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Topic: Seeking your thought- Triptans (Read 1095 times) |
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pubgirl
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Sorry longish post, but am in thinking mode....... 
Carrie and my GP have just made me aware of something I knew instinctively as being an old bird I know my body quite well, and I know it doesn't like Imigran (especially as posted before in high dose nasals)
They tell me variously that Imigran is very old for a triptan, is very short-lived, is the most likely triptan to cause side effects and the least likely to block attacks/most likely to cause rebounds. Most of this information is based on migrainers as they are studied more than us, but sorry to say I don't think WE should ignore it because of that as I believe we are closer cousins than many here think (IMHO only)
I have already been instinctively using Zomig with my 02 prophylactically with some small success (a few hours only) and am picking up a Frova prescription today to try the same thing with that as growing anecdotal evidence suggests that it may work for some people in this way.
I am looking for people's opinions or real evidence, would love either as I am just thinking at the moment.
Why is Imigran the only injectible Triptan?
Why are there only two Triptans with fast delivery systems? is this because we are supposedly few and migrainers many and they don't need it?
Zomig nasal is faster than Imigran nasal and the effects last longer, why isn't this common knowledge?
Is Imigran as big a part of the problem of CH conditions worsening over time as Verapamil (which usually takes the blame for episodics turning chronic)
Thanks in advance if you have the time to answer this.
Wendy the Brit
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don
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Re: Seeking your thought- Triptans
« Reply #1 on: Sep 1st, 2005, 7:12am » |
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Quote:| Why is Imigran the only injectible Triptan? |
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That is a damn good question and one I never thought of.
Must have something to do with patent laws or cost/ benefit ratio to manufacture and market injectables.
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oudista
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Re: Seeking your thought- Triptans
« Reply #2 on: Sep 1st, 2005, 1:02pm » |
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Only other Triptan I ever tried was Rizatriptan (Maxalt melts) which sadly did absolutely nothing for me  . Others may have better experiences.
Tony
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NotH20
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Re: Seeking your thought- Triptans
« Reply #3 on: Sep 2nd, 2005, 11:00am » |
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Wendy,
DHE is also in the injection form as an abortive, but not sure if it's a Triptan or not.
Good luck w/ the Frova.....
Mia
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Jill
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Re: Seeking your thought- Triptans
« Reply #4 on: Sep 2nd, 2005, 1:25pm » |
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Quote:| Why are there only two Triptans with fast delivery systems? is this because we are supposedly few and migrainers many and they don't need it? |
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I am not sure that these are triptans but there a couple of abortives that can be used that have a fast delivery.. well as fast as they can..Let me see if I can think of them..
Both Maxalt and Zomig come in dissolvable tablets - Maxalt worked pretty fast for me and worked great for awhile.. then it stopped working.
There is also Migranal nasal spray which I think is the same thing as the DHE nasal spray, correct me if I am wrong. I know that there is another one but I cant think of it right now.. my mind isnt working right.
Those are the ones that I can think of. I know my neuro put me on relpax and said to take it when I felt the first twinge, even if it didnt go full blown because it lasts a lot longer than imitrex and has the possibility to prevent them. That didnt happen but that is what he said,...
Hope this helps some.
Jill
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pubgirl
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Re: Seeking your thought- Triptans
« Reply #5 on: Sep 2nd, 2005, 5:48pm » |
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Sorry folks , think you are missing my point. No offence Jill but I'm not looking for options for currently available triptans that are SLOWER than Imi or Zomig injectibles/nasals (e.g. dissolvables) and eletriptan appears useless as it is slow acting AND the half-life is less than some other triptans. I'm trying to scale down my dosages of Imi as I KNOW this is the way to go for me, so I'm afraid I'm also sure as hell not going to have DHE in any form! Frankly my view is that if Imigran is a dinosaur triptan, DHE is a Big Bang one!. In patient IV DHE may be a different matter, but part of my regime, no thanks.
What I'm looking for I suppose is people's experiences of using triptans in different ways and I suppose truthfully I'm looking for a fast acting form of a triptan whose effects last longer and whose side effects are minimal which I don't think exists anywhere in the world.
Where I am now is that Frova is giving me some potentially great prophylactic help but is no use as an abortive as it is pill form only. Used with 02 it is serving me very well at the moment and I am not touching Imi or prevents, but when I am without 02 I have to reluctantly use Imi or Zomig as NONE of the so-called "new age" triptans with a longer half-life come in a fast delivery form to abort as well.
