sumatriptan, Imitrex
Economic implications of early treatment of migraine with sumatriptan tablets.

Cady RK, Sheftell F, Lipton RB, Kwong WJ, O'Quinn S.

Headache Care Center, Springfield, Missouri, USA.

BACKGROUND: Early treatment of migraine with sumatriptan 50 mg and 100 mg, while pain is mild, has been reported to enhance pain-free response 2 hours and 4 hours postdose and sustained pain-free response 2 to 24 hours postdose compared with treatment when pain has become moderate to severe. Early treatment with sumatriptan 50 mg and 100 mg also resulted in less redosing, which translated to a reduction in the mean number of doses used per migraine episode. OBJECTIVE: We examined the economic implications of early treatment with sumatriptan 50 mg and 100 mg while pain is mild versus treatment when pain has become moderate to severe. METHODS: Using data from retrospective analyses of a dose-ranging clinical trial of sumatriptan (protocol S2CM09) involving 1003 patients, we estimated the mean cost per treatment success for a hypothetical population of 1000 migraine patients who received treatment with sumatriptan 50-mg or 100-mg tablets early while pain was mild versus treatment when pain had become moderate to severe. RESULTS: With a conservative estimate of migraine frequency of 1.5 episodes per month, the total cost of early migraine treatment with sumatriptan 50 mg and 100 mg was reduced by $31.68 and $20.16, respectively, per patient per year. The average cost per pain-free treatment success was reduced by 32% to 57% with sumatriptan 50 mg and 100 mg if migraines were treated while pain was mild in intensity versus when pain had become moderate to severe. CONCLUSIONS: Treatment of migraine with sumatriptan 50-mg and 100-mg tablets is effective regardless of whether pain is mild, moderate, or severe. However, initiating treatment while pain is mild may be more cost-effective than delaying treatment until pain has become moderate to severe.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11293561&dopt=Abstract sumatriptan Imitrex



sumatriptan, Imitrex
Sumatriptan: economic evidence for its use in the treatment of migraine, the Canadian comparative economic analysis.

Caro G, Getsios D, Caro JJ, Raggio G, Burrows M, Black L.

Caro Research, Montreal, QC, Canada.

The objective of this study was to evaluate economic and health effects of sumatriptan relative to customary therapy in Canada. The relationship between treatment and functionality was established based on analysis of existing data from a multinational study. A Monte Carlo model was developed to simulate 1 year for each of customary therapy and six sumatriptan formulations. Costs are expressed in 1998 Canadian dollars. Sumatriptan is expected to reduce the time spent with migraine symptoms and resulting time lost. Under customary therapy, the annual cost of lost time is estimated at pound908 ($1973). With sumatriptan, these costs ranged from pound406 ($882) with subcutaneous sumatriptan to pound577 ($1254) with nasal sumatriptan 10 mg, saving pound331-502 ($719-1091) in the annual cost of time lost. All these benefits are expected to be obtained at an additional drug cost ranging from pound869 ($1889) for subcutaneous sumatriptan to pound278 ($605) for sumatriptan suppository. The cost of sumatriptan treatment is significantly offset by a substantial reduction of costs associated with time lost due to migraine symptoms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11298658&dopt=Abstract sumatriptan Imitrex



sumatriptan, Imitrex
Delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan.

Kallen B, Lygner PE.

Tornblad Institute, University of Lund, Sweden; Glaxo Wellcome AB, Molndal, Sweden.

OBJECTIVE: To evaluate delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan. BACKGROUND: The safety of the use of drugs for migraine during pregnancy is not established. Design and METHODS: Using the Swedish Medical Birth Registry which contains information on drug use reported by women at the first antenatal visit, 912 infants (born in 905 deliveries) whose mothers had used drugs for migraine were identified, the majority of whom (n = 658) had used sumatriptan. RESULTS: These women differed from the general population of women who had delivered by being older and more often of first parity, but they had similar smoking habits. Slightly more often, the infants were preterm, and they had a birth weight less than 2500 g; neither of these effects were statistically significant. There seemed to be no difference between infants exposed to sumatriptan and those exposed to other drugs used for migraine. No increase in the rate of congenital malformations was seen. CONCLUSIONS: The data indicate that use of sumatriptan in early pregnancy does not result in a large increase in teratogenic risk, but do not rule out the possibility of a moderate increase in risk for a specific birth defect.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11318881&dopt=Abstract sumatriptan Imitrex



sumatriptan, Imitrex
Modifications by sumatriptan and acetylcholine of nitric oxide-mediated neurogenic dilatation in dog cerebral arteries.

Ayajiki K, Fujioka H, Noda K, Okamura T, Toda N.

Department of Pharmacology, Shiga University of Medical Science, Seta, 520-2192, Ohtsu, Japan.

