Medications

8 June 2011

The Dangers of NSAIDs (such as ibuprofen) For Heart Attack Victims

James Discoveries & Stats, Medications 1

A new study cautions heart attack victims when it comes to common over the counter medications such as ibuprofen.

It’s not news that taking ibuprofen may increase your risk of high blood pressure, heart disease, and stroke. This is especially a concern to those who are already at a higher risk. And the more ibuprofen you take, the higher your risk becomes.

A new study on NSAIDs (such as ibuprofen) ramps up the discussion for heart attack survivors taking ibuprofen.

The study, published in Circulation: Journal of the American Heart Association, reviewed the cases of 83,675 adults who had had their first heart attack between 1997 and 2006. 42% had been prescribed a NSAID, such as ibuprofen (23%) and diclofenac (13.4%).

The patients who had been prescribed a NSAID after heart attack had a 45% increased risk of another heart attack or death within a week of treatment. That’s not a prescription right after the heart attack, but anytime after the heart attack. In fact, when the prescription was given within 3 months, the risk rose to 55%. (Note – that’s increased risk compared to the other patients, not increased change of heart attack or death!)

The highest risk came with diclofenac (sold under many brand names including Voltaren, Cataflam, Dicloflex, Voltarol, Defenac). The lowest risk (no noticeable risk) came with naproxen.

More studies need to be done, especially since the outlook is so serious. Meanwhile, patients should be extremely cautious about taking NSAIDs anytime after heart attack. Also, you need to talk to your doctor about the risks if your risk of heart disease is already high.

More on this study: Some Painkillers May Be Risky After Heart Attack
Full Ibuprofen Dosage and Risk information here.

6 June 2011

Is Valproic Acid Helpful for Acute Confusional Migraine?

James Discoveries & Stats, Medications 0

Valproic acid, and the related compound divalproex acid (Depakote) are very common migraine preventatives. But their use as abortives – to kill a specific migraine attack – has never been established.

However, some researches still see possibilities, especially in the emergency room.

One case in Israel concerned an adolescent with Acute Confusional Migraine (ACM). This is a rare migraine manifestation in children, generally those ages 5-16. During an attack, the patient becomes confused, and usually agitated. There may be headache before or after this phase of the attack. The full attack usually lasts from 30 minutes to 24 hours. The suggestion has been made that this is a clear link between migraine and epilepsy.

In this particular case, a 12 year old girl with ACM was given valproic acid intravenously 3 hours and 45 minutes into the attack. Within 30 minutes, the girl had recovered fully, and had no symptoms for at least several months.

Another case study, involving a 10 year old girl, involved valproic acid as a preventative (2007).

Further research certainly needs to be done into the use of valproic acid in the emergency room, and especially its use in ACM patients, since there has been very little research done for the treatment of this rare type of migraine.

For the full case report, read Acute Confusional Migraine in an Adolescent: Response to Intravenous Valproate

19 March 2011

Topamax – Kidney Stones and Birth Defects?

James Medications, News 0

One of today’s preventative drugs for migraine Topamax (topiramate) has come under fire lately as the medical community expresses concern about some of its possible side effects.

Coming first in December, a study out of the University of Texas brought up the issue of kidney stones (nephrolithiasis). Patients on topiramate for two years were tested. 10.7% of them had kidney stones with outward symptoms. However, among patients with no history of kidney stones, the CT scan showed that 20% had kidney stones with no symptoms after two years of taking topiramate!

What does that mean? It means that, if you take Topamax for a couple of years, you have a very good chance of developing kidney stones. (read Nephrolithiasis in topiramate users.)

Then, just this month, the FDA in the United States issued a warning that topiramate could cause development of cleft lip and/or cleft palate in newborns. Taking Topamax could double your risk – still a small risk, but quite a jump. This is particularly a concern in the first trimester, but the dangers thereafter are not well understood. We do know that topiramate passes into breast milk.

Another reason for pregnant women to carefully consider the risks before taking Topamax during pregnancy.

Topamax has helped many migraine patients. There’s a reason why it’s frequently prescribed. But we need to remember that it does have risks. Many patients stop taking it because of side effects (and migraine patients may have more Topamax side effects than everyone else). But the fact of the matter is, some side effects are not known right away. There are other treatments that should be tried first, including both drug and non-drug options.

via Warnings about Topamax (topiramate)

19 January 2011

Calcium Channel Blockers and Antibiotics – Dangerous Combination

James Discoveries & Stats, Medications, News 1

Researchers at the Sunnybrook Research Institute in Toronto, Canada, warn that taking calcium channel blockers (calcium antagonists) along with certain antibiotics could lower blood pressure, and be dangerous to high risk patients.

