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Neurological problems
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
There are few data regarding pizotifen (Sanomigran®), a serotonin antagonist used for the prevention of migraine outside pregnancy, but its use is justified after the first trimester if first- and second-line prophylactic agents are not effective.
Common problems in pregnancy
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
Prophylactic treatment is rarely indicated during pregnancy and should be reserved for women with long-lasting or frequent attacks where standard treatment approaches are not sufficiently effective.41 Prophylaxis should not be used in the first trimester as there is inadequate evidence of safety; in later stages, a beta-blocker or pizotifen are possible options.
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
Pizotifen is a benzocycloheptathiophene derivative that is structurally similar to cyproheptadine and the TCAs. It has a long elimination half-life (about 23 hours) and can be given as a single evening dose. Pizotifen is a 5-HT2 and histamine-1 antagonist with the side-effects of drowsiness and increased appetite with associated weight gain. Pizotifen has proven effective in controlled117 and placebo–controlled118–120 trials. In an open trial, it was less effective than methysergide121 but more effective than placebo. In another placebo–controlled trial, it was as effective as naproxen sodium, and both were more effective than placebo. Pizotifen (2–3 mg) daily was as effective as fiunarazine 10 mg daily. Pizotifen is often used for adolescent migraineurs at doses of 0.5–1.5 mg daily. Adults, in contrast, may require up to 3 mg daily. Pizotifen has no interaction with specific antimigraine compounds, such as ergotamine or the triptans. Pizotifen is not available in the USA.
Cluster headache therapies: pharmacology and mode of action
Published in Expert Review of Clinical Pharmacology, 2020
Jasper Mecklenburg, Margarita Sanchez Del Rio, Uwe Reuter
The chemical structure of pizotifen is similar to the structure of tricyclic antidepressants [147]. The mode of action is derived from the observation that pizotifen exerts a strong central anti-serotonergic activity and probably mimics rather than antagonizes the vasoconstrictive effects of serotonin [147].
Predicting quality of life outcomes in children with migraine
Published in Expert Review of Neurotherapeutics, 2022
Adherence to migraine preventive treatment can be enhanced if the medication is given as a single daily dose in an easy to swallow preparation. Initial adverse effects of pizotifen, amitriptyline and topiramate such as sleepiness can be lessened if the medication is given as a single dose in the evening.