Canine cerebral arterial strips denuded of endothelium responded to nicotine and transmural electrical stimulation with relaxations, which were abolished by NG-nitro-L-arginine and methylene blue. Magnitudes of relaxation did not differ in the arteries contracted with prostaglandin F2alpha and sumatriptan, an effective therapeutic of migraine. Sumatriptan concentration-dependently contracted the arteries responding to 2 Hz stimulation with persistent relaxations, and the concentration of this 5-HT1B/1D/1F receptor agonist to overcome the relaxation averaged 1.06 x 10(-7) M. Acetylcholine inhibited the response to nerve stimulation due possibly to its action on prejunctional nitroxidergic nerves; the inhibition did not differ in the arteries contracted with prostaglandin F2alpha and K+. It appears that sumatriptan does not interfere with the release of nitric oxide from nerves but counteracts the neurogenic relaxation by functional antagonistic action on smooth muscle. Prejunctional inhibition by muscarinic receptor activation is unlikely associated with opening of neuronal K+ channels.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11412840&dopt=Abstract sumatriptan Imitrex



sumatriptan, Imitrex
Relaxation induced by serotonin and sumatriptan in isolated guinea pig gallbladder strips.

Emre-Aydingoz S, Erdem SR, Tuncer M.

Hacettepe University, Faculty of Medicine, Department of Pharmacology, Sihhiye, Ankara, Turkey.

The effects of 5-hydroxytryptamine (5-HT) and sumatriptan were investigated on isolated guinea pig gallbladder strips. While 0.1 microM-50 mM of 5-HT exhibited contractile and/or relaxant effects in quiescent preparations, the same concentrations of sumatriptan did not. On the other hand, carbachol-precontracted tissues were relaxed by the same amounts of 5-HT and sumatriptan in a concentration-dependent manner. The relaxant responses to 5-HT were not antagonized or changed by tetrodotoxin, indomethacin, capsaicin, NG-nitro-L-arginine (L-NOARG), GR55562 [(+/-)-propranolol, 3-[3-(N,N-dimethylamino)propyl 1-4-hydroxy-N-[4-(pyridin-4-yl)phenyl]benzamide , S(-)-propranolol, methysergide, ketanserin. tropisetron, GR 113808 ([1-[2-(methylsulphonylamino)ethyl -4-piperidinyl]methyl-1-methyl-1H-indole-3-carboxylate maleate salt). pargyline, and fluvoxamine. The relaxant responses to sumatriptan were antagonized by GR55562 but not by S(-)-propranolol. These results suggest that 5-HT and sumatriptan cause relaxation in carbachol-precontracted isolated guinea pig gallbladder strips by yet undefined mechanisms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11426669&dopt=Abstract sumatriptan Imitrex



sumatriptan, Imitrex
5-HT1B receptor binding in degenerative movement disorders.

Castro ME, Pascual J, Romon T, Berciano J, Figols J, Pazos A.

Department of Physiology and Pharmacology, Unit of Pharmacology, University of Cantabria, Santander, Spain.

Using [3H]sumatriptan as a radioligand, 5-hydroxytryptamine (5-HT)1B receptors were examined in posterior striatum and midbrain post-mortem tissue sections of 12 patients who had died from representative degenerative movement disorders as compared to nine controls. In the control human basal ganglia, the highest densities of [3H]sumatriptan binding were observed in the globus pallidus and substantia nigra. No significant change in the density of [3H]sumatriptan binding sites was found in the striatum and substantia nigra of the six Parkinson's disease brains. In the two brains from patients with progressive supranuclear palsy an increase was found in the densities of [3H]sumatriptan binding sites, most marked in the substantia nigra. In contrast, [3H]sumatriptan labelling was almost absent in the striatonigral degeneration brain and was markedly reduced in the three Huntington's disease brains. This study indicates that the status of 5-HT1B receptors is different in each degenerative movement disorder and suggests that human 5-HT1B receptors are located somatodendritically on GABAergic and peptidergic caudate-putamen neurons which project to the substantia nigra and globus pallidus, where these receptors are presynaptic. Copyright 1998 Elsevier Science B.V.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9593971&dopt=Abstract sumatriptan Imitrex



sumatriptan, Imitrex
Dosing of oral sumatriptan: a review of our first 104 patients.

Solomon GD, Frizelis K, Becker J, Kunkel RS.

Department of General Internal Medicine, Cleveland Clinic Foundation, Ohio, USA.

BACKGROUND: The introduction of oral sumatriptan in the United States at doses of 25 and 50 mg, compared with 100-mg tablets worldwide, has created the need to develop a protocol for appropriate dosing. METHODS: We evaluated the first 104 patients in our practice to treat two migraine attacks with oral sumatriptan. For their first treatment with oral sumatriptan, patients were evaluated on their response to 25-mg tablets and the total number of tablets taken. For their second treatment, patients were evaluated on their response to sumatriptan, number of 25-mg tablets taken, and dosage prescribed for future migraines. RESULTS: [table see text] After the second treatment, 41 patients (40%) continued therapy with 25-mg tablets, 54 (53%) were prescribed 50-mg tablets, 2 patients (2%) were prescribed two 50-mg tablets, and 5 patients (5%) were prescribed injectable sumatriptan. Seventy patients had previously used injectable sumatriptan, while 34 had not previously used sumatriptan. There were no significant differences in their response to oral sumatriptan. CONCLUSION: Oral sumatriptan was effective in clinical practice at doses of 25 and 50 mg. The majority of patients required more than one 25-mg tablet for a migraine attack, reflecting both inadequacy of dosing for some migraines and recurrence of headache, yet 40% of patients continued on treatment with 25-mg tablets. There were no significant differences in response to therapy in patients being switched from injectable to oral sumatriptan compared with those initiating therapy with oral sumatriptan. Both tablet strengths of oral sumatriptan are useful in clinical practice.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9630786&dopt=Abstract sumatriptan Imitrex