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Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • June 12, 2023; (Issue 1678)
An oral nonopioid analgesic is often sufficient for
acute treatment of mild to moderate migraine pain
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to...
An oral nonopioid analgesic is often sufficient for
acute treatment of mild to moderate migraine pain
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to severe
migraine in most patients without vascular disease.
Treatment of pain when it is still mild to moderate in
intensity improves headache response and reduces
the risk of recurrence.
Opioids for Pain
The Medical Letter on Drugs and Therapeutics • December 12, 2022; (Issue 1665)
A new CDC guideline for prescribing opioids for pain
recently became available. Nonopioid drugs for pain
were reviewed in a previous...
A new CDC guideline for prescribing opioids for pain
recently became available. Nonopioid drugs for pain
were reviewed in a previous issue.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • March 7, 2022; (Issue 1645)
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary....
Nonopioid drugs can be used in the treatment of
many nociceptive and neuropathic pain conditions.
For severe pain, especially severe chronic cancer
pain, use of opioids may be necessary. Noninvasive
nonpharmacologic treatments, including physical
and psychological therapies, have been shown to
improve pain and function in patients with some
common chronic pain conditions and are unlikely
to cause serious harms. A multimodal approach to
analgesic therapy can increase