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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Time for Frova
        
(Message started by: DerbyDemon on Aug 24^th, 2004, 4:57pm)

Title: Time for Frova
Post by DerbyDemon on Aug 24^th, 2004, 4:57pm

For those of you that think I'm already on a lot of meds...I've added another...Frova. My history for those who don't know - hadn't had a HA for two years when they decided to return this June. After three rounds of steroids they have increased in frequency and intensity.

Med history is on my earlier post ("Seen...motivation"). Now I'm adding Frova 2x/day and 50mg Indocin 3x/day. A third Frova can be taken at the onset of a HA. Imitrex injections are out for the moment (personally a scarry thought). All other meds are to be taken as usual.

Will update as we progress this minefield.

Title: Re: Time for Frova
Post by pubgirl on Aug 24^th, 2004, 5:27pm

Derby Demon

Sorry, I don't follow, why Frova and not Imitrex?

Wendy

Title: Re: Time for Frova
Post by DerbyDemon on Aug 24^th, 2004, 5:34pm

Why Frova and not Imitrex? Couldn't really say. I'm about 250 miles from the neuro so we've been attacking this episode by phone. All I can really say is that we are looking for anything that will break it. Since the steroids didn't work, adding Depoke hasn't helped, I can only imagine that the Indocin/Frova combination is just another trick up her sleeve.

Different strokes for different folks as we've all learned. Meanwhile, I'm off for a bourbon on the rocks while I know I can still take an Imitrex injection. I love my buddy.

Title: Re: Time for Frova
Post by Superpain on Aug 24^th, 2004, 7:15pm

Frova is not meant to be taken as a preventative is it?
As in you should only take it at the onset of a ha, not twice daily etc... Am I wrong?

Title: Re: Time for Frova
Post by pubgirl on Aug 24^th, 2004, 7:19pm

That is certainly the expert advice over here Chris. Triptans shouldn't be used for prevention.

But some people do. Amazed if a neuro is suggesting it though [smiley=huh.gif]

Wendy

Title: Re: Time for Frova
Post by mynm156 on Aug 24^th, 2004, 7:20pm

Here some info I found....

Uses for taking Frova
Frova is a prescription medicine used to treat migraine headache attacks in adults. Frova is not used to prevent migraines, or to decrease the number of migraine attacks. Frova has not been shown to treat headaches called cluster headaches.

MYNM156

Title: Re: Time for Frova
Post by Kris_in_SJ on Aug 24^th, 2004, 8:18pm

Wow - from what was posted above, I'd be a little leary. Maybe do a little research? Maybe find a neurologist closer to you who specializes?

Good Luck - Keep Posting!

Kris

Title: Re: Time for Frova
Post by Lizzie2 on Aug 24^th, 2004, 8:47pm

The issue of using a triptan as a preventative has come up many times on these boards. The problem is that this seems to be a "relatively" new idea, and the jury seems to be split on whether or not it is a good idea. Frova has been used successfully to prevent menstrual migraine in a way where you take it a few days before menstruation and then a few days into the cycle. It is a short term use. Frova and relpax have both been used in studies for prevention of cluster headache both with some success. I do not recall the duration that these meds were used in those studies. Amerge has been used preventatively by NECH for the treatment of certain types of headaches. Dr. Volcy said that even after 2 years of daily use, the patients had no adverse effects.

That being said: I wanted to do Amerge preventatively, but haven't gotten the OK. I last spoke with the nurse practitioner at the headache center where I go about this earlier this month. I brought her the full text article from NECH about the study on Amerge used preventatively. She said she does not feel comfortable using it in this way at this time. And the fact is, not enough is known. I read over that study with a fine toothed comb and there are still a lot of variables that are unknown. The study was done retroactively I believe, so they weren't necessarily controlling other variables when they did the study...just looking back on charts of patients who had tried this method.

I spoke to another neurologist about this, and he told me that rebound is still a factor...even with slow-acting triptans like Frova and Amerge. That's where you have to pick and choose. I personally felt that rebound is not any worse than the continuous headache that I always have...and then the clusters on top of it. I feel that in my case..the worst side effect of rebound would be if the Amerge lost its effectiveness. The neuro I asked about this said something to the effect that he did not know if rebound in the case of preventative use for Amerge would occur with clusters in the same way it can for migraine.

