Posted by pinksharkmark (64.32.117.33) on January 27, 2002 at 11:19:36:
In Reply to: limit on triptan use? posted by mike on January 27, 2002 at 09:17:25:
...such as they are, are described in the link below. My philosophy is that I will take as much as it takes to keep The Beast at Bay.
I am not a physician myself, but my neuro has no problems subscribing this amount for me. He says he has many other clusterhead patients who exceed the manufacturer's suggested limit (which was established with tests on migraineurs after all, not clusterheads) listed on the insert that accompanies the Imitrex.
He pointed out that the reason the instructions limit the quantity to 200 mg of oral Imitrex in a 24 hour period (400 per day on the instructions that are distributed in Canada) is NOT necessarily because taking more than that is dangerous, but simply because so far no studies have been published where the subjects took more than that amount. Again, remember that all of the manufacturer's clinical studies have been done with migraineurs, and few if any migraineurs will need to take more than 200 mg in a day. Also, few if any get multiple migraines every day for months on end.
There is no data that shows that high doses of Imitrex taken for extended periods is harmful. There is no data that shows it is harmless, either.
There is no "high dose" data, period.
Until there is, the pharmaceutical companies BY LAW must base their maximum recommended doses only on the results of existing studies. The fact that I and hundreds of other clusterheads have routinely exceeded these amounts for years has no weight whatsoever, since our experiences are not part of a rigorous clinical study; they are considered "anecdotal" evidence of no scientific value, and especially of no legal value when it comes to potential lawsuits.
My neuro is of the opinion that the longer-acting triptans are probably better to take for those who have no success with preventatives and must rely solely on triptans for pain relief. The newer-generation triptans such as Zomig and especially Amerge work at much smaller dosage levels (a tenth to a fortieth of the amount of oral Imitrex required) and have a longer half-life than Imitrex. They are also much more narrowly "targeted" than Imitrex, affecting a smaller sub-group of 5-HT receptors. Anyone who has compared Imitrex to Zomig, for example, has noticed that Zomig has much less of a "speedy" feel to it than Imitrex.
pinky