1,720,971 research outputs found
How do you choose the appropriate migraine pharmacotherapy for an elderly person?
No full textMigraine is ranked as the third most prevalent disorder, the eight
most burdensome disease and the seventh cause of disability
worldwide [1]. Although its prevalence decreases after the age of
60, it still affects 7% of women and 3% of men over 65. A successful
treatment of a late-life migraine is particularly important due to the
association with increased risk of ischemic stroke, white matter
lesions and other transient neurological phenomena (migraine
accompaniments) responsive to prophylactic medication
Acute, transitional and long-term cluster headache treatment. pharmacokinetic issues
No full textIntroduction: The cornerstones of cluster headache therapy are based on the tripod of acute, transitional and preventative treatments that respectively aim to the control of the bouts, the transitional suppression of the relapse and the prevention of the entire cluster period. Particularly in chronic cluster headache, where a long-term preventative therapy is necessary, multiple drug regimens increase the risk of drug-drug interactions leading to variability in the clinical efficacy and to potentially harmful adverse effects. Areas covered: We focused on how clinically significant pharmacokinetic drug-drug and food-drug interactions can be carefully managed both in cluster headache patients with a progressive frequency of bouts and in chronic cluster headache sufferers. In fact, in these cases a long-term preventive therapy is indicated, increasing the possibility of interactions both with other transitional and acute cluster headache medications and with other foods or xenobiotics. Expert opinion: Pharmacokinetic interactions for both preventive, transitional and acute drugs are significant with a number of xenobiotics and other medications. Therefore, the pharmacokinetic issues knowledge is advisable for a safe and effective cluster headache management
Choosing the safest acute therapy during chronic migraine prophylactic treatment. pharmacokinetic and pharmacodynamic considerations
No full textIntroduction: Drugs used in the treatment of migraine have been reported to be highly associated with the occurrence of clinically significant drug-drug interactions (DDIs). Multiple drug therapy regimens are used for migraine treatment, particularly for chronic migraine. In fact, additional pharmacological agents are usually administered during an acute migraine attack in patients chronically treated with the prophylactic therapy. The variety of drugs available for migraine prophylactic and acute treatment, and consequently their pharmacological interactions, might complicate the choice of a safe combination therapy.Areas covered: This study discusses the prophylactic-Acute DDIs from a pharmacokinetic and pharmacodynamic perspective, particularly interactions between antiepileptic drugs, tricyclic antidepressants, β-blockers, calcium channel blockers, triptans, nonsteroidal anti-inflammatory drugs and ergot derivatives. The available online tools have been used to evaluate the clinically significant DDIs.Expert opinion: The interactions between different drugs might be accurately predicted by the huge and detailed knowledge about the molecular pathways involved in pharmacodynamics and pharmacokinetics. Pharmacogenomic research has shed further light onto the mechanisms involved in the inter-individual variation in drug response and DDIs. Based on this knowledge, this paper will provide suggestions to improve the appropriateness of the drug choice in the prescription of preventative and acute migraine medications
Pharmacogenetic considerations for migraine therapies
No full textIntroduction: Migraine is a common neurological disorder with a complex pathophysiology. It has been estimated that incidence between adults of current headache disorder is about 50%. Different studies show that this condition has an important and complex genetic component in response to drug therapy. Areas covered: This review shows and summarizes the importance of the polymorphisms associated with the major antimigraine drug metabolizing enzymes. The research of bibliographic databases has involved only published peer-reviewed articles from indexed journals. Expert opinion: Pharmacogenetics is based on the identification of polymorphism and promises personalized therapy with efficacy and reduction of adverse events. The association between genotype and an altered metabolizer status could guide clinical decision to evade concomitant treatments and adverse events. The introduction of routine genetic testing could help to choose the efficacy drug on the individual and genetic profile
Precise medical decision making in geriatric anti-depressant therapy
No full textIntroduction: Human aging is characterized by increasing vulnerability not only to diseases, but also to the treatments applied to that diseases. Geriatric depression is a frequent mental disorder often requiring pharmacological treatment, which commonly is added to other medications taken to treat chronic or acute co-morbidities. The challenges of appropriate treatment of elderly are increasingly recognized as an urgent health problem.
