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        New Message Board Archives >> Medications, Treatments, Therapies 2002 >> Amerge, Imitrex, Prednisone
        
(Message started by: dazee8 on Apr 27^th, 2002, 10:24am)

Title: Amerge, Imitrex, Prednisone
Post by dazee8 on Apr 27^th, 2002, 10:24am

For the past week, I've been taking a highly effective cocktail of Amerge, Imitrex, and Prednisone. Here are my dosages for the current cycle:

From about March 25 to about April 7, I was on a tapering course of Prednisone (starting w/ 30 mg and tapering off to 10 mg). I also took 50 mg Imitrex tablets and, occasionally, the nasal spray, to abort. If I used the Imitrex tablets as soon as I felt a shadow, they worked. If the ch had already started, though, I found that I had to use the nasal spray or forget about it. I used up to two Imitrex tablets or nasal treatments per day. For this period of time, I didn't use Amerge.

On about April 12 through today, I've been on a second downward tapering course of Prednisone (again, 30 mg to 10 mg). I also have been using the Imitrex tablets and nasal spray to abort as necessary.

Additionally, for about the past week, I've been using two 2.5 mg Amerge tablets twice a day as a preventative, one in the early morning and one before I go to bed. I think the Amerge is really helping! Before starting on the Amerge, I was having strong shadows twice a day. Since taking the Amerge, the shadows have seemed a lot weaker and slower in their approach. During this time, I've been using up to two Imitrex tablets when I feel a shadow and have found that this works every time. I'm not sure it's that safe to take so much Imitrex. In fact, my neurologist said I should take only one Imitrex a week. I then told him that I didn't think it was realistic for me to limit myself to one Imitrex a week because I was sure I'd get an attack. He then relented and said I could take one Imitrex a day.

In any case, this morning, I woke up with what seemed to be the start of a ch, took an Amerge, and the pain went away after about an hour. The pain was only the strength of an ordinary bad headache and decidedly not the pain of a ch. So I'm happy to report that, in at least this one case, the Amerge worked as an abortive. I'm going to try to not take Imitrex and see what happens.

Two additional comments, maybe both obvious:

1. During this current cycle, alcohol has almost always triggered an attack. I've been able to fight these attacks w/ Imitrex, but it's no doubt better just to lay off the booze.

2. Is Glaxo Wellcome fleecing us for all we're worth? Bless them for Imitrex and Amerge, but what kind of profit is GW making on these drugs? Are Imitrex and Amerge available in Mexico or other countries? Is there any organization to join to pressure Congress, GW, etc., to bring down prices?

Title: Re: Amerge, Imitrex, Prednisone
Post by rick on Apr 27^th, 2002, 11:57am

Dazee-

Whoa! I know there are a number of people who use this site who will be better able to explain this to you in greater detail, but I'll give you what I can.

Amerge (Naratriptan) and Imitrex (Sumatriptan) are of the same family, and both are meant to be used as abortives, not preventatives. My neuro stresses to me that neither is to be taken more than once every four days, although in the past, I had used each on a daily basis for short stretches. I know that others on this site have told stories of having serious issues as a result of overuse of Imitrex, such as heart attacks.

In my own experience, I tried taking Amerge as a preventative over a three day period. On day four, I ended up with a headache so bad I found myself in the ER (what some people call a rebound). I seemed to build up a tolerance to Imitrex after consecutive days of use.

One thing I have found in using the tablets: If I did not take one IMMEDIATELY at the onset of an attack, I would have a headache for at least an hour. If I take nothing at all, I have a headache for at least an hour. A number of people use Imitrex through injection, which works in about 5-15 minutes. Prednisone for me has worked better than anything as a preventative, I typically only would have one headache per cycle of prednisone. And yes, alcohol is not the best thing for you during a cycle, I've quit drinking permanently.

I'm concerned for you about your neuro's ability to address your problems. Did he not speak to you about a drug called Verapamil? It does not work for me personally, but it's usually the first line of defense for most people. Oxygen? Check out the medications button on the left, as well as the OUCH website button. You will find surveys on the success rates of both of these. I can tell you that Amerge is not meant to be taken twice daily, on that alone I would recommend you seek another doctor.

There's a list of recommended physicians over on the OUCH website, but you really just need to find someone who has experience with CH, or at least understands it better. This might be hard, I'm fortunate enough to live in a big city where I have a number of options. Educate yourself, so that you yourself will be able to better understand your doctor's capabilities. Question them. Spend time reading this site and the OUCH site, so that you can better address your own needs if they can't.

-Rick

Title: Re: Amerge, Imitrex, Prednisone
Post by dazee8 on Apr 28^th, 2002, 12:28pm

Thanks for your concern, Rick. I think I will read up further on what constitutes a safe dose of Amerge.

In the meantime, just a comment (thinking out loud) on your doctor's advice re: maximum dosage of Amerge: my sense is that different doctors have different philosophies as to maximum dosages--it may be that your doctor is more on the conservative side. I think in general that it's safer for doctors to prescribe less medication because it reduces their chances of committing malpractice. It's not going to hurt a doctor in this regard to be very conservative about maximum dosages of Amerge. On the other hand, to the extent that a certain dosage is safe, I want to have the ability to take as much of an effective ch drug as possible--my last ch was so awful, I don't think I could bear another w/out going to the ER.

