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Headache
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Stephen Silberstein, Shuhan Zhu
The triptans are 5-HT IB/ID receptor agonists effective in treating migraine headache and the accompanying symptoms of photosensitivity, nausea, and vomiting. The data obtained from close to 20 years of prospective monitoring of pregnancies exposed to sumatriptan and naratriptan have not shown a substantial increase in the risk of all major birth defects. However, the size of the registry is currently insufficient to evaluate the risk of specific defects or to permit definitive conclusions of the risks associated with sumatriptan or naratriptan [28]. The triptan class is category C, and is not recommended for use in pregnancy. Nevertheless, on the basis of the pregnancy registry, if a patient has unwittingly taken sumatriptan prior to knowledge of her pregnancy, reassurance is appropriate given the lack of teratogenicity of this drug. It is not known whether this positive outcome may also be extrapolated to other medications in the triptan class.
Substrates of Human CYP2D6
Published in Shufeng Zhou, Cytochrome P450 2D6, 2018
CYP2D6 plays an important role in the metabolism of many indolealkylamines agents, which are 5-hydroxytryptamine (5-HT/serotonin) analogs that mainly act on the serotonin system (Yu 2008). Structurally, this group of compounds contains an indole moiety and a basic nitrogen atom, which are connected by an alkyl chain usually of two carbons in length. They mainly act on the 5-HT receptors, and some indolealkylamines such as ergotamine and a series of triptans including sumatriptan, zolmitriptan, naratriptan, almotriptan, frovatriptan, and rizatriptan have been developed for the clinical treatment of migraine (Saper and Silberstein 2006). However, many other indolealkylamine agents are widely abused compounds in developed countries although some have demonstrated therapeutic potential in psychopharmacotherapy. These include the notorious lysergic acid amides such as D-lysergic acid diethylamide and ergine; tryptamine derivatives such as psilocybin (O-phosphoryl-4-hydroxy-N,N-dimethyltryptamine), N,N-dimethyltryptamine (DMT), bufotenine (5-hydroxy-dimethyltryptamine), 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT), and 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT, “Foxy,” or “Foxy Methoxy”); and β-carbolines such as harman, harmaline, harmine, and ibogaine (Yu 2008). All these compounds produce hallucinogenic and stimulant activities and high doses of administration will cause mydriasis, nausea, jaw clenching, and overt hallucinations with auditory and visual distortions.
Migraine: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Oral sumatriptan (25 mg tid) was used 2–3 days before the expected headache onset and continued for a total of 5 days in an open-label study of 20 women with menstrual migraine.142 In 126 sumatriptan-treated cycles, headache was absent in 52.4% of subjects and reduced in severity by 50% or greater in 42%. Breakthrough headaches were rare and significantly reduced in severity compared with the baseline headaches. Naratriptan, which has a longer half-life than sumatriptan, is currently in placebo-controlled, double-blind trials for short-term perimenstrual prophylaxis of menstrual migraine.142
Predicting initiation of preventive migraine medications: exploratory study in a large U.S. medical claims database
Published in Current Medical Research and Opinion, 2020
Janet H. Ford, Krista Schroeder, Dawn C. Buse, Shivang Joshi, Steven Gelwicks, Shonda A. Foster, Sheena K. Aurora
All patients receiving Medicaid assistance were excluded due to the heterogeneity of the patient population and a notably different health services and reimbursement structure compared with commercial providers. Patients with claims for human immunodeficiency virus infection or cancer from 1-year pre-migraine diagnosis date to 1-year post-migraine diagnosis date were not included in this study. Patients with an ICD-9 code for a non-migraine disease treated by that PMM class (i.e. received an anti-epileptic/antihypertensive/beta-blocker/antidepressant drug during the 1-year post-migraine diagnosis AND received an epilepsy/hypertension/congestive heart failure/depression diagnosis in the 1 year before receiving the specific drug class) were also excluded. In addition, patients with a claim for any PMM without proven efficacy (Level C) per the treatment guidelines during the 1-year post-migraine diagnosis date period were excluded in an effort to increase the validity of medication use specific to treating migraine9,11. Finally, patients prescribed naratriptan and zolmitriptan (drugs only recommended for short-term use associated with menstrual headache) were also excluded.
Menstrual migraine: a review of current and developing pharmacotherapies for women
Published in Expert Opinion on Pharmacotherapy, 2018
G. Allais, Giulia Chiarle, Silvia Sinigaglia, Chiara Benedetto
Only one RCT [60] has investigated naratriptan (2.5 mg) for the treatment of acute MRM, defined as migraine attack occurring during the PMW of days −2/+4 in 229 women. Pain free at 4 h was achieved in 58% of drug-treated patients and 30% of controls. Significant differences in total pain relief at 2 h (p = 0.004) and sustained pain free at 24 h (p < 0.001) were noted for naratriptan also when evaluated for the absence of associated symptoms at 2 and 4 h (p = 0.004). Only three drug-related adverse events (AE) were recorded. The data are insufficient to recommend or not this triptan for acute treatment of MM attacks.
Pharmacological strategies to treat attacks of episodic migraine in adults
Published in Expert Opinion on Pharmacotherapy, 2021
It should in spontaneous migraine attacks be investigated in controlled trials whether other triptans than naratriptan, given by injection, can also reach an almost maximum effect. If this is the case for a triptan it should be developed either as a subcutaneous injection or as an administration with similar pharmacokinetics.