I don't know the pharmaceutical restrictions but right now I want Frova or other long lasting triptan in subcutaneous or nasal version to replace Imi or Zomig. Doesn't bloody exist!
Unless you know different????
Wendy
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Jill
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Re: Seeking your thought- Triptans
« Reply #6 on: Sep 2nd, 2005, 5:54pm » |
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I am sorry, I did misunderstand you...
I havent heard of any triptans that are longer last AND come in the injectable form... sorry..
Have you tried the Relpax? It is a pill, not as potent as imitrex or Zomig, and lasts alot longer. I know that I get bad side effects from imitrex but none with Relpax...
Sorry that I misunderstood you...
Jill
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pubgirl
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Re: Seeking your thought- Triptans
« Reply #7 on: Sep 2nd, 2005, 6:02pm » |
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Relpax is eletriptan, slower than Imi or Zomig , shorter half-life than Frova, can't see the point of it
Wendy
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hm54
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Re: Seeking your thought- Triptans
« Reply #8 on: Sep 3rd, 2005, 4:09pm » |
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Glaxo has a patent.
There are other injectables in clinical trial. It's all about the money. The pharmaceutical industry doesn't care how we feel only about how much money they make. More people have acid reflux than cluster headache. Therefore they make more selling little purple pills than injectables. The pharmaceutical industry will never find a cure. If they did, they would put themselves out of business.
Imagrin has a higher advertising budget than Zomig
I believe I read somewhere (same place as the clinical study info) that all subcue triptans , by virtue of being subcue triptans, have about the same half life, and therefore the same longevity. The delivery system has an effect on the half life. For instance, antibiotic treatment can be done for ten days by pill or one day by IV. Anti-depressants-4-6 weeks to kick in by pill, one week by injection but you have to be hospitalized.
My question- Is the drug truly responsible for the condition worsening or is it just time itself that worsens the condition? After all, everything else deteriorates with time alone.
Far-fetched idea? Before high doses of verapamil and sumatriptan, if I used 02 I would have a moderate CH for several hours, as long as I kept using the 02. If I did nothing, I would have a horrendous CH for 45 minutes. This was consistent for numerous headaches (daily for months on end). Could it be that the beast must deliver a certain amount of pain before it subsides? Expressed mathematically, does 10 units of pain for 1 minute equal 1 unit of pain for ten minutes and then it subsides in either instance? Anything is possible. Therefore. does the reduction of pain (caused by drugs), increase the length of the episodes, making the episodes appear to become chronic? There are countless analogies in nature, ie: high water flow erodes quickly until the bank is gone (episodic), low pressure erodes slowly until the bank is gone (chronic). In either case, the bank is gone.
More support of this theory- Prior to having surgery, I was episodic, having CH's daily for 2-3 months twice a year. Immediatley after surgery for CH, I had headaches daily for two years but felt no pain (nerves were destroyed in the painful region). The headaches stopped for about two years, then started up again but still without pain being felt for another year. At that point, the nerves grew back, the pain started up again chronically. I felt no pain for five years and used no drugs. When the CH's returned with pain, my episodes began to last 2=3 years before remissing for one year intervals. These patterns have been like clock work for thirty years.
Not being a smart ass, Just thinking also, you seem to have an objection to dinosaur triptans and more objection to big bang DHE because they are old. Has it occurreds to you that they may be safer drugs because we no the longer term side effects of old drugs? Look at the vioxx disaster. When given a choice, I always opt for the older, non-designer drugs. We know better what they're gonna do down the road. When I first deteriorated to injectables, I opted to try DHE first
Sorry my answer is so long. I went off. 
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pubgirl
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Re: Seeking your thought- Triptans
« Reply #9 on: Sep 3rd, 2005, 9:06pm » |
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Long but very interesting!
Quite a lot of people seem to subscribe to the view that we are "preprogrammed" to have the attacks, so all we do is delay them, and sooner or later we will have them. I'm not sure about this as I haven't much personal history to go on (thank God!)
I object to Imigran because for me it gets rid of the attack I use it for, but it makes me feel awful and the effects are so short lasting. I also really do think my attacks afterwards are worse. Just a personal feeling.
I object to ergotamine as I don't like the idea of a drug that so definitely compromises circulation. As a smoker I'm already doing that and it worries me to do it further.
