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Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Sumatriptan (Imitrex) is a selective 5-hydroxytryptamine receptor agonist. It is used primarily as acute therapy for migraine headaches. The frequency of birth defects was not increased among 658 infants born to women who used sumatriptan during the first trimester (Kallen and Lynger, 2001). Among 479 first-trimester exposures to sumatriptan, the frequency of major birth defects was not increased (Cunnington et al., 2009). According to the manufacturer’s registry, 52 infants born after first trimester exposure did not have an increased frequency of birth defects (Sumatriptan Registry, 2009). Sumatriptan has been shown to cause birth defects in rabbits, but it was not teratogenic in rats. Sumatriptan was shown to cross the placenta by passive transport in the ex vivo isolated perfused cotyledon technique (Schenker et al., 1995). Under the old FDA classification system, it is a category C agent. However, available data suggest the drug is safe for use during pregnancy (Table 8.2). Other triptans include naratriptan, almotriptan, rizatriptan, zolmitriptan. None of these migraine drugs has been adequately studied during pregnancy.
Miscellaneous
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
i – The patient describes a classical migraine that is unilateral with an aura. Typically they last 4 to 72 hours and can be associated with nausea or vomiting. Light, noise and physical activity can aggravate the symptoms. Well-known triggers include red wine, chocolate and cheese. Treatment is usually symptomatic relief with simple analgesics such as paracetamol or non-steroidal anti-inflammatory drugs. Triptans are also used in patients who do not respond to simple analgesia.1
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.
Triptanophobia in migraine: A case-control study on the causes and consequences of the nonuse of triptans in chronic migraine patients
Published in Expert Review of Neurotherapeutics, 2021
Enrique Martínez-Pías, David García-Azorín, Ane Minguez-Olaondo, Javier Trigo, Álvaro Sierra, Marina Ruiz, Ángel L. Guerrero
Triptan nonuse was not justified by a worse efficacy compared with NSAIDs or ergots, presence of contraindications, or an increased frequency of vascular risk factors. Two other explanations seem possible: a worse tolerability profile or treatment expense. Concerning tolerability, frequency of adverse is estimated around 17–41% in ergots [42], 5–28% in NSAIDs and up to 40% in triptans [8,12]. In our sample, adverse events led to triptan discontinuation in 12% of patients. Adverse event profiles differ: NSAIDs typically cause gastrointestinal AE [43], and ergot derivatives cause nausea or vomiting [44]. The most frequent triptan adverse effects are nausea (4–13%), dizziness (2–11%), fatigue (2–14%) and paresthesias (3–11%). Other frequent adverse effects are somnolence (2–10%), chest tightness (2–7%) or vomiting (2–7%) [10,43].
Real-world insights on the management of migraine patients: an Italian nationwide study
Published in Current Medical Research and Opinion, 2019
Elio Agostoni, Piero Barbanti, Fabio Frediani, Gianluca Trifirò, Luigi Burgio, Lisa di Nola, Valeria Pegoraro, Stefania Pulimeno, Mario Cepparulo
Cohort A included all patients with at least one triptan prescription during the selection period. The selection period for Cohort A was defined as November 2015–October 2016. This period allowed having the most updated data (at the time of analysis conduct), whilst also allowing having 12 months of data availability after first triptan prescription for each patient included. For each patient, we considered the date of the first triptan prescription within the selection period as the Index Date. Starting from the Index Date patients were followed up for a 12 month period (i.e. follow-up), where we looked for all triptan prescriptions, as well as for indometacin/caffeine/prochlorperazine (ICP) prescriptions. Triptans are highly effective and well tolerated agents for the treatment of acute migraine attacks, with a convincing body of evidence and scientific rationale supporting their use17. In addition, triptans have the treatment of migraine acute attacks as their only indication. ICP is the most commonly used drug in Italy for the treatment of acute migraine25 and its indications are the treatment of acute migraine attacks and of tension-type headache26. A 6 month period preceding the Index Date was considered for each patient to look for anxiety and depression records. Also, we extracted demographic characteristics at the Index Date (age and gender) and MPT prescriptions (i.e. beta-blockers, calcium-channel blockers, antiepileptics, antidepressants, and antiserotoninergics [i.e. pizotifen] prescribed to treat migraine as specified by the GP) during the entire study period.
Almotriptan: a review of 20 years’ clinical experience
Published in Expert Review of Neurotherapeutics, 2019
Regarding the use of ALT during pregnancy/lactation no specific data appear to have been published and, in line with the summary of product characteristics, caution should therefore be exercised [85]. A recent publication by Spielmann and colleagues evaluated 432 cases of pregnancy in women treated with triptans and found 9 cases of teratogenicity; however, none of these involved ALT [86]. Following a comparison with control groups the authors concluded that triptans cannot be considered major teratogens. In a separate publication involving 353 pregnant Norwegian women, the authors also reported that there was no evidence that triptans increased the risk of teratogenicity [87]. Finally, sporadic reports of pregnancy while using ALT, after approximately 200 million daily doses have been distributed by the manufacturer, again found no evidence of an increased incidence of pregnancy-related adverse events. Indeed, the incidence of teratogenicity was much lower than the baseline rate in the general population. There are no studies available relating to ALT excretion in milk. Since the bioavailability of triptans is low, minimal quantities would be expected to be excreted in the milk and these low amounts are unlikely to cause any adverse effects in breastfeeding infants [88].