Don't worry.....


Title: Triptan safety--latest statement
Post by Bob_Johnson on Jun 1st, 2004, 9:47am
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Since this is a report on medications and not on the condition being treated, I believe it would be O.K. to apply these findings to folks with Cluster. NOTE: there are no comments about using triptans at the high/multiple dosing which is often done by cluster patients. (Treat everything below the line as a quotation. These are selected para. from the total report.)
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Consensus Statement: Cardiovascular Safety Profile of Triptans (5-HT1B/1D Agonists) in the Acute Treatment of Migraine

Headache 44(5):414-425, 2004.

Posted 05/25/2004
Abstract
Background: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan-associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine.
Objective: To summarize the evidence reviewed by the Triptan Cardiovascular Safety Expert Panel and their recommendations for the use of triptans in clinical practice.
Participants: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology.
Evidence and Consensus Process: An exhaustive search of the relevant published literature was reviewed by each panel member in preparation for an open roundtable meeting. Pertinent issues (eg, cardiovascular pharmacology of triptans, epidemiology of cardiovascular disease, cardiovascular risk assessment, migraine) were presented as a prelude to group discussion and formulation of consensus conclusions and recommendations. Follow-up meetings were held by telephone.
Conclusions: (1) Most of the data on triptans are derived from patients without known coronary artery disease. (2) Chest symptoms occurring during use of triptans are generally nonserious and are not explained by ischemia. (3) The incidence of serious cardiovascular events with triptans in both clinical trials and clinical practice appears to be extremely low. (4) The cardiovascular risk-benefit profile of triptans favors their use in the absence of contraindications.

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These data should be interpreted in view of characteristics of the patient population in migraine clinical trials. Generally, controlled clinical trials with triptans excluded patients with cardiovascular risk factors including known ischemic heart disease, symptoms or signs consistent with ischemic heart disease, cardiac arrhythmias requiring medication, and supine diastolic blood pressure >95 mm Hg and/or systolic blood pressure >160 mm Hg. Thus, the clinical trials data cannot be generalized to migraine sufferers with cardiovascular risk factors.

Triptans are associated with a modestly elevated incidence of chest symptoms (ie, triptan sensations) relative to placebo in well-controlled clinical trials that excluded patients with significant cardiac risk factors or known ischemic heart disease. The chest symptoms in clinical trials were generally transient, mild, and nonserious.

Given the widespread use of triptans, the risk of serious cardiovascular adverse events during postmarketing surveillance appears to be very low. While the risk of a serious cardiovascular event during triptan use appears to be very small, it cannot be dismissed. Serious cardiovascular events, some of which resulted in death, have been reported in association with triptans during postmarketing surveillance. The causal association of triptan use with serious cardiovascular adverse events is difficult to determine based on the postmarketing surveillance data alone.

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Headache. 2004 May;44(5):414-25.Related Articles, Links
Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine.

Dodick D, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A, Loutfi H, Welch KM, Goadsby PJ, Hahn S, Hutchinson S, Matchar D, Silberstein S, Smith TR, Purdy RA, Saiers J; Triptan Cardiovascular Safety Expert Panel.

Department of Neurology, Mayo Clinic Scottsdale, AZ 85259, USA.

BACKGROUND: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan-associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine. OBJECTIVE: To summarize the evidence reviewed by the Triptan Cardiovascular Safety Expert Panel and their recommendations for the use of triptans in clinical practice. PARTICIPANTS: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology. EVIDENCE AND CONSENSUS PROCESS: An exhaustive search of the relevant published literature was reviewed by each panel member in preparation for an open roundtable meeting. Pertinent issues (eg, cardiovascular pharmacology of triptans, epidemiology of cardiovascular disease, cardiovascular risk assessment, migraine) were presented as a prelude to group discussion and formulation of consensus conclusions and recommendations. Follow-up meetings were held by telephone. CONCLUSIONS: (1) MOST OF THE DATA ON TRIPTANS ARE DERIVED FROM PATIENTS WITHOUT KNOWN CORONARY ARTERY DISEASE. (2) CHEST SYMPTOMS OCCURRING DURING USE OF TRIPTANS ARE GENERALLY NONSERIOUS AND ARE NOT EXPLAINED BY ISCHEMIA. (3) THE INCIDENCE OF SERIOUS CARDIOVASCULAR EVENTS WITH TRIPTANS IN BOTH CLINICAL TRIALS AND CLINICAL PRACTICE APPEARS TO BE EXTREMELY LOW. (4) THE CARDIOVASCULAR RISK-BENEFIT PROFILE OF TRIPTANS FAVORS THEIR USE IN THE ABSENCE OF CONTRAINDICATIONS.

Publication Types:
Consensus Development Conference
Research Support, Non-U.S. Gov't
Review

PMID: 15147249 [PubMed - indexed for MEDLINE]
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Triptan Use Not Linked With Increased Ischemic Events




NEW YORK (Reuters Health) Aug 04 - Triptan use is not associated with an increased risk of any ischemic events in migraineurs, according to a report published in the July/August issue of Headache.

"It has been speculated that the use of triptans or ergot alkaloid drugs might increase risk of ischemic events through vasoconstriction," Dr. Priscilla Velentgas of Ingenix Epidemiology, Auburndale, Massachusetts, and colleagues at Pfizer Inc. write.

To investigate, the team matched a retrospective cohort of 130,411 migraineurs with 130,411 nonmigraineurs who were members of UnitedHealthcare between 1995 and 1999.

Both migraineurs and nonmigraineurs had rates of myocardial infarction of about 1.4 per 1000 person-years.

Compared with nonmigraineurs, those with migraine were 67% more likely to have a stroke during follow-up. Migraineurs also had higher rates of unstable angina and transient ischemic attacks.

However, the risk of myocardial infarction or stroke did not increase with current or recent triptan use.

Current ergot alkaloids user were more likely to have a stroke or serious ventricular arrhythmia than other migraineurs although the relationship was not significant, the researcher note. No associations were seen between current ergot alkaloid use and risk of unstable angina or transient ischemic attack.

The study was supported by a contract between Pfizer and Ingenix Epidemiology.

Headache 2004;44:642-651.

Which triptans are you taking?  Imitrex is pretty tough on the ol' ticker.  Zomig and Amerge (zolmatriptan and naratriptan respectively) are a lot less hard on the heart.

I had a similar problem after using Maxalt Melt, getting heart palpitations which ended up with an overnight stay in hospital. So I'm avoiding using any of the triptans. Luckily oxygen works wonders for me!

I'm with Dennis, I'll use trex only as a last resort. Thanks to 02, that's almost never!

Joe

From what I am hearing, it sounds worth my time to try to get a much higher flow rate on the tank.  8 L just doesn't cut it on the tough ones.  I would LOVE to never need the triptans, but until I get back to my doc here in a couple of months I'll just live with them because they do work.  Thank you all!  I've learned much more in 3 days than I have in 3 years!