Medications

15 May 2008

Treximet (formerly Trexima)

The drug now known as Treximet has been approved for sale in the USA (on the 15th of April, 2008). It’s expected to hit the shelves any time now, as a prescription medicine.

But what is Treximet (formerly Trexima)? And is it worth all the hype?

Actually, I’ve written about Treximet several times before (here for example) – it’s been in the testing phase for a long time. It’s a combination drug – containing sumatriptan succinate (Imitrex) and naproxen sodium (Aleve). You can expect to see more drugs like this in the future, as Triptans such as sumatriptan go generic and companies look for new things to sell.

With the approval, I thought it would be a good time to summarize the good and the bad about this much talked about drug.

First, the good. Tests have shown that it seems to work well. Tests were done on a mostly female Caucasian group with migraine. Results? Noticeable relief from pain both short term (after 2 hours) and longer term (up to 24 hours). And better relief than from either key ingredient alone, or a placebo. In the end, Treximet seems to work a little faster and better than either drug alone. Trexima uses something called RT Technology, which gets the ingredients into action in your body quickly.

The other benefit is that it also seems to help with nausea, and sensitivity to light and sound.

Sounds great, right? Well, there are a few concerns about Treximet. Most of these come from the fact that it’s a combination drug.

For example, sharp readers will notice that Treximet was compared to sumatriptan succinate and naproxen sodium in the clinic trials – each by itself, but not in combination. With the expected price of the pills, we have a right to ask – is Treximet really that much better than just taking sumatriptan succinate and naproxen sodium together? With the changes over the next few months, it looks like that option would be far cheaper.

Speaking of cost, will insurance companies be willing to cover Trexima prescriptions?

Another good question – do you need Trexima every time you feel you need to take an abortive medication? In other words, might you want the sumatriptan alone sometimes, and would your doctor and insurance company allow you to have both? And if you take Treximet in the first dose, do you need the combination again for the second dose? (Good discussion on that here)

Being a combination drug, you do get the potential for side effects from both ingredients – for example, increased risk of stroke and gastrointestinal problems (from the naproxen sodium – typical for this type of drug).

So, might Treximet help you? Yes. But proceed with caution to avoid both over-paying and over-drugging. Keep informed on this discussion. And feel free to join in with your comments.

5 May 2008

Topamax for children?

James Medications 2

After all the discussion here about the side effects of Topamax, it was interesting to read the research about Topamax for children that was published last month.

In reality, there hasn’t been a lot of testing when it comes to topiramate for children. However, the researchers in Italy pulled the research together that has been done in the past, and made some interesting observations.

Has Topamax helped children with migraine? Yes, we have seen a reduction in migraine attacks in children taking Topamax.

Were there side effects? Yes, but which ones and how bad they were varied a LOT from child to child. The most common problems were weight loss, anorexia, abdominal pain, tiredness, trouble concentrating, and itchy or tingling skin (paraesthesia). Sometimes the side effects were only temporary.

The researchers made a good point regarding side effects. They said,"Since these adverse events, although often transitory, may be distressing for the child, we strongly recommend to assess the disability caused by the migraine episodes before deciding to initiate a prophylactic treatment."

In other words, be cautious, because these side effects may impact the life of a child far more than it would an adult.

It’s been noted before that decreased sweating, another possible side effect, may be particularly dangerous for children. Children on Topamax need to be watched closely.

By popular demand, there’s now a more in depth article on Topamax side effects here.

2 April 2008

Atenolol (Tenormin) for migraine

James Medications 0

Atenolol, sold under the brand name Tenormin, is from a drug class commonly known as beta-blockers. Beta-blockers (beta-adrenergic blocking agents) have a long history of success as migriane preventatives. Although they’re not the first line of attack, they have worked with some patients who have not responded to the more usual migraine medications.

But what about Atenolol? Is it a good option for you?

Tenormin is actually a very common beta blocker. It’s usually used to treat cardiovascular diseases, such as hypertension. Each beta-blockers works a little differently, and so they are prescribed to specific patients according to their situation.

Although Tenormin has helped some patients with migraine, it’s far more common to be prescribed Propranolol (Inderal) or metoprolol (Toprol), since right now the stats say they have the best chance of success.

As for beta-blockers themselves, there are common reasons why they might not be used. For example, athletes don’t usually use them for migraine because they are less able to exercise. Also, patients that already have low energy and/or depression are not the best candidates for this class of drugs, due to possible side-effects such as drowsiness, nightmares, depression, impotence, memory problems and sleep disorders.

Tenormin probably won’t be the first migraine drug your doctor prescribes, or even the first preventative or beta-blocker. If you’ve tried it and it hasn’t helped, there are probably other choices out there that have a better chance of success.

Read more details about Tenormin at the MayoClinic. Thanks to Migraine and Other Headaches, The Pill Book, and Headache: The Journal of Head and Face Pain for much of this information.

24 March 2008

DosePro: toward needle-free injections

James Medications, News 2

A world where you can inject yourself without a needle? Well, we’re one step closer.

I’ve injected myself with medication – maybe you have too. There are few things worse, in my opinion, than asking someone with a migraine attack to poke something sharp into her/his skin. But the technology is progressing through the system – technology which will get the medication where it’s needed fast – no need to put anything in your mouth, no need to shove something up your nose, no need to put a needle in your skin.

I first wrote about Intraject back in 2004. Since then there has been a merging of companies and a renaming of the product. The company is Zogenix, and the product is now called DosePro.

Sumatriptan DosePro is the specific product which is now moving through the system in the USA. The product now has an official application with the FDA, and it will be reviewed (all going well) later this year. It will be marketed for both cluster and migraine. Sumatriptan is, of course, a common migraine-fighter, a triptan, marketed as Imigran and Imitrex.

Administered to the thigh or abdomen, it only takes a tenth of a second. Tests so far indicate it’s every bit as good at fighting an attack as an injection. But, as we all know – the less pain the better!

More on the recent application of Sumatriptan DosePro here.

19 March 2008

Topamax may cause language disturbances

James Discoveries & Stats, Medications 113

A team of researchers led by Dr. Francesca Coppola from the University of Perugia (Universiti degli Studi di Perugia), Italy, recently investigated some side effects of the drug topiramate, sold as Topamax. Specifically, they were looking at patients taking the drug for migraine, as compared to patients taking other medications. They wanted to see if Topamax was more likely to cause "language disturbances".

By language disturbances we mean things like not being able to think of the right word, mixing words up, difficulty coming up with the words you want to use. This is actually a symptom of migraine, so we shouldn’t be surprised to see language problems in migraineurs.

But the research did show a clear difference. Patients on other drugs had no language problems, but over a quarter of those on topiramate did.

The good news is that the symptoms were mild, and usually disappeared after a month without any change in dosage. In other words, it’s something to be aware of, but probably nothing to worry about.

Topamax has helped many migraineurs, but it is a powerful drug and should not be among the first you try. Read more about Topamax and migraine here.