It’s always wise to keep up with the latest research on drug combinations, since patients seem to be taking more and more medications together. This recent research could impact migraine and cluster headache patients, who often take calcium channel blockers (CCBs) as preventatives.

CCBs that are commonly taken for migraine or cluster include diltiazem (Cardizem, Dilacor and Taztia), nifedipine (Adalat, Procardia, Nifediac and Nifedical), nimodipine (Nimotop) and verapamil (Calan, Verelan, Covera-HS and Isoptin).

Now CCBs are actually prescribed in order to lower blood pressure. So we’re already aware that this can happen. The concern, however, is that taking the CCB along with certain antibiotics could actually increase the effect to dangerous levels.

The antibiotics we’re talking about are macrolide antibiotics. These antibiotics include erythromycin, clarithromycin, spiramycin, josamycin and azithromycin, and they’re very widely used, with millions of prescriptions being written each month.

The research involved elderly patients only, the ones who would be at the highest risk. Using public health records, the researchers discovered that patients on CCBs who had received the antibiotic erythromycin were six times as likely to be hospitalized for hypotension.

Would the same hold true for younger patients? Likely there will be a drop in blood pressure, though younger patients would be at a lower risk overall. The important thing to remember is that you need to let your doctor know what medications you’re taking. It’s easy to get a quick antibiotic when you’re feeling terrible, not thinking about other conditions that don’t seem to be related.

Being simply a survey of public health records focused on a certain group, more research needs to be done to understand the impact on migraine and cluster headache patients of various ages. In the mean time, this is another reminder that your doctor needs to know if you’re at high risk for other condition, and she needs to know what medications you’re taking.

17 January 2011

Children’s Headaches – Should I Consider a Preventative Medication?

James Information, Medications 0

It’s a challenge to diagnose headache disorders, especially in younger children. But it’s becoming clear that it’s important, and more and more research is being done to help fight pediatric headaches.

Headaches are surprisingly common in children.

The catch is that sometimes even the children don’t really know how bad they are. The matter is further complicated when it comes to issues like migraine, where the symptoms can be so varied. Many people with migraine simply "don’t feel well", and have very little actual head pain. In children, abdominal migraine is common, where nausea may be the main symptom and the pain may be in the stomach.

It takes time to work with your doctor and child to uncover the symptoms and find a good treatment. But it’s important to do so. Catching headache disorders early can help avoid later complications. And children with frequent headaches can have extra trouble at school that can leave them farther behind than they need to be.

A preventative medication is something that your doctor may recommend if the headaches are frequent. The good news is, many medications have been found to really help children with migraine.

Some of the common medications that have helped children include:

Propranolol: A beta-blocker. Some brand names include Inderal, Avlocardyl, Inderalici, InnoPran XL, and Sumial
Flunarizine: A calcium-channel blocker. Brand names include Adalat, Cardizem, Isoptin, Nimotop, and Sibelium.
Topiramate: An anticonvulsant drug. Brand name Topamax.
Sodium valproate: An anticonvulsant. Brand names include Depakote, Epilim, Orlept, and Epival.
Amitriptyline: A tricyclic antidepressant. Brand names include Vanatrip, Elavil, and Endep.

Here are some things you and your doctor will want to consider when thinking about preventative medications:

How disabling are the symptoms? How often is the child having attacks? How is this impacting their daily life?
Are there other symptoms or co-existing disorders that could potentially be treated with the same medication? (For example, nausea, epilepsy, etc)
What are common risks and side effects associated with this medication? How will your doctor help you watch for these things over time?
Will a preventative medication help the child cut down on abortive medications? If you are giving your child "painkillers" more than twice a week, it’s very important you look for other options.
Is there a trial period? Is there a time when we could try taking the child off the preventative in the future?
What other treatments can be used alongside of (or instead of) the preventative medication? For example, changes in diet, biofeedback, an exercise program, CoQ10 etc.

In certain cases, preventative medications have helped children effectively fight headache and migraine symptoms. But do your homework, and remember that this is something you need to take one step at a time. Don’t expect an instant cure-all. But do expect to find a combination of treatments that works well.