As for Verapimil and oxygen, I may look into that, too, but one thing I've noticed from my research is that there are so many different treatments and the effectiveness seems so hit and miss that I wonder if you can really say you should try a certain drug first, then, if that doesn't work, go to a specific second drug, etc. Also, my impression is that there's no real uniform consensus among doctors as to the best treatment(s), drug dosages, etc., maybe in part b/c response to treatment is so individualized or b/c not a lot of doctors are that well-informed about ch.

That said, I want to say again that I appreciate you taking the time to comment on my Amerge dosage. If I have to get a heart attack, I hope it will at least be during a ch--anything to take my mind off the pain!

dazee

Title: Re: Amerge, Imitrex, Prednisone
Post by Ueli on Apr 28^th, 2002, 7:52pm

Whoa, there are quite some confusing ideas in this thread. :-[

About the Triptans:
Always keep in mind that they were developed to treat migraines. Therefore, the usual statement: The safety of treating an average of more than 4 headaches in a 30-day period has not been established. But this does not imply that using them more often is unsafe. After all, what would be the point if we were only allowed to treat 4 attacks out of 50 or 100 a month. >:( To run tests that prove the safety of the amounts the average clusterhead consumes would be too expensive for the pharma industry; and we buy the stuff anyway.

Another issue is the amount taken in any 24 hour period. The recommendations are not to exceed

2 Imitrex tablets (@ 100 mg)
or
2 Imitrex nasal sprays (@ 20 mg)
or
2 Imitrex injections (@ 6 mg) (The "Imitrex Tip" comes handy to treat more than 2 attacks per day)
or
2 Amerge tablets (@ 2.5 mg)
or
the daily maximum of any other Triptan
or
the daily maximum of ergot compounds

Note the or above: It means you can take the maximum of one, but not of two or three. You stay within the limits when taking half the max of two different Triptans.
The reason of this daily maximum is that too much could severely interfere with blood circulation in general (this is especially true for the old fashioned ergotamine). But then, there are people who have take twice or thrice the maximum for extended periods, and they are still alive and kicking.

What to take when and why:
The general consent is that Imitrex injections work fastest to abort an attack, 2 to 5 minutes (not 5 - 10 as Rick said).
For people afraid of needles (can anybody tell me why?) the spray is a good alternative, but a bit slower than jabs and sometimes not successful if not taken correctly.
Imitrex tablets give only relieve in a reasonable time for people who take them 10 minutes before the attack, e.g. those who recognize their precursor in time.
As an abortive Amerge is completely useless, unless you expect an attack with a duration of 2 hours or more. It is far to slow kicking in, about 45 to 60 minutes.

Although the leaflets say not to use the Triptans as a preventative, this recommendation holds for migraines only. For CH this use has its merits: If someone is hit regularly 90 minutes after going to sleep, after watching TV for an hour or on any other fixed and predictable time, it makes sense to take an Amerge as a preventative. (In this case Amerge is to preferred over Imitrex tablets as its action lasts 2 or 3 times longer.) I take a prophylactic Amerge before going out for a dinner of which I cannot be sure that it is not poisoned with MSG.
I'm awaiting eagerly for the availability of the new Frovatriptan which is said to have a half life time of over 24 hours.

I'm sorry to say, but dazee's neuro seems not to be very experienced in treating CH. :( The first line of attack should be Verapamil (in a high enough dose) as a preventative and oxygen as an abortive. They have the least side effects and are relatively easy on the wallet. A Prednisone taper can sometimes stop dead a cycle, but there is no guarantee for that. It should therefore be used to give a few days relief, until the preventative (such as Verapamil), that should be started at the same, time kicks in. Also, if I understood dazee correctly, a starting dose of 30 mg Prednisone per day is very low for CH, most start with 60 - 100 mg.

Finally, for all, look up your meds at http://www.rxlist.com! Although this site is rather demanding, even a layman can get more from it than from the wishy-washy of the leaflets that come with the meds.

PFNAD's
Ueli

Title: Re: Amerge, Imitrex, Prednisone
Post by dazee8 on Apr 30^th, 2002, 2:01pm

Thanks for the tips, Ueli. Maybe it's hypochondria, but since your and Rick's responses to my post, I've begun to feel some tightness in my chest. Last night before I went to bed, I took an Amerge because I felt a shadow (I'd taken an Amerge and an Imitrex earlier in the day), and I felt faint--it was definitely unpleasant. I'm going to really try to cut back on exceeding the recommended two-a-day Amerge or Imitrex dosage.

Another comment on the Verapamil. Both you and Rick have questioned my neuro for not trying this first. But none of the three neuros I've seen has prescribed Verapamil for me. Maybe they don't know what they're doing, but maybe there's a legitimate difference of opinion about whether Verapamil and oxygen should be the first line of defense. But I'm going to look into Verapamil.

dazee