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Microwave as a Greener Alternative in the Synthesis of Organic Compounds
Published in Ahindra Nag, Greener Synthesis of Organic Compounds, Drugs and Natural Products, 2022
The indole structure represents an essential structural moiety in drug discovery. In recent years, many synthetic pathways leading to indole derivatives have been developed. On the other hand, 3-substituted indoles are common components of drugs and are generally found to be of pharmaceutical interest in a variety of therapeutic areas.36 This basic skeleton is present in the essential amino acid tryptophan and the key neurotransmitter serotonin. Additionally, this heterocycle is present in several commercial drugs of the triptan family that were developed for the treatment of migraine headaches, for example, frovatriptan, zolmitriptan and sumatriptan (Figure 4.4). Other well-known drugs such as the antibiotic indolmycin and the NSAID Indomethacin also have an indole moiety.37
Vestibular and Related Oculomotor Disorders
Published in Anthony N. Nicholson, The Neurosciences and the Practice of Aviation Medicine, 2017
Nicholas J. Cutfield, Adolfo M. Bronstein
Some patients with a prominent headache respond to symptomatic treatment such as simple analgesics, with or without antiemetics or triptans. However, this has not been well validated for migrainous vertigo. In many cases, the vertigo develops too quickly to be easily terminated with symptomatic treatment, and the frequency of attacks can warrant daily prophylactic treatment. The initial choice depends on the side-effect profile of the drug for the individual. Beta blockers can cause hypotension and erectile dysfunction and can trigger bronchial spasm in susceptible individuals. Tricyclic antidepressants can induce sedation and a dry mouth, and sandomigran can increase appetite and lead to weight gain. Any drug needs to be assessed for at least four to six weeks before being withdrawn on the grounds of lack of efficacy. Typical regimes are given below, but if these treatments are not tolerated or are ineffective, an anticonvulsant such as topiramate can be considered, though it carries the risk of sedation and weight loss.
Device profile of the Nerivio™ for acute migraine treatment: overview of its efficacy and safety
Published in Expert Review of Medical Devices, 2019
The efficacy of REN is clinically meaningful as it seems higher than that of available devices for the acute treatment of migraine, though not in head-to-head studies, and is similar to acute migraine pharmacological treatments in the same patients. Though not compared in head to head trials, the efficacy of REN also seems superior to emerging pharmacological acute treatments including gepants and ditans, which do not constrict cranial arteries as triptans, but their clinical benefit is limited [29,30]. Overall, the efficacy of REN suggests that it may offer an effective alternative for the acute treatment of migraine and should be suitable for first line treatment for some patients. Specifically, REN may offer a valuable treatment option for people who are unable to take or do not tolerate migraine medications and for those who do not respond well to current acute migraine specific medications. REN can be used with other acute care treatments, but this needs more careful study. The non-pharmacological nature of REN alleviates the adverse events and medical risks associated with some current migraine pharmacological treatments. For example, triptans, which are the treatment of choice for acute migraine, have been associated with up to 20% incidence rate of side effects includes tingling, paresthesia, warm sensations, and flushing. Of more importance are the less frequent central nervous system (CNS) AEs’ (asthenia, abnormal dreams, agitation, aphasia, ataxia, confusion, dizziness, somnolence, speech disorder, thinking abnormal, tremor, vertigo, and other focal neurological symptoms) and notably the ‘chest‐related AEs’ (chest pressure, chest pain, radiating pain in arm, other chest feelings, heavy arms, shortness of breath, palpitations, and anxiety) [31]. Side-effects may reduce patient compliance, limit treatment initiation and impair workplace productivity and effectiveness [32]. Therefore, side effects remain a barrier to effective migraine management. REN may overcome this barrier as its safety and tolerability profiles are favorable.