The only triptans I have seen used in any preventative sense are Amerge, Frova, and Relpax. Frova takes wayyyyyy too long to work to have it all out abort a cluster. If you take it, it might prevent the next couple? Amerge takes 2 hours to have an effect for me. I have to either judge how badly I need it or go off of how bad my constant headache is to know if it is worth taking. I've never tried Relpax...but it is supposed to work a little faster than Amerge and Frova.

Sooooooooooooo in the end, I'm not suprised to hear of a neuro trying it for preventative use. I believe there are a couple other people on these boards who take one of the triptans nightly as a preventative in some way shape or form. It is going to take more time for this to become a more widely accepted use, IMHO. More studies with more definitive data showing the risks and benefits.

The only place I guess I would question your regimen is why take the 3rd frova tablet when you get an additional headache? First of all, it exceeds the 2/24 hour rule, and also...is it really going to help that headache if it takes so darn long to kick in? That's just my thoughts on it!

At any rate, I'd just keep a close eye on everything going on. Ask lots of questions. It is the only way we learn anything, sometimes!

Good luck!
Carrie/Lizzie2 :)

Title: Re: Time for Frova
Post by karma on Aug 25^th, 2004, 9:57am

Alcohol is a major trigger for most people during cycles.
I 'm not sure if you were jokng or not but if your getting hammered then alcohol may be whats doing it.
Good Luck

Title: Re: Time for Frova
Post by Bob P on Aug 25^th, 2004, 11:24am

Like most of the triptans, Frova has not been specifically tested for clusters but will work. I asked the mfg. if they intended to test it on clusters and they said no.

The difference with Frova is it's half-life. Imitrex about 3 hours, frova about 23 hours. So Frova stays in your system for a much longer time. This is probably why it is picked to be used in a preventative fashion.

Title: Re: Time for Frova
Post by Lizzie2 on Aug 26^th, 2004, 11:05am

on 08/25/04 at 11:24:52, Bob P wrote:

A study on frova and CH has been accepted for publication in Cephalalgia, and will hopefully turn up there sometime soon! Wish that I could find out sooner, but if the author of the study doesn't know, then I don't think I'll have much better luck!!!

Just wanted to let ya know. :)

Title: Re: Time for Frova
Post by Bob P on Aug 26^th, 2004, 5:24pm

That's good Lizzie.

What I was referring to is that Imitrex is the only triptan that lists it for use on clusters in the literature that comes with the product. Glaxo went out and studied it's use on clusters and satisfied whomever the powers are who authorize this stuff.

When I first read about Frova being released in the near future, I contacted the mfg and asked if they had any intentions of testing it on clusters. They said no. That was a couple of years ago though and things do change.

The more of these triptans we get tested on clusters and proven effective the easier it will be to get the insurance companies to authorize them for clsuters.

I wouldn't mind trying Frova on a preventative basis.

Title: Re: Time for Frova
Post by Lizzie2 on Aug 26^th, 2004, 5:46pm

Good info, Bob.

I think one of the big components of doing drug trials at headache centers is to get them FDA approved for the treatment of that particular condition. Botox is a big one that several centers have been working on getting approved for migraine treatment...which will hopefully cause more insurance companies to pay for it as a legitamate treatment for migraine.

The drug inserts are so sketchy for what is FDA approved to treat migraine/cluster/ or any condition for that matter! Topamax just got approved to treat migraine, which adds to a list of like 5 or 6 drugs actually approved for migraine prevention. The triptans only have imitrex for CH for now, but hopefully doing trials like the Zomig NS trial at NECH and other centers will get Zomig FDA approved for CH, too!

I don't remember all the details of the Frova study done. It was done as prevention for CH for a short-term basis, I do believe. Will be able to say more once I read the published article. :) I guess I can see why the mfg's dont' want to test Frova on CH. It takes so long to work that it would be have to be used preventatively instead of as an all out abortive. The medical world isn't ready to accept triptans as preventatives, but the studies are coming out more and more! Hopefully some high up powers will do some more testing on certain triptans being used preventatively so that we can get more things available according to the FDA. In the meantime, I guess it is most important for neuros and doctors to get the word that these drugs can be used for CH, even if it is off label!

Time will tell. :)

Lizzie :)