Medications

22 September 2008

Demerol for Migraine in the Emergency room

James Discoveries & Stats, Medications, Tips 84

If you end up in the emergency room here in North America, and you’re diagnosed with migraine, there’s a very good chance you’ll end up with an injection. That injection is usually something called Demerol, or meperidine hydrochloride. But is that the best way to go?

Of course, Demerol for migraine is nothing new. Basically, it’s prescribed for the pain (usually headache pain). Meperidine is a powerful, fast-acting opiod (narcotic) drug.

Though Demerol may help with the pain, there are problems. It doesn’t tend to last as long as some drugs, there are issues with toxicity, and concerns about dependence. Is Demerol really the best drug to take in an emergency situation?

Though it’s being used less and less in many countries around the world, it’s still prescribed for migraine in the emergency room. A study over the summer set out to find out what other options might be better.

This was a meta-study – a review of information on the use of drugs for migraine in emergency (11 clinical trials were studied in all). The study found that many of the alternative drugs already used were more effective (or similarly effective) than Demerol at killing the headache pain itself (for example, a DHE (dihydroergotamine mesylate or Migranal) injection). (overview here)

Surely there are many options for dealing with advanced migraine symptoms, far beyond DHE and Meperidine. I hope more studies are done to find the best, fastest treatment for someone who so urgently needs it.

There may not be much we can do in the meantime. However, if you have ended up in emergency before, it would be a good idea to take a note of what worked for you (I remember being in emergency and going through a lot before finding real help!). You could make the information part of an emergency card or medicine log that you carry around and can pull out at the hospital (after all, you don’t want to try to explain it in the middle of an attack!). Remember, what worked well for someone else may not work well for you – these studies are simply looking for what is generally most effective.

9 September 2008

Concerns about Topamax and Uric Acid

James Medications 1

A new study suggests that people taking Topamax (topiramate) for migraine may have increased levels of uric acid. What does that mean?

What’s Uric Acid?

Let’s back up a bit. It’s actually normal to have uric acid in your body. It’s simply a waste product that comes from food, that usually dissolves in your blood and leaves the body in urine. But problems come when your body starts producing too much, or getting rid of too little. High levels of uric acid in the blood is the result – this is called hyperuricemia.

Too much Uric Acid

Too much uric acid in the blood can be caused by many things – obesity, certain foods ("purine-rich" foods like sardines, gravy, beer and liver), certain diseases and certain medications.

The result can be conditions like gout, uric acid stones in the urinary tract, and buildups of uric acid in other parts of the body.

Where does Topamax fit in?

This was a small study of 97 patients, 53 who had migraine and who took topiramate. The migraineurs had significantly higher levels of uric acid.

I take Topamax – why should I care?

Every medication we take is a balance against pros and cons. This small study is not a reason to panic, but it is something worth talking to your doctor about, especially if you have a history of problems related to uric acid.

It’s also another indication that more studies need to be done on Topamax. It has been a help to many migraineurs, but we do need to be aware of the risks.

1 September 2008

Taking certain drugs with juice could be dangerous

James Discoveries & Stats, Medications, Tips 3

Do you take your medicine with juice? It might be time to rethink that habit.

Professor David Bailey from the University of Western Ontario specializes in clinical pharmacology. He has been involved in studies about how drugs interact with other things you put in your mouth, like herbal supplements and, of course, juice.

Doctors already caution their patients about taking grapefruit juice with certain medicines. The fear is that the juice will actually enhance the drug – meaning you’ll get more of the drug than you should be getting, possibly causing an overdose.

But the new study had surprising results. When taking an antihistamine with grapefruit juice, only about half of the drug was absorbed! Far from an overdose, this was instead making the drug far less effective.

Bailey, the author of the study, is concerned about other juices that contain similar chemicals. Orange juice and apple juice might have a similar effect – either decreasing the drug absorption or increasing it to dangerous levels.

Some drugs that might be affected include antihistamines (allergy headaches) and beta-blockers (often used for migraine prevention).

My medication? I think I might just stick to water, unless my doctor says otherwise.

See the BBC report Fruit juice ‘could affect drugs’, the University of Western Ontario report Fruit juice restricts drug absorption. via ChronicBabe.com

12 July 2008

Genetic mutations, migraine auras, and epilepsy

James Discoveries & Stats, Medications 0

Genetic research into migraine continues to suggest directions of treatment that haven’t been widely considered before. The latest studies out of the Vanderbilt University Medical Center in the USA are doing just that, and also increasing interest in studying links between migraine and epilepsy.

Here’s the story in brief. The study is about a rare form of migraine known as Familial Hemiplegic Migraine type 3. Studies of FHM have helped us understand genetic markers in the past. Often the focus has been on what are called calcium channels in the body.

But the new research is focusing on something different – sodium channels. A mutant gene causes problems with the normal functioning of the calcium channel in the body. Sodium channels act as "gateways" to allow sodium into the cell. When the channel gets "stuck" open, too much sodium gets through.

It may be that the genetic problem is involved in causing the cortical spreading depression in the brain, which comes early in the migraine chain of events.

Though FHM3 is not a common form of migraine, there may be some similarities here with more common forms. And it looks like drugs that act as sodium channel blockers may be worth further investigation.

The team at Vanderbilt University was studying the same gene for epilepsy issues. Finding a common cause between migraine and epilepsy could strengthen the suspected link between the two diseases.

The Vanderbilt Medical Center has an article on this research published yesterday if you want more depth – Mutations reveal clues to biological basis of migraines.

16 June 2008

Antidepressant side effects (Q&A)

James Medications 3

Many with migraine take antidepressants for migraine itself, and not for depression. Some take it for both, or for depression alone. Whatever category you are in, it can be a challenge to find your way through all the different types of medication, the differing opinions, the side effects, etc.

I thought a good starting point for conversation may be this question and answer time with Dr. Joseph Glenmullen from Harvard Medical School. The article is over 3 years old now, but many of the points brought up are still very current. The article mostly deals with those who have been diagnosed with depression, but the side effects can be similar no matter why you’re taking them.

Anything in the article that sounds familiar? What problems have you had with antidepressants? Or how have they helped?

An excerpt from the article:

If you tried to stop your antidepressant and couldn’t because of withdrawal symptoms, a good question to ask is: Are you caught in what I call the “antidepressant catch 22”? Antidepressant withdrawal symptoms like anxiety, depression, insomnia, and crying spells can mimic a patient’s original psychiatric condition. Countless patients have tried to lower the dose of their antidepressants and mistook these withdrawal symptoms for depressive relapse. Their doctors make the same mistake if they are not well informed about antidepressant withdrawal. When this happens, patients are needlessly put back on the drugs, often for years and despite severe side effects. In this “antidepressant catch-22,” patients are unaware that they were undergoing withdrawal rather than a return of their original psychiatric condition. The antidepressant catch-22 can be avoided by learning how to distinguish withdrawal symptoms from depressive relapse.