Antimigraine drugs

NERVOUS SYSTEM DRUGS ANTIMIGRAINE DRUGS Ergot derivatives 

Primary drug Secondary drug ANTIMIGRAINE DRUGS Effect Mechanism Precautions 

ERGOT DERIVATIVES ANAESTHETICS-GENERAL - HALOTHANE i efficacy of ergometrine on the uterus Uncertain Use alternative form of anaesthesia for surgery requiring use of ergotamine 

ERGOT DERIVATIVES MACROLIDES, QUINU-PRISTIN/DALFOPRISTIN, t ergotamine/methysergide levels with risk of toxicity Inhibition of CYP3A4-mediated metabolism of the ergot derivatives Avoid co-administration 

ERGOT DERIVATIVES TETRACYCLINES Cases of ergotism with tetracyclines and ergotamine Uncertain Avoid co-administration. If absolutely necessary, advise patients to discontinue treatment immediately if numbness and tingling of the extremities are felt 

Acute or chronic poisoning with ergot alkaloids may be referred to as ergotism. The most important side effects are extreme thirst, severe CNS effects, circulatory 

Ergot alkaloids interact with beta-blockers, antimigraine drugs, antibacterials, and glycerol nitrate. Concomitant administration with erythromycin causes ergotism.147,148 

Sumatriptan Succinate Sumatriptan is a drug of abuse, and it interacts with ergotamine, serotonin, rizatriptan, antidepressants, and antipsychotics. 

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The two antimigraine drugs proxibarbal and valofan (11.153 and 11.154, respectively, Fig. 11.19,a) attain lactam-lactone equilibrium, the mechanism of which is summarized in Fig. 11.19,b. In aqueous media, the proxibar-bal/valofan ratio increased linearly with pH, from 78 22 at pH 6.75 to 84 16 at pH 7.4. As for the two diastereoisomers of valofan, their cis/trans ratio remained constant and close to 63 37 in the pH range of 6-9 [164],... 

Gromek D, Kisiel W, Stojakowska A, Kohimunzer S. (1991). Attempts of chemical standardizing of Chrysanthemum parthenium as a prospective antimigraine drug. Pol J Pharmacol Pharm. 43(3) 213-17. 

Sumatriptan and other triptans are antimigraine drugs that possess agonist activity at 5-HTi receptors of the B, D and F subtypes and may thereby alleviate this type of headache (p. 322). 

Clonidine, a central acting antihypertension agent (q 2 adrenergic agonist) is classically cited as an antimigraine drug although it is less effective than beta-blockers. 

Durham PL, Russo AF New insights into the molecular actions of serotonergic antimigraine drugs. Pharmacol Ther 2002 94 77. [PMID 12191595]... 

Durham, P.L., and Russo, A.F. Regulation of calcitonin gene-related peptide secretion by a serotonergic antimigraine drug, J. Neurosci. 1999, 19, 3423-3429. 

Parthenolide may have a similar mechanism of action as seen following administration of sumatriptan, which is an effective analgesic and antimigraine drug. Sumatriptan has a selective agonist for serotonin receptor subtype, causing vasoconstriction of cranial arteries. 

The oxazolidinone-based compounds are the most common (Figure 23.1), and examples include antibacterial,27-28 adhesion receptor antagonists,29-30 tumor necrosis factor inhibitors,31 platelet aggregation inhibitors,32 antimigraine drugs,33 and monoamine oxidase inhibitors.3435 In one case, an oxazolidinone has been used as a transdermal drug delivery agent.36... 

Analgesics Anticholinesterases Antiemetics Antiinfectives Antimigraine drugs Antimuscarinics Cardiovascular drags CNS stimulants... 

Side effects that arise as a consequence of a known mechanism of action are plausible and the connection with drug ingestion is simple to recognize. It is more dif cult to detect unwanted effects that arise from an unknown action. Some compelling examples of these include fetal damage after intake of a hypnotic (thalidomide), pulmonary hypertension after appetite depressants, and fibrosis after antimigraine drugs. 

ST JOHN S WORT ANTIMIGRAINE DRUGS -TRIPTANS t risk of serotonin syndrome - For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome Possibly additive effect Avoid co-administration... 

REBOXETINE ANTIMIGRAINE DRUGS-ERGOT DERIVATIVES Risk of hypertension Additive effect Monitor BP closely... 

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