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        New Message Board Archives >> Medications, Treatments, Therapies 2005 >> Imitrex half-lives?
        
(Message started by: LasVegas on Aug 19^th, 2005, 1:25pm)

Title: Imitrex half-lives?
Post by LasVegas on Aug 19^th, 2005, 1:25pm

We have all learned from Glaxo it is not recommended to exceed 12mg of Imitrex injections within a 24 hour period. Many take the risk, even though it is not recommended. Many are smarter not to take the risk and to try the Imitrex Tip on the left side of the screen or perhaps try dividing doses with an insulin syringe.

If Imitrex comes in the following dosages.....

Imitrex injections---6mg typical shot, known to be effective at 3mg, even 2mg

Imitrex inhaler....20mg spray

Imitrex tablets....50 mg, 100mg tablets that can be divided into 50mg to be creative

what combinations based on dosages listed above are safe within a 24 hour period?

Realize your reply is based on personal experience and you may not be a medical doctor. However, many of us are prescribed all three of these Imitrex medicines due to restrictions from insurance companies limiting quantities of just injections, or just inhalers or jus sprays. For example, two years ago my insurance would not cover a bunch of injections; but they would allow a few, along with a few tablets, along with a few nasal sprays within the one month timeframe. Any links, personal experiences or ideas to share?
Gregg in Las Vegas

Title: Re: Imitrex half-lives?
Post by jcmquix on Aug 19^th, 2005, 9:52pm

Hey LasVegas..

Glad to see that you are getting some PF time.. and all the tips that you have gathered have helped you through some rough time.

I have basically been staying with the TREX inj, divided into 3 shots, I try to still follow the recommendations.. Do not exceed 12mg in 24 hrs, when I was going over that, I was getting what I call a rebound HA... Some people here call them something else...

But I was told by a few Veterns & my Dr, Do Not Mix the Pills, Nasal and/or Inj...They are at different Med Volumes, If this makes any sense. They each work differently in your system and they each take different amounts of time to go through you system...

I also recommend that you try the Melatonin, if you have not. I have been off all the TREX for over 2 weeks now. The Melatonin, you take at night before you go to bed. I take 9mg (Have been since the 2nd week of June) It took about 4 days to start working, but it made a huge difference in my cycle and the night time hits.
I was getting Kip 9-10 hits, after about 1week of using the Melatonin, I was still getting some hits, but they were weaker and less frequent. PM me for more information on thois, or check some of the threads.

Also go for the O2, this also made a huge difference in the TREX usage. The O2 is pretty Cheap. It takes a little practice, but I got the hang of it in about a week. I was using the TREX and the O2, but I learned to try the O2 first, then a last resort use the TREX.

Its just after you use the TREX for a few weeks, you really start feeling like crap. Try to alternate the abortive meds in my opinion, they seem to work better and you use less of them to abort an attack.

PFDAN's to You...
Charlie

Title: Re: Imitrex half-lives?
Post by purpleydog on Aug 20^th, 2005, 9:22am

This is the way I've always been told to take the trex.

6mg injections: a total of 12 mg in 24 hours

20 mg nasal spray: a total of two nasal sprays in 24 hours

50 mg pills: a total of 2 pills, or 100 mg in 24 hours

100 mg pills: a total of 200 mg, or 2 pills in 24 hours

Two different neuro's I had suggested taking the 100 mg pills, and splitting them, then I could use 4 in 24 hours. Doesn't really make sense, compared to the 50 mg pills, and I've been over my limit before on all of these.

I split the vials I get now into 3 shots, and it works just fine for me. I can take up to 6 shots per day that way. Sometimes I have to.

I have also used shots and nasal spray in the same day, but I don't use the pills anymore. My neuro told me if I were to use a 50 mg tablet, and a nasal spray, or a 50 mg tablet and a 6 mg shot in the same time period, it would be fine.

Title: Re: Imitrex half-lives?
Post by LasVegas on Aug 20^th, 2005, 2:06pm

Interesting, thanks for the replies

Title: Re: Imitrex half-lives?
Post by docblondie on Aug 20^th, 2005, 10:24pm

Hey Vegas,

Not that this is the norm,
But my 37 year old self has used up to 11 full 6mg imitrex shots in a week and I am still here. Sometimes 3, 6mg shots in one day. Not that it is reccommended, but I took the chance and nothing happened- now I know this is not a safe dose, but if you check the emergency room docs. They may tell you up to 300mgs. before an overdose is suspected. Give them a call and talk to them- I had to call once in fear that I took too much- (the three shot day) I called 911, and they followed their protocol of 300mgs before overdose- That's a lot of imitrex! Call and check.
Try your best to split the shots in threes- the least you can put in your bod- the best!
~Chris

Title: Re: Imitrex half-lives?
Post by Svenn on Aug 21^st, 2005, 4:19pm

on 08/20/05 at 09:22:55, purpleydog wrote:

I have asked my neuro and Professor Inge Monstad about this.

This is for the migrainers he said,NOT YOU CLUSTERHEADS he gave as a reply

You clusterheads need to take what you need to get a "normal life"

The last couple of years we have found out "start to believe" that the triptans is not as bad for the heart as first expected he said.

Another Dr at the competence-senter for headaches here tells me that he has a clusterhead for patients that he prescibe 14 FORTEEN shots of trex DAILY

Hopefully not many of us uses that amount.
I use up to 8 shots a day so i can get what someone will call a normal life.