I have used Frova but not for an attack itself as it is too slow and I prefer 02. I am currently using it with 02 and am going 10 hours pain free before the next attack. It also appears to clear all the shadowing during that time.
From what you say though, if Frova (or another longer lasting triptan) were in injectible form, it's half life would be reduced anyway, so that may squash that dream. 
Wendy
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don
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Re: Seeking your thought- Triptans
« Reply #10 on: Sep 4th, 2005, 7:11am » |
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Quote:| triptans that are longer last |
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A longer lasting triptan makes no sense. Aren't all triptans designed to eliminate one hit at a time?
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lionsound
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Re: Seeking your thought- Triptans
« Reply #11 on: Sep 4th, 2005, 8:30am » |
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on Sep 4th, 2005, 7:11am, don wrote:
A longer lasting triptan makes no sense. Aren't all triptans designed to eliminate one hit at a time? |
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sort of. I could be totally wrong here, but I believe that some of the ones with a longer half-life are designed to battle a migraine which can be not as much as quick hit,more like a long drawn out neuro event.
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pubgirl
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Re: Seeking your thought- Triptans
« Reply #12 on: Sep 4th, 2005, 8:33am » |
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I thought triptans were designed to kill a migraine and keep it away for a "while", I don't see any reason why, if they have the will to do it (which they haven't I don't think because it wouldn't make their development money back for the) that the drug companies can't design one which kills fast via fast delivery methods AND blocks attacks for a useful amount of time
Wendy
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BikerBob
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Re: Seeking your thought- Triptans
« Reply #13 on: Sep 4th, 2005, 4:20pm » |
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During the peak of my most recent cycle, I was consistently getting hit hard at about 7pm, 10pm, 1am, 3am and 5am. O2 at 12 lpm would abort the 7pm, 10pm, 3am and 5am hits in 10-15 minutes but the 1am hits were too strong for O2 so I had to resort to Imitrex injections for those. On several nights, I took a 100mg Imitrex tablet at midnight, an hour before the expected 1am hit, as a preventive for the 1am and 3am hits and was able to get 6 hours sleep.
BB
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Re: Seeking your thought- Triptans
« Reply #14 on: Sep 5th, 2005, 2:05pm » |
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It has always been my understanding that the purpose of triptans was to kill a single attack. Any lasting prophylactic effect would be a secondary benefit.
As was said before it's all about the money. There are meds that work well enough for the largest percentage of the migrainers. That's where the money is. The ongoing improvement and production of triptans is going to be geared towards that market. There is no med out there specifically for CH, because the return on the investment in R&D would be minimal to non-existant, in relative terms.
Speaking strictly on the trex vs zomig thing. Each person metabolizes the meds differently and therefore has a different experience. A lot of people report that Zomig will keep the attacks away for anywhere from 10 to 24 hours. For me, it lasts no longer than trex. Within an hour or so, I can get pummelled again after taking Zomig. The trex injects works quicker for me and I do not have the same experience with feeling like crap and I don't get the so-called rebounds with trex that some people report. Plus I don't have to fight the insurance company to get trex like I do Zomig.
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Roxy
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Re: Seeking your thought- Triptans
« Reply #15 on: Sep 5th, 2005, 9:55pm » |
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Hey Wendy, sounds like you and I have had some of the same thoughts. At this point, I think there might be one triptan that I haven't used, but like everything else with clusters...YMMV.
I agree totally with your assessment of imitrex. Yes, it worked, in under ten minutes, but I had more hits and felt like the floor of a nasty ass bar. And I usually had to use two or more shots a night, then three or four during the day. Once I stopped using trex, even the kids could tell a difference in me.
I used Relpax, starting at 5mg and quickly building to the 40 mg tablet over a period of three months. Immunity seems to have built fast with this triptan, and there were breakthroughs. I used this triptan as a preventative though.
I then moved on to Frova, twice a day, used as a preventative. A different neuro saw what and how much I was taking, pulled me off the pills and wanted to know what idiot prescribed that for me. I had the pleasure of telling him it was his partner.
Maxalt sucks. Won't even get rid of a hangover.
Amerge has worked ok, some breakthroughs when used as a preventative.
My drug of choice now, and I wish like hell they made an injectable is Zomig. The nasal, used to abort, will usually keep me PF for almost twelve hours. So will the 5mg tablet.
