Topiramate - Indication: migraine ppx

Toradol - Indication - Dose

Ketoralac - Indication: tx of migraine - Dose: 30-60mg IM/15-30mg IV/10mg q4-5H PO

Naprosyn - Indication - Dose

Naproxen - Indication: tx of menstrual migraine - Dose: 500mg BID

Indocin - Indication - Dose

Indomethacin - Indication: tx of migraine - Dose: 50mg

Cambia - Indication - Dose

Diclofenac Voltaren - Indication: tx of migraine - Dose: 50mg single dose mix with water

Motrin - Indication - Dose

Ibuprofen - Indication: tx of migraine - Dose: 200-400 mg

Metoclopramide - Indication: migraine

Compazine - Indication

Prochloperazine - Indication: migraine

Amergen For all triptan: - MOA - Indication - SEs Sumatriptain: - C/I - DDI - Rec for kids age 6-11 - Counseling

Naratriptan - MOA: 5HT receptor agonist - Indication: tx of migraine - SEs: N/HA, chest tightness, dizziness, paresthesias (numbness/tingling), sleepiness Sumatriptan: injection site rxn/bitter taste - C/I: CAD, uncontrolled HTN, take with Ergots and MOAIs - DDI: SSRI's: very rare MOAI's: incr systemic exposure to triptan Ergots: vasospastic rxn Cimetidine: Inc [ ] of Zolmitriptan OCP: Inc plasma level of naratriptan & zolmtriptan - Rec for kids age 6-11: rec maxalt tab or Imitrex nasal Counseling: - Max dose - Relieve acute migraine but doesn't prevent or reduce the of future attack - If experience chest pain, SOB, heart throbbing, or skin rashes notify MD - Do not take if pregnant (preg cat C) - Avoid prolong sun exposure: wear sunscreen and protective clothing

Maxalt - Max dose - Form

Rizatriptan Benzoate - Max dose: 30mg/day - Form: PO

Imitrex - Max dose of PO and NS - Counseling of transdermal system

Sumatriptan succinate Forms/Max Dose - PO: Max 200mg/d - NS: Max 40mg/d

Sumatriptan + Naproxen - Sum 85mg and Nap 500mg May repeat after 2H

ZOmig - Forms - Max dose

ZOLmitriptan - Forms: tab, nasal spray - Max 10mg/d

Migraine Flashcards by Christina Marie

When it’s indicate for migraine prophylaxis

Agents

Indication for ppx when > 3 migraine attacks/mo or if associated with disability

Agents
- BB: Propranolol, timilol
- CCB: Verapamil
- TCA/SNRI: Amitriptyline, Venlafaxine ER - Effexor 
- AntiEpileptic: Divalproex - Depakote/Stavzor
  Topamax - Topiramate
- Botulinum toxin - Botox
- Feverfew, buterbur

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Topamax

Indication

Topiramate

Indication: migraine ppx

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Botox

Indication

Botulinum toxin

=> Use in pt who have at least 15 days of migraine attacks/month and last > 4H
- Indication: migraine ppx

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Toradol

Indication
Dose

Ketoralac

Indication: tx of migraine
Dose: 30-60mg IM/15-30mg IV/10mg q4-5H PO

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Naprosyn

Indication
Dose

Naproxen

Indication: tx of menstrual migraine
Dose: 500mg BID

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Indocin

Indication
Dose

Indomethacin

Indication: tx of migraine
Dose: 50mg

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Cambia

Indication
Dose

Diclofenac

Voltaren

Indication: tx of migraine
Dose: 50mg single dose mix with water

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Motrin

Indication
Dose

Ibuprofen

Indication: tx of migraine
Dose: 200-400 mg

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Reglan

Indication

Metoclopramide

Indication: migraine

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Compazine

Indication

Prochloperazine

Indication: migraine

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Amergen

For all triptan:

MOA
Indication
SEs
- Sumatriptain:
C/I
DDI
Rec for kids age 6-11
Counseling

Naratriptan

MOA: 5HT receptor agonist
Indication: tx of migraine
SEs: N/HA, chest tightness, dizziness, paresthesias (numbness/tingling), sleepiness
**Sumatriptan: injection site rxn/bitter taste
C/I: CAD, uncontrolled HTN, take with Ergots and MOAIs
DDI:
SSRI’s: very rare
MOAI’s: incr systemic exposure to triptan
Ergots: vasospastic rxn
Cimetidine: Inc [ ] of Zolmitriptan
OCP: Inc plasma level of naratriptan & zolmtriptan
Rec for kids age 6-11: rec maxalt tab or Imitrex nasal