We are talking the full 6ML shots here

Svenn

Title: Re: Imitrex half-lives?
Post by unsolved1 on Aug 21^st, 2005, 4:43pm

I agree with what Svenn said above... a clusterhead has to take it when they need it. I've used between 2 - 8 shots a day for years now. My (local) neuro said basically the same thing, use it when you need it. It's not any limits I'm worried about, it's the headaches!!

UNsolved

Title: Re: Imitrex half-lives?
Post by LasVegas on Aug 21^st, 2005, 5:13pm

Thanks again for the replies.....but my question reeally is I guess not understood.....suppose you have a few inhalers, a few shots and a few pills....each has it's own dosage....inj 6mg, inhaler 20mg, tabs 50/100mg....so curious if yu did need to mix within a 24 hr period what is safe? The answer might be based on weight, or diet or other factos to be specific, however there must be some kind of guideline to mix the 3 of these within a 24 hr period!? Maybe i'll ask Glaxo

Title: Re: Imitrex half-lives?
Post by Svenn on Aug 21^st, 2005, 6:52pm

Well then, all i can say as we all should know then is:

NEVER MIX ANY TRIPTANS!!!!!!!!!!!!

Beside that om only refering to what my neuro told me

Svenn

My advice is to lissen to your doc

Title: Re: Imitrex half-lives?
Post by pinksharkmark on Aug 24^th, 2005, 12:05pm

Hell, I always used however much I needed. There were stretches at the peak of some cycles where I would eat as many as five 100 mg tablets per day. My neuro was okay with that. He said he had patients who used more than that for even longer stretches than I did.

But to answer your question --

I think it would be logical to presume you could get away with whatever totals up to the recommended maximum, regardless of the form of delivery. By that I mean something like:

Tablets are supposed to max out at 200 mg per day. So at 6:00 am you take half of 100 mg tablet (50 mg), at noon you take the other half (50 mg). You are now at 50% of the maximum "recommended" total of Imitrex for that 24 period. I honestly can't see why you couldn't then (for example) choose to expend your the other half of your remaining daily allowance as, say, two 3 mg injections. Or as one more 50 mg oral and one 3 mg injection.

pinky

Title: Re: Imitrex half-lives?
Post by Bob P on Aug 24^th, 2005, 12:13pm

I think rather than mess with the actual measurements, you just look at it as "doses". Glaxo says 2 doses per day.

So 1 inhaler and 2 half injections is ok. 1 injection and 1 tablet, etc.

I always seem to come back to this study though:

Quote:

Sumatriptan overuse in episodic cluster headache: lack of adverse events, rebound syndromes, drug dependence and tachyphylaxis.

Centonze V, Bassi A, Causarano V, Dalfino L, Cassiano MA, Centonze A, Fabbri L, Albano O.

Dept of Internal Medicine and Public Medicine, University of Bari, Italy.

This observational study was designed to examine the pattern of sumatriptan use in patients with cluster headache using more than the recommended daily dose of subcutaneously injected (s.c.) sumatriptan. Thirteen patients suffering from episodic cluster headache were asked to record the characteristics of their attacks and drug intake for 1 year. All reported a high daily frequency of attacks (more than 3 per day) and the related overuse of s.c. sumatriptan. The results show that the overall incidence of adverse events among patients receiving sumatriptan injections for the treatment of cluster headache is low. The extended administration of this drug in episodic cluster headache did not result in tolerance problems or tachyphylaxis. Only 4 patients experienced minor adverse events and recovered more slowly than the others. They suffered from migraine without aura and cluster headache, and showed a family history of migraine. Even though they must be viewed with caution, due to the observational nature of the study and the low number of patients included, these results suggest that the profile of sumatriptan may differ in cluster headache compared with migraine.

Hi Mark.

Title: Re: Imitrex half-lives?
Post by pinksharkmark on Aug 24^th, 2005, 12:20pm

As for mixing triptans, I'd never tell anyone to go against the advice of their neurologist. But I will tell you what MY neurologist has to say on the subject:

He says the reason all the triptan manufacturers give this warning is that they are afraid someone will reason as follows:

"I'm allowed to use up to 200 mg of oral Imtrex per day. So far today I've used 150 mg. But the day is just half over and I'm getting hit again. So I'll switch over to Maxalt. I've used no Maxalt at all today, so I can still take the whole daily allowance of 20 mg of Maxalt if I have to."

This reasoning is faulty, because by the time the person in question has applied this reasoning, he is already at 75% of his "maximum" triptan intake for the day. If he then takes 100% of Maxalt's recommended maximum, he'll be at 175% of his daily recommended triptan intake.

As I indicated in my previous post, my neuro is less worried about "overdosing" on triptans than the neuros of others whom I see posting here. He is even less worried about the second-generation triptans (Maxalt, Zomig) than he is about Imitrex. He says the second-generation triptans are much more specifically "targeted" (this is why their dosage levels are so much smaller than oral Imitrex -- just 2 mg for Zomig, for example) and have far less peripheral effects on the heart than does Imitrex.

So my neuro (while he doesn't advocate switching back and forth between say Maxalt and Zomig several times a day) is not especially concerned with mixing more than one triptan in a 24 hour period. As he says, "If you find Maxalt isn't working as well for you as Zomig was, why on earth should I tell you to stop taking Maxalt for 24 hours and let you get whacked four or five times before you can take your next Zomig? I won't tell you to do that."

Again, I repeat that I provide this as information only. I do not advocate you blithely ignore advice of your own neuro. I provide the information only to show that not every neuro thinks identically on the matter.

pinky

Title: Re: Imitrex half-lives?
Post by LasVegas on Aug 26^th, 2005, 1:25am

Good replies, thanks guys, let's keep this going, any other research or studies to share?