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Toradol for Migraine

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In certain cases, Toradol for migraine is a good option. But there are some risks and side effects that should be considered.

Toradol is actually a brand name, one of many, for ketorolac tromethamine. There are many other brand names, although Toradol may be the most familiar.Toradol for Migraine

Ketorolac belongs to a group of drugs known as NSAIDs – nonsteroidal anti-inflammatory drugs. Other drugs in this category include ibuprofen and fenoprofen.

Toradol for migraine is probably most useful as an emergency treatment at the hospital. Ketorolac, along with diclofenac, are both recommended in the emergency department, although they are not necessarily the first option to try (see Sequence of Treatments in Emergency – what works?).

In the journal Neurology‘s evidence-based guidelines, ketoprofen is one of the higher rated NSAIDs, considered to be “probably effective” according to clinical trials. There are, however, better treatments that should be tried first.

Common side effects with Toradol for migraine include swelling (in feet, ankles, face) and weight gain. As with most NSAIDs, there may be stomach issues such as diarrhea, nausea and stomach pain. Older adults seem to be more sensitive to side effects of ketorolac. It is not recommended for use during pregnancy.

There are some serious side effects, and your risk increases if you take the medication for a longer period of time. Usually ketorolac is recommended for one-time use in the emergency room, or for a brief time (a day or two) to stop a migraine attack at home.

To avoid some stomach related issues, a nasal spray may be prescribed (SPRIX).

If prescribed by your doctor, temporary use of ketorolac may help stop a migraine attack, and is often combined with other medications. However, it’s only a temporary solution.

For more information, see:

Nasal Spray: Still Waiting.

Unique Migraine Nasal Spray: We’re still waiting

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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.

Nasal Spray: Still Waiting.
Photo courtesy of robin_24

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

The Top 12 Mistakes People Make With Nasal Sprays

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Medication isn’t cheap.  So when you’re using a nasal spray, make sure you’re making the most of it by using it properly!

Here are the top 12 nasal spray mistakes that people make.  Learn from their mistakes!

Nasal Spray Mistakes
Photo courtesy of Kristina
  1. They don’t blow their nose first:  Don’t rush!  Gently blow your nose before using a nasal spray.  You don’t want the medication to get stuck, or just come out again.
  2. They tilt their head too much:  Sometimes it’s recommended that you tilt your head slightly forward or back, but leaning way over can make your medication less effective.  And remember, keep your head up for a while after you’ve taken the medication.
  3. They point the spray the wrong way:  The nozzle should not point toward the centre of your nose.  Point it up, and slightly out (away from the centre of the nose).
  4. They keep both nostrils open:  Close the other nostril with your other hand.  You don’t want the spray just to go out the other side.
  5. They hold their breath:  Breath in gently as you spray.  
  6. They snort:  Breath in gently, like you’re smelling a flower.  Don’t “snort” the medicine.  The spray could end up in the wrong place.
  7. They don’t clean the nozzle:  Obviously, this isn’t needed for a one-time use medication (for example a one-dose migraine spray).  But if you’re using the spray over and over, follow instructions on how to clean the nozzle.  Otherwise tiny bugs will soon have large families, and they’ll vacation in your nose.
  8. They blow their nose afterwards:  Yes, some people really do.  Don’t!  Give the medication a little time before you blow your nose again.
  9. They prime – or don’t prime:  Some nasal sprays should be primed first – that is, you give it a little spray into the air first.  Other medications you should not prime.  If it’s a one-dose medication, you’ll lose your only dose!
  10. They use it past the expiry date:  Not only may the medication be less effective, it may be contaminated over time.
  11. They share their nasal spray:  Never, ever share a nasal spray with someone else.
  12. They don’t read through the instructions:  Read the instructions in the package carefully before using.  It will answer many questions, such as – should I shake it first?  Should I prime it?  How do I clean it (if needed)?  How much is safe to use, and for how long?

    13. Nasal sprays can be much more effective than other medication “delivery systems”.  But they do need to be used properly so that the right dose can get where it needs to go when it needs to be there.

OptiNose: In Search of a Better Nasal Spray

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OptiNose is a new nasal drug delivery device aimed to get the drug into your system in a more efficient manner.

It’s pretty irritating to spend your money on a drug, and find that it doesn’t work – and the only reason may be that it’s not getting into your system fast enough, or not all of it is getting to the right part of your body.  There can be a number of reasons for this, but one reason has to do with the way the drug is delivered.

The OptiNose company was founded in 2000 by Dr. Med. PG Djupesland to find a better nasal spray.  Currently they’re testing two therapies – and one is for migraine.

Sumatriptan is the first migraine drug to be tested (brand names Imitrex, Imigran).  At the end of Phase II trials, it’s looking positive.

It works like this: the small plastic device has a tube that goes to the nose, like any nasal spray.  But another spout goes to your mouth.  You blow into the spout, and two things happen.  First, your own breath powers the unit.  Second, blowing closes the airway to the lungs and throat, meaning that the medicine is more effectively spread through the nasal cavity where it belongs.  As a side bonus, there’s less of the bitter taste that tends to go with other nasal sprays.

I would like to see more trials comparing OptiNose to other types of sumatriptan delivery.  However, trials against a placebo were very positive – there’s no doubt that the product "works" and will be a positive addition to the drug arsenal to fight migraine.

Thanks for the heads up at Somebody Heal Me.

A New way to take Toradol

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Toradol is actually a brand name, but I mentioned it in the title because people are more familiar with that name.  It’s also sold as Acular, Glicima, Supradol, Apo-Ketorolac, Ketanov and Ketorol.

The actual name of the drug is ketorolac tromethamine, or simply ketorolac.  Most commonly it’s given as an oral tablet or injection.

Sprix

But there’s a new way to take ketorolac, and it has a new name – Sprix.  Sprix comes from ROXRO PHARMA, Inc.

What makes Sprix special?  It’s a nasal spray.  Nasal sprays may be an easier alternative particularly for those who are tired of taking injections.

Ketorolac is non-narcotic, a non-steroidal anti-inflammatory drug (NSAID).  It’s often used for fever and moderate to severe pain relief.  Obviously as an anti-inflammatory it’s helpful for reducing swelling and inflammation.

It’s not usually recommended for chronic conditions, however is an option for short term pain relief (usually up to 5 days).

Sprix is not yet available, but was just approved on the 17th of May (2010) by the FDA in the United States, so it should be available soon and will probably be a well accepted alternative to other forms of ketorolac.

For more on Sprix, including the official press release, visit the Sprix website.

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