Areas covered: The challenges of appropriate geriatric anti-depressant prescription, and the role of novel tools developed by Precision Medicine. The data were obtained searching in MEDLINE: pharmacokinetics, pharmacodynamics, pharmacogenetics, antidepressants, drug-drug interactions and elderly, in the period 1994–2016.
Expert commentary: The Precision Medicine approach take advantage by novel decision-supporting tools, as pharmacogenomic testing, drug-drug interactions evaluation and therapeutic drug monitoring, allowing to improve informed-decision making in prescription of antidepressants
Lasmiditan for the treatment of migraine
No full textMigraine is one of the most common diseases in the world, with high economical and subjective burden. Migraine acute therapy is nowadays based on specific and non-specific drugs but up to 40% of episodic migraineurs still have unmet treatment needs and over 35% do not benefit from triptans administration. Serotonin-1F receptors have been identified in trigeminal system and became an ideal target for anti-migraine drug development as potential trigeminal neural inhibitors. Lasmiditan, a novel serotonin1F receptor agonist, showed specific affinity in vitro for the receptor without any vasoconstrictive action and inhibited markers associated with electrical stimulation of trigeminal ganglion in migraine animal models. Areas covered: This article reviews both preclinical and clinical studies on lasmiditan as a potential acute therapy for migraine, as well as pharmacokinetic and pharmacodynamic features. It also summarizes safety and tolerability data gathered in the various human studies. Expert opinion: The absence of vasoconstrictive effects makes lasmiditan a promising novel migraine acute therapy. Although preclinical and Phase I and II studies established a significant efficacy, the limited knowledge about pharmacokinetics and metabolism, the high rate of non-serious central nervous system side effects and the lack of larger studies remain still a matter of concern that should be addressed in future studies
O066. Kynurenine pathway metabolites in cluster headache
Full text linkIn this preliminary study we enrolled 14 cluster headache patients (CH, 13 males) and 15 age-matched healthy controls (HC, 14 males). We developed a HPLC tandem mass spectrometry method to assess the serum concentrations of KYNA, QUINA, Anthranilic acid and Kynurenine. Kynurenine serum levels resulted not significantly different between the groups (HC 0.33±0.1 and CH 0.35±0.14; Z= -0.53, p = 0.597), while both QUINA, KYNA and Anthranilic Acid were significantly reduced in cluster headache patients with respect to healthy controls (QUINA: HC 18.94±5.24 and CH 3.14±4.87; Z= -4.38, p < 0.001; KYNA: HC 3.53±1.33 and CH 2.53±1.20; Z= -12.45, p = 0.041; Anthranilic Acid: HC 1.28±1.14 and CH 0.17±0.06; Z= -4.46, p < 0.001). These results highlight that the endogenous regulation of the glutamatergic transmission in cluster headache might play an important role in its pathophysiology. Written informed consent to publication was obtained
from the patient(s)
Eletriptan in the management of acute migraine. An update on the evidence for efficacy, safety, and consistent response
Full text linkMigraine is a multifactorial, neurological and disabling disorder, also characterized by several autonomic symptoms. Triptans, selective serotonin 5-HT1B/1D agonists, are the first-line treatment option for moderate-to-severe headache attacks. In this paper, we review the recent data on eletriptan clinical efficacy, safety, and tolerability, and potential clinically relevant interactions with other drugs. Among triptans, eletriptan shows a consistent and significant clinical efficacy and a good tolerability profile in the treatment of migraine, especially for patients with cardiovascular risk factors without coronary artery disease. It shows the most favorable clinical response, together with sumatriptan injections, zolmitriptan and rizatriptan. Additionally, eletriptan shows the most complex pharmacokinetic/dynamic profile compared with the other triptans. It is metabolized primarily by the CYP3A4 hepatic enzyme and therefore the concomitant administration of CYP3A4-potent inhibitors should be carefully evaluated. A relatively low risk of serotonin syndrome is given by the co-administration with serotoninergic drugs. No clinically relevant interaction has been found with drugs used for migraine prophylactic treatment or other acute drugs, with the exception of ergot derivatives that should not be co-administered with eletriptan
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