Counseling:

Max dose
Relieve acute migraine but doesn’t prevent or reduce the # of future attack
If experience chest pain, SOB, heart throbbing, or skin rashes notify MD
Do not take if pregnant (preg cat C)
Avoid prolong sun exposure: wear sunscreen and protective clothing

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Maxalt

Max dose
Form

Rizatriptan Benzoate

Max dose: 30mg/day
Form: PO

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Imitrex

Max dose of PO and NS
Counseling of transdermal system

Sumatriptan succinate

Forms/Max Dose

PO: Max 200mg/d
NS: Max 40mg/d

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Treximet

Dose

Sumatriptan + Naproxen

Sum 85mg and Nap 500mg
May repeat after 2H

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ZOmig

Forms
Max dose

ZOLmitriptan

Forms: tab, nasal spray
Max 10mg/d

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Axert

Max dose

ALMOtriptan

Max dose: 25mg/day

Frova

Max dose
Half life

FROVAtriptan

Max dose: 7.5mg/day
Half life: longest

Relpax

Max dose
DDI

Eletriptan

Max dose: 80mg/d
CYP3A4 substrate

Migrana
D.H.E. 45

Dose
MOA
Indication
C/I
SE
DDI
Counseling

DiHydroErgotamine Mesylate

Migrana - 4mg/mL w/ 10mg caffeine
1. 5mg/spray. Max 3mg/d = 6 sprays. 15sprays/7day period
D.H.E. 45 injection
1mg IM. May repeat 2x at 1H interval
Max = 3mg/day and 6mg per 7day period
MOA: Vasoconstriction, interacts with 5HT, DA, NE
Indication:
Inj/PO: to abort/prevent vascular HA - migraine, cluster HA
Nasal spray: only for migraine

C/I

Preg Cat X
Hypersensitivity
PVD
Hepatic/renal imp
CAD
HTN
Sepsis

SEs

N/V, numbness/tingling of fingers/toes
Pain/weakness of arms/legs

DDIs

BB: peripheral ischemia (cold extremities), gangrene
Inhibitors of 3A4

Counseling

Do not exceed rec dose
Contact MD if irregular heart beat
N/V
Numbness/tingling of fingers or toes
Pain or weakness of the extremities

ERGOmar

Form

ERGOtamine Tartrate

SL tab

CafERGOT

Form

Ergotamine + Caffeine

Tab: 1mg ergo/100mg caffeine
Max: 6 tabs/attack; 10tabs/week
Suppositories: 2mg ergo/100mg caffeine
Max: 2sup/attack; 5supp/week

Fioricet
Esgic

Indication
Dose

Butalbital + Caffeine + APAP = 50/40/325

Indication: tension or muscle contraction HA
Dose: 1-2 tabs or cap Q4H. Max 6 tabs/day

FiORINal (CS III)

Indication
Dose

Butalbital + Caffeine + ASA

Indication: tension or muscle contraction HA
Dose: 1-2 tabs or cap Q4H. Max 6 tabs/day

Excedrine Migraine

Dose
Preg cat:

APAP + ASA + Caffeine = 250/250/65

Dose: 2 tabs PO Q6H. Max 8 tabs/day
Preg Cat D

Maxalt MLT

Rizatriptan - Form: - Max dose: 30mg/day Counseling: - Phenylketonuric pt should not take Maxalt MLT - Keep Maxalt MLT in foil package until just prior to use - Use clean dry hands to remove Maxalt MLT from foil - Place Maxalt MLT on top of the tongue

Sumavel DosePro - Form - Max dose:

Summartriptan - Form: SC - Max: 12mg/d

Zecuity - Form: - Max dose: - Counseling

Zecuity: Iontophoretic transdermal system - Transdermal: delivery 6.5mg over 4H. Apply to upper arm Counseling - Single-use, battery powered patch that actively delivers sumatriptan 6.5mg over 4H - Once Zecuity is applied, the activation button must be pushed and the red light will turn on. When dosing is done, the sys stops operating and the activation light turns off - It uses a mild electrical current to deliver the medicine the the skin - Contain metal parts and must be removed b/4 MRI

Zomig ZMT - Max:

Zomitriptan ODT - Max dose: 10mg

Alsuma - Form

Sumatriptan - Form: Sol'n