None of the above triptans, excluding imitrex, seem to worsen my ch or leave me with the same nasty feelings as trex. I think those that use trex do have their cycles worsened by the drug. I didn't realized what was happening till I was off of the stuff. I'm just glad it wasn't a permanent effect.
I am still convinced that if the drug companies realized the amount of triptans ch'ers use, they would change their tunes about producing what we need. I'll never forget the look on the drug reps faces at NECH when we told them the amount of trex just used for Cat and I. They really didn't have a clue and were shocked. In one month, we used as much as most migraine patients use in a year.
Zomig nasals aren't quite as fast as trex, it will sometimes take up to 20 to 25 minutes.....sometimes it's only 10. Then sometimes I'll snort one before going out to dinner or a party and use it as a preventative instead. But, I haven't found any adverse effects, and then I have the relief of knowing that I'm good to go for about 12 hours after using it. I hoard my Zomig nasals like gold. Right now, with my new insurance, I'm only getting 12 a month.
Sorry this got long winded....I tend to start ranting when talking about triptans.
T 
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pubgirl
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Re: Seeking your thought- Triptans
« Reply #16 on: Sep 6th, 2005, 2:44pm » |
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Thanks for the great reply Roxy!
I think we share another problem, being female of a certain age and having migraine AND CH.
I am not posting in detail yet but am quite hopeful about my own personal Frova trial. Luckily my total gem of a GP gives me anything I want. Sorry your doesn't as although my experiment is in the early stages, provisionally I think it has real value for CH sufferers.
I still have my Imigran but it really is for emergencies only, bloody hate the stuff.
Wendy
P.S. Research yet to be released is that Zomig nasal trials show it as faster than Imi nasal but slower than Imi subcutaneous.
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Gator
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Re: Seeking your thought- Triptans
« Reply #17 on: Sep 7th, 2005, 12:34am » |
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I don't know about the clinical trials, but in my personal experience you are right, Wendy. Trex injects are the fastest. Zomig is much faster than trex nasal and a hell of a lot more effective in my case.
It would seem a no-brainer - Locally, Trex vials = $135.00 Zomig NS= $30 per. Why in the world my insurance company would rather give me trex over Zomig is a mystery. Well, not really. GSK gives Aetna "incentives" to prefer trex. It says so right on Aetna's website.
BTW, good luck with the frova trial.
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Roxy
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Re: Seeking your thought- Triptans
« Reply #18 on: Sep 7th, 2005, 11:16am » |
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on Sep 6th, 2005, 2:44pm, pubgirl wrote:
P.S. Research yet to be released is that Zomig nasal trials show it as faster than Imi nasal but slower than Imi subcutaneous. |
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About half of the time, Zomig nasal works as fast as the trex injection....on me. First time I used the nasal, it worked in five minutes. It's the other half of the time that's a sonofabitch.
One thing I noticed with the trex injections, and I know Mast noticed the same thing. When you injected, it ramped you up damn fast, and then it was ten minutes of hell till it kicked in. I guess Zomig has the same effect at times.
I very seldom use the Zomig when I'm at home, I always just rely on 02, but yesterday I had to use it. Had a good one going that nothing would work on....02 wasn't touching it. After using the nasal I stayed on the 02....and timed it. Took three minutes, and even the remnants of pain were gone. This was at 1:30pm, and that one nasal held me all night, and it's got to be strong stuff to hold me through the night. Actually got some sleep for a change...  .
Imitrex would only keep me PF for about an hour to an hour and a half after an injection.
Everyone always talks about the bad taste of the nasals......best taste in the world to me.
T
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pubgirl
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Re: Seeking your thought- Triptans
« Reply #19 on: Sep 8th, 2005, 5:23pm » |
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Looks like we are getting some sort of consensus going here
Now I just want to know if there is any reason other than financial why the dreaded Trex is the only triptan available in injection form?
I want Zomig and Frova injectibles, or at least a Frova nasal.
But I bet I don't get it
Wendy
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ozzy
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Re: Seeking your thought- Triptans
« Reply #20 on: Sep 9th, 2005, 10:02am » |
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Wendy,
In the past we have talked about Verapamil and Imitrex, and how Imitrex in particular seem to supress hits until the drug wears off, only to retun later.
