topiramate

5 April 2013

Warning: Generics and “Brand Names” are NOT (always) the same…

James Information, Medications, News, Tips 5

Yes, there are differences between brand name migraine drugs and generic migraine drugs. And those differences might make all the difference.

We talked about this back in 2009. Dr. Alexander Mauskop from the New York Headache Center had written about a study that had been done on Topamax and its generic counterparts.

Last week he wrote a little more about his patients’ experiences with brand name and generic medications.

This is not necessarily about brand name manufacturers wanting to make you pay for their products (although I’m sure they do want that – can you blame them?). The fact of the matter is, due to differing manufacturing processes, differing ingredients, and differing policies from country to country, brand name meds can be slightly different from the generics. And slightly may be all that is needed between “it works” and “it doesn’t work”.

Dr. Mauskop shares some wise advice in his post, which you can read here:

I have also seen this with sumatriptan â€“ my patients tell me that some generics do not work very well or at all. Out of about 10 generics of sumatriptan, I would guess that two are of poor quality. Once you find a generic that works for you, try to stick with the same generic manufacturer. The name of the manufacturer is printed on the bottle the pharmacy gives you. If one pharmacy does not have your generic, try another one.

He goes on to share a note from a patient dealing with pharmacies and changing availability of medications.

Of course, this involves pharmacies, drug companies, and insurance companies (oh, patients too!). One change anywhere along the line, and something that worked well for you can disappear.

If you run into trouble, share these posts with those you’re talking to, so they’re aware of the issue. Again, many times it may make no difference, but sometimes it will.

The most frustrating part of this story is that there are surely patients out there who have tried a triptan, and have given up on it, even though the very same triptan of a different brand might work.

So it may be worth your while to not only try different triptans (yes, one may work well when another doesn’t work at all), but try different brands of the the same triptan. And of course this goes for other medications too, like Topamax (topiramate) and whatever you may be trying.

Pharmacies and insurance companies need to understand that this isn’t just hype – in some cases the difference is very important. How can you in the industry better serve your patients?

1 May 2012

From Current Studies: What Migraine Treatments Work?

James Medications, News, Treatments 2

New guidelines have just come out based on the evidence we currently have for migraine treatment. We’ll talk about some of the guidelines in a moment, but first there are some key things to remember.

Caution: Dangerous Waters Ahead!

These guidelines were created by checking out the studies that have been published to date. This means that we do or do not have high quality studies that show successful treatment using [whatever medication or supplement]. If we don’t have enough quality studies, the item will be lower on the list.

We should also note that the guidelines are talking about what works in general, NOT what works for you or what is best for you. Some treatments high on the list are also high in side effects. Or they may be dangerous for certain people. Or they may not work well for your particular type of migraine. Do not take this as a list of what to try first. Something lower on the list may be something far better for you that something on the top.

This list also doesn’t address combo-treatments, such as MigreLief (with magnesium, feverfew and riboflavin).

The list does help doctors prioritize what to consider. If you’ve tried a number of things and haven’t tried something high on the list, it may be time to ask your doctor about it.

Highest rated treatments

Here are some of the highest rated treatments for migraine. There are four categories:

Over-the-counter: Petasites (butterbur) (such as Petadolex) (please note the current controversy over butterbur)
Triptans: frovatriptan (especially recommended for menstrual migraine)
Antiepileptics: divalproex sodium, sodium valproate, topiramate
beta-blockers: metoprolol, propranolol, timolol

Lowest rated treatments

These are the items that had a negative rating, meaning that they’re not recommended at this time: Lamotrigine, Clomipramine, Acebutolol, Clonazepam, Nabumetone, Oxcarbazepine, Telmisartan, montelukast.

Everything in-between

Of course, just because something isn’t on the top of the list doesn’t mean it’s not an excellent, helpful treatment for many people. For example, very close to the top were well-recognized treatments such as amitriptyline, zolmitriptan, feverfew, naproxen sodium, riboflavin (vitamin B2), and magnesium.

It should also be noted that Botox migraine treatment was not a part of these studies.

For some of the medications that are being used today, check out Migraine Medications: So many choices.

19 December 2011

Exercise Fights Migraine (a study of comparison)

James Discoveries & Stats, Tips, Treatments 2

It shouldn’t be surprising that exercise is a migraine-fighter, but a recent study published in the journal Cephalalgia in October helps to put the benefits in perspective.

Walking – an excellent way to start

The study of 91 women who had migraine attacks with headache 2-8 times per week. The migraineurs were split into three groups. One group was given topiramate (Topamax), the next was put in a relaxation program, and the last group in an exercise program.

Which helped the most?

Over a three month period, with a follow-up of 3 and 6 months. The surprising result was – that all three groups experienced about the same benefit.

Some patients even found that their symptoms dropped by 75% – a remarkable improvement for any kind of treatment of such frequent migraine attacks.

Considering the possible side effects of topiramate and other medications, and the additional and long term benefits of exercise, it’s clear what we should be focusing on here.

I admit I was surprised at the language of the doctoral student who carried out the study, Dr. Emma Varkey. She says,"Our conclusion is that exercise can act as an alternative to relaxations and topiramate when it comes to preventing migraines, and is particularly appropriate for patients who are unwilling or unable to take preventative medicines."

So we take medicines, and if that doesn’t work we go the alternate route of exercise? I think that this study and a mountain of related research should be putting things the other way around. Let’s find wise, safe ways that migraineurs can exercise, and help them long term, instead of taking money out of their wallets and encouraging them to rely on a pill.

For many migraine patients, it’s going to be a combination – exercise, medication, and other treatments such as relaxation techniques. We need to look to long term benefits and treatment as well as short term relief.

Read more about headache and exercise here, and then get started with these Headache exercise tips…

More on the study from Science Daily: Exercise Just as Good as Drugs at Preventing Migraines, Swedish Study Suggests

18 April 2011

Topamax Recall

James News 0

57,000 bottles of Topamax distributed in the USA and Puerto Rico have been recalled. If you take Topamax, you should check here right away to see if the bottles you have are included.

After consumer complaints of a "musty" odor, the company voluntarily issued the recall. The bottles will be investigated for TBA (2,4,6-tribromoanisole) contamination.

TBA is a by-product of chemicals used to treat wood. It’s not toxic, but there are concerns that it can cause gastro-intestinal problems in patients.

There were several recalls in 2010 of medications due to possible TBA contamination. Companies have taken action to try to avoid contamination, but it looks like the problem may not be solved yet.

via Important News: Topamax Recall and Thousands of Bottles of Topiramate Recalled Due to ‘Musty’ Odor

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)