons: (i) intranasal administration bypasses small bowel gastrointestinal tract absorption, which is often significantly delayed during the acute phase of a migraine attack; (ii) nauseated patients may prefer non-oral formulations as they decrease the chance of vomiting and are more rapidly effective; (iii) intranasal administration causes no pain or injection site reaction and is easier and more convenient to administer than injection or suppository and so may be used earlier in a migraine attack, resulting in better efficacy; (iv) intranasal medication produces the same number or fewer adverse events than injections; and (v) intranasal formulations offer a more rapid onset of action than oral medications, for some of the above reasons and, as such, may be more useful in patients with cluster headache, although this needs to be verified. However, it is important to emphasise that a preference study showed that most patients prefer oral tablets to an intranasal formulation. Also, some nasal preparations have significant adverse effects or are not well absorbed and therefore do not work consistently; others are more challenging to administer as a result of their delivery apparatus. Nevertheless, it is our opinion that nasal preparations increase therapeutic options and may result in faster response times and better efficacy than oral formulations and better patient satisfaction than injectable preparations.
PMID: 15270595 [PubMed - in process]
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Bob Johnson
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IndianaJohn
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Re: Intranasal meds--overview
« Reply #1 on: Aug 23rd, 2004, 11:52am » |
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20 mg Imitrex nasal spray is the abortive I have been using for years. I get a fairly reasonable response time of 5 to 10 minutes.
Though some of the findings I have to take a very slight disagreement with. When I use my Imitrex, I invariably end up swallowing a little of it that causes a slight stomach upset.
Another word of caution. There have been times that I did not administer the nasal spray properly. I didn't properly position the applicator and would end up with the Trex running out of my nose. Usually a costly mistake even with insurance. Proper placement of the applicator so that the Trex gets into your sinuses is imperative, otherwise it becomes ineffetive as you don't get the full dose.
Otherwise, the Imitrex 20mg nasal spray has been an effective abortiove treatment for me.
And did I say I hate needles?
my 2cents...
John
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Did my brains fall out or is this headache over?
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lionsound
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Re: Intranasal meds--overview
« Reply #2 on: Aug 23rd, 2004, 12:42pm » |
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I hate needles too!
Good thing my doc (Shefttell) is one of those listed above.
(Phew)
John, Good tip about the NS.
-R
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