I am convinced that in my case Imitrex works temporarily and the the frequency of attacks increases. As you may have read (or not) Kudzu worked fantastically for me ... until it stopped being effective. Now I'm getting hit at least 4 times a day variying from k6 to k9. I have a case of Imitrex Nasal at home, untouched. I still remember the hell of getting hit every 2 hours 24 hours a day. Four hits doesn't seem to be bad in comparison. I'm getting my O2 again.
Will I go back to triptans. Gut feeling, no. But I can't be certain. I miss being episodic.
I hope this adds to the conversation.
Ozzy
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Kris_in_SJ
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Re: Seeking your thought- Triptans
« Reply #21 on: Sep 9th, 2005, 8:32pm » |
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I wish I had an answer to your question, Wendy. I just tend to blame everything on the pharmaceutical companies. I have noticed in the last few months that Glaxo has stopped advertising Imitrex as a drug for "Migraine Sufferers Only."
I consider my self lucky to be an every 3-4 year episodic who suffers exactly 2 CHA's a day at peak of cycle - 9 PM and 2 PM on the clock. Trex is perfect for me. If I start high-dose Verap at the beginning of a cycle, I rarely need Trex for longer than 3 weeks and have never had rebound effects. However, it takes a DAMNED long time to wean of the Verap.
It seems to me that all we can do is put pressure on the companies that produce Zomig and other abortives to come up with an injectible form. It will cost us of course!
I hate using Trex as much as you, and don't start using it until those kip 9-10's start kicking in. I also stop using it once the side effects (burning all over, rapid heart rate, etc.) become more painful than the HA itself. When I'm at peak, those particular side effects mean immediate relief and I'm grateful. What a conundrum! (sp?)
Kris
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Re: Seeking your thought- Triptans
« Reply #22 on: Sep 9th, 2005, 8:45pm » |
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I have a closet full of trex that I try my hardest not to touch. I use it if absolutely desperate.
O2 is working the way it did and zyprexa though still effective is not as good as it was.
I don't think I would try another triptan at this point.
I deal with my ice and fingers like the old days plus my coping mechanisms are a lot better.
I definitely think that there has to be the capabilities to make injections of the other stuff though.
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Re: Seeking your thought- Triptans
« Reply #23 on: Sep 10th, 2005, 12:28am » |
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Another question to ponder is if they were to make an injectible form of the Zomig or Frova, would they have to water it down in order to lessen the potential side effects? If they did, would it be as effective as it is for some?
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andredulak
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Re: Seeking your thought- Triptans
« Reply #24 on: Sep 10th, 2005, 12:34pm » |
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A warm good morning, good afternoon or good evening to all as the case may be. I am new at this and this is my first post.
I am 53 years old and just experienced my second episode of CH (6 weeks) after the first one of the same duration four years ago.
From reading extensively the previous posts on this site, I realize that most of you might be envious and I certainly understand and sympathize!
I don't know if I am in the right "place", but I would very much love to have any possible feedback concerning the side effects of Imitrex.
I tried it this time, and only because I was able to convince my GP that I had CH (that was easy, as the neurological exams were conclusive 4 years ago) and that Imitrex was the treatment of choice (that is thanks to this website - thank you!).
My girlfriend, horrified at the pain I was going through, bought me 2 doses of injectable Imitrex (to this day, she refuses to say how she managed it, as it requires a prescription) and it worked fine.
My GP, after prescribing massive doses of OTC pain medicines, then prescribed Imitrex 50 mg tablets.
The pain usually took 40-50 minutes to go away.
The side effects, however, were absolutely horrendous.
I read the list on a GSK site and I believe I experienced them all : skin rash, eye pain, but mostly this "tingling" headache, which kept getting worse and worse, lasting for hours on end. I seriously thought that I might have a brain tumor ...
My daily bouts (average duration 3 hours) stopped as suddenly as they appeared, after 6 weeks, and 12 Imitrex tablets. I even "skipped" taking my Imitrex during my last bout, for fear of the side effects. I would rather hurt as hell for 2 to 3 hours rather than feel terrible all day long.
I have been CH free now for 18 days, and the side effects I experienced have disappeared only very recently.
Thank God the beast is gone, and I hope it stays away for a very long time.
I also took Inderal 80 mg CR for 6 weeks, and I originally thought the side effects were due to it.
Would anybody care to detail his/her side effects, as I've read so many things about how Imitrex helps, but also how people "really hate it".
Thank you and excuse the beginner who might be in the wrong forum.
Any feedback will be greatly appreciated.
Thank you and God bless.
André Dulak, Wavre, Belgium.
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