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Prochlorperazine

Nasal Spray: Still Waiting.

Unique Migraine Nasal Spray: We’re still waiting

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Back in 2008 we talked about some unique nasal sprays that were being tested for migraine treatment.  One of these was AZ-001, a nasal spray using the drug prochlorperazine.

Nasal Spray: Still Waiting.
Photo courtesy of robin_24

I’m not sure if that specific version is being actively developed by Alexza Pharmaceuticals or not, but the concept is still being researched.  Dr. Venkata Yellepeddi from Roseman University of Health Sciences has developed a nasal spray based on prochlorperazine.  Here’s what he had to say:

Prochloperazine is a dopamine receptor antagonist that is widely used as an anti-nausea medication.  Comparative clinical studies have shown that prochloperazine provides better pain relief than other anti-migraine drugs such as sumatriptan, metoclopramide, and ketorolac.  Currently, there are no marketed nasal spray formulations of prochlorperazine available for the treatment of migraine.  Prochlorperazine is only available in tablet form, which has delayed onset of action.

Prochlorperazine is already used for migraine, and is especially useful for migraine with nausea.  It’s also used for severe nausea from other causes, and in some cases as a antipsychotic.  It’s sold under brand names such as Compazine, , and Buccastem among others.

Nasal sprays are useful for a number of reasons.  For one thing, by bypassing the gut they are more useful for patients with nausea.  A more precise amount of medication will get into your system, and will be available faster.

Dr. Yellepeddi has also created a nasal spray with no preservatives, which may cause problems in some patients.  The formulation seems to be stable, but unfortunately testing is still in the early stages.  We may have to wait several more years before this one is available.

For more, read the press release from the American Association of Pharmaceutical Scientists:  First-in-class nasal spray demonstrates promise for migraine pain relief

Being tested: Inhaler for migraine

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The last thing a migraine patient needs is to be poked with more needles.  But research is slowly making more options available.  One of the methods that is actively being tested is an inhalation system.

Alexza Pharmaceuticals is working on a system they call Staccato.  The device is the size of a small cell phone.  Inside is a surface that has been sprayed with the needed drug.  When they patient breathes into the device, a reaction is triggered and the drug is vaporized, entering the lungs.  It’s quickly absorbed – and that speed is what migraine patients need.

There are some drugs already in use (such as ZOMIG nasal spray) that are inhaled.  One problem with the traditional systems, according to Alexza, is that it’s hard to get the exact right dosage.  As a result, other ingredients are added to get the right rate of flow.  Staccato should avoid this problem, and also get the drug into your system faster than the traditional inhalation techniques.

Much of the focus of the project has been on drugs related to mental health.  However, there is interest in drugs that can be used for migraine as well.  Two of the drugs now being tested fit into this category:  prochlorperazine and loxapine.

Prochlorperazine has actually been used in emergency rooms for migraine for a number of years.  It’s especially valued for fighting nausea.  For mental health it’s used as an antipsychotic.  Its brand names include Phenotil, Compazine, Buccastem and Stemetil.

Less used for migraine is loxapine, sold as Loxitane and Loxapac.  Also an antipsychotic, it’s prescribed for schizophrenia.  There is hope that it may be useful for some migraineurs as well.

Alexza is optimistic that both of these drugs may be able to replace triptan drugs in patients that can’t take them or don’t find them useful.

Both these drugs are in phase 2 of trial with Staccato and are soon to head into the last phase.

We’ll keep a watch on these new technologies.  Anything needle-free is great for migraine – especially if it gets the medication into your system faster.

Other needle-free options being tested

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