Your Medication Didn’t Work: The Surprising Reason Why
Today’s podcast will focus on something everyone taking medication needs to be aware of – gastric stasis. This is especially important for migraineurs – find out why…
Medications
FDA Warning: Reglan (Metoclopramide)
On the 26th of February 2009, the FDA issued a warning about metoclopramide, commonly sold under the brand name of Reglan, as well as many others (Clopra, Maxolon, Reclomide, and Octamide). The warning is for patients taking high doses, or taking it over the long term.
Reglan is commonly used for migraine, particularly migraine in children, because of its ability to treat both nausea and pain. It also is given along side other migraine medications, because it can help them absorb better.
It is an antiemetic and gastrointestinal stimulant, and is also prescribed for things like gastroesophageal reflux disease (GERD), stomach ulcer, and even to increase milk production in nursing mothers.
The FDA warning says that too much metoclopramide can cause tardive dyskinesia, which causes patients to make involuntary, repetitive, purposeless motions. This has actually been known for some time, and there are other drugs that cause the same thing. However, according to the FDA press release, a recent analysis has suggested that metoclopramide is the most common cause. The symptoms often go away several weeks after the medication is stopped, but not always. The effect can be permanent.
The concern is especially with patients who are taking metoclopramide for more than three months. If you’re taking an unusually high dosage, or are taking the medication regularly over a long period of time, be sure you know the risks.
The concerns about Reglan are just a reminder that many drugs that are fairly safe for a short period of time can cause problems over a longer period. More is not always better. Be sure to know the risks, and take your medication only as directed by a doctor who understands your medical history and knows what other medication you’re taking.
Take 3 minutes to learn about safe use of Pain Meds
A lot of the problems caused by pain medications could be eliminated by following a few simple rules. In the US, the FDA is trying to address some of these simple issues with an article they published this past February, A Guide to Safe Use of Pain Medicine.
Some examples of the issues they address:
- With acetaminophen: Taking a higher dose than recommended will not provide more relief and can be dangerous.
- With opioids: The dose of an opioid pain medication that is safe for you could be high enough to cause an overdose and death in someone else, especially children.
- A specific area of concern with OTC pain medicines is when products sold for different uses have the same active ingredient. A cold and cough remedy may have the same active ingredient as a headache remedy or a prescription pain reliever. To minimize the risks of an accidental overdose, consumers should avoid taking multiple medications with the same active ingredient at the same time.
The article doesn’t specifically cover every issue (for example, headache-related issues like rebound headache), but it’s worth taking a few minutes to read about pain medication for the safety of you and your family.
Thanks to Marijke Durning for the heads up.
ADX10059 – another Migraine Drug in the Pipeline
A couple of weeks ago I mysteriously referred to a drug called ADX10059, but didn’t say much about it. So let’s take a quick look at another new migraine drug that is currently in the testing phase.
As I mentioned in the post The Latest on Tezampanel, a new Migraine Drug, ADX10059 also has to do with glutamate. You can read the previous post for more on the connection between glutamate and migraine, as well as various types of chronic pain.
The technical description of ADX10059: a metabotropic glutamate receptor 5 negative allosteric modulator. Wow! We won’t go into every detail of how it functions, except to say that it inhibits glutamate, though in a different way than Tezampanel.
Testing is still in the second phase. At the very least, the results so far show that ADX10059 is getting rid of migraine pain in some people, so there’s reason to continue with the testing.
As with Tezampanel, it is hoped that this drug will break into the migraine chain-reaction and "interrupt the migraine circuit". Keep an eye on these emerging drugs – they’re different than what has come before, and are opening up a new field of study for migraine and other types of chronic pain.
ADDEX Pharmaceuticals is testing ADX10059, and has a brief explanation of mGluR5 & migraine on their site. Expect to hear more about ADX10059 next year (2010).
Namenda Migraine Treatment
It’s time to take a look at what’s new with Namenda migraine treatment. Namenda is actually just one brand name for memantine. It’s also sold as Axura, Akatinol, Ebixa and Memox.
Namenda is commonly used for Alzheimer patients, but is being tested for a number of other neurological disorders.
Technically known as a moderate affinity NMDA-receptor antagonist. In Alzheimer patients, excessive glutamate inhibits the normal sending of messages in the body. This drug blocks the effects of the excessive glutamate.
Namenda is being investigated for migraine, chronic tension-type headache, and various kinds of pain.
In one sense the news so far hasn’t been overwhelming. However, memantine may bring improvement to patients that are having difficulty finding other medications that work for them (Bigal, Rapoport, Sheftell, Tepper, Tepper 2008).
In Namenda treatment for migraine, small studies have shown some improvement in migraine patients who have significant disability and a significant number of attacks each month. The dosage is usually 10-20mg per day. Some studies saw over a 50% reduction in attacks (Krusz, Cammarata, 2005).
Namenda migraine treatment shows promise, but it’s still lacking the large, double blind trials that can really show us how well it works (and who it works best for).
I should also mention that there is some indication that Namenda may help with chronic tension-type headache. The results haven’t been as promising as with Namenda migraine treatments, but patients have seen a reduction in pain intensity, and some have seen a reduction in attacks (Lindelof, Bendtesn 2009)
Again, these are very small studies. But researchers are hopeful that memantine will be a good addition to migraine treatment, especially migraine that has been harder to treat in certain people. Since tension-type headache and cognitive problems often go along with migraine, there may be certain patients that see significant improvement with Namenda.
An interesting side note on the study of memantine is new light on the differences between men and women when it comes to migraine. Read more about Namenda, Migraine and cortical spreading depression