Medications

15 December 2014

Topiramate + Nortriptyline (and another reason why treatment is not simple)

James Discoveries & Stats, Medications, Treatments 1

We’ve talked about nortriptyline, an antidepressant commonly prescribed for chronic pain, and topiramate, an anticonvulsant often used for migraine in particular, in the past. As you can see from the comments people leave here, both have been a wonderful help – or haven’t been so great – depending on the patient.

It’s not unusual for someone to try one or the other, discover that they’re still having migraine attacks, and drop the medication permanently. But that may not always be the best option.

A study published in the Journal of Headache and Pain in 2010 tested both of these medications together as a migraine treatment.

Researchers started with patients that had experienced less than 50% reduction in symptoms with either topiramate (Topamax) or nortriptyline after trying either one for eight weeks. 78.3% of the patients improved more when taking both together than when taking just one.

It is not unusual for a combination of treatments to be better – sometimes drastically better – than one or the other. This is just another example.

When your doctor suggests you retry something you’ve already tried – but this time with something else, whether it be a supplement or drug or other type of treatment, don’t brush the idea aside quickly (even if the drug didn’t work in the past at all).

On the other hand, be very cautious if you have experienced significant side effects in the past. For example, when it comes to topiramate watch out for heart palpitations or chest pain, visual changes, weakness, confusion, or a loss of appetite. For nortriptyline, common things to watch for are depression, trouble breathing, seizures, fever, fatigue or weakness.

And remember, never change your dosage without checking with your doctor.

Thanks to:

8 December 2014

OptiNose for Migraine: Not Approved Yet

James Medications, News, Treatments 0

Last month the FDA announced that they would not (yet) approve a new migraine nasal spray, known as AVP-825 from OptiNose.

We’ve talked about this new delivery system for sumatriptan in the past (see OptiNose: In Search of a Better Nasal Spray). AVP-825 is a unique delivery system that delivers the medication (sumatriptan powder) quickly an effectively. For reasons of economy and health, it’s important to get all of the medication where it needs to go in your body as soon as possible.

OptiNose The phase III trials demonstrated that the medication and delivery system work, providing relief as early as 15-30 minutes after use, with most patients finding relief and nearly 20% completely free of migraine symptoms at 1 hour.

So what was the problem? Why did the FDA reject the medication?

“Human factors”. In other words, is the treatment easy enough to use so that us humans won’t mess it up.

Hopefully this will be a simple question to answer. Avanir Pharmaceuticals Inc. will be conducting a new trial with real humans, and hopes to respond to the FDA before the middle of next year.

For more information:

4 December 2014

The “Revolution” in Migraine Treatment (Dr. Peter Goadsby)

James Medications, News 2

Last month the American Headache Society had their annual symposium in Arizona, USA. There was a lot of discussion about the new treatments coming down the pipe to fight migraine.

Dr. Peter Goadsby from the University of California did a brief interview which you can see here. But here is a quick summary of some of the things that he said. It’s worth while taking a look, because Dr. Goadsby did give an excellent summary about some of the new migraine treatments that are now being tested.

What follows is a summary of the interview…

The Problem

Today we have various treatments for migraine, most of which were not developed specifically for migraine. We’re not sure why many of them work, and patients must struggle with a number of side effects. “It’s a really awful mishmash of things that we have to offer.”

What’s Coming

There are some very exciting treatments that are being developed. The two that the interview focused on are related to CGRP (calcitonin gene-related peptide neurotransmitter).

Now the exciting thing about both of these is that they are working well in various trials. In fact, some people taking these are going a long time with no migraine attacks whatsoever.

How does this work?

The treatments use monoclonal antibodies directed against the CGRP. (Note: these are antibodies created in the lab for a specific purpose. Monoclonal antibodies are also being used in cancer treatment.)

One question is just how to best deliver the antibodies to have the maximum effect.

A big question is – why do these medications work so well (“spectacularly well”, said Dr. Goadsby more than once) for certain patients? If we can figure that out, we could “deliver personalized, highly effective treatments that are well tolerated to a group of people who are otherwise horribly disabled“.

Dr. Goadsby thinks that the clue will probably be found in a genetic marker. If we can find better personalized treatments, we will help patients, doctors, and society as a whole.

When is it going to happen?

Dr. Goadsby was reluctant to make a prediction, but he finally said,“I’m going to predict that in five years or so we will be using these medicines in clinical practice and they will revolutionize practice.”

Click the image below to go to the interview.

via The Daily Headache

17 November 2014

Unique Migraine Nasal Spray: We’re still waiting

James Medications, News 4

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.

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

14 November 2014

ZECUITY: New Migraine Treatment Coming Soon…

James Medications, News 2

An old and yet brand new migraine treatment is about to be released – the ZECUITY migraine iontophoretic transdermal system (TDS)!

ZECUITY has gone through a lot of changes. It was formerly called the Zelrix Migraine Patch, and it was developed by NuPaths. It was approved this past January. Earlier this year, NuPathe was acquired by Teva Pharmaceutical Industries, a company based in Israel.

Through all this change, ZECUITY has survived. Teva has talked about launching new migraine treatment on the market this year, although the rumour now is that it may not be available to consumers until 2015.

ZECUITY is new and old because the medication is sumatriptan, an early migraine medication. But the delivery method is all new, and for some patients that makes the difference between a drug that doesn’t work and a drug that does.

Dr. Deborah E. Tepper from the Cleveland Clinic describes it this way:

The sumatriptan patch consists of a single-use patch that comes in a foil packet. After tabs are pulled to expose a small well of sumatriptan and another well of salt solution, these areas are each rubbed to release the two compounds. The patch is placed on the upper arm or thigh, in an area where there are no tattoos or skin irritation. A tiny battery embedded in the patch is then turned on by pushing a button. A red light comes on, indicating the patch is activated.
[Source]

When the medicine has all been delivered into your system, the light goes off. Easy as that.

The beauty of this approach is that it bypasses the stomach and gets into your system a lot faster, which may make all the difference. It also means no needles, for those who have been using, or have tried to use, injections.

If the patch is successful, we will likely see more migraine meds coming out with a similar delivery system.

If you’re in the USA and would like to get news directly from the source when ZECUITY is available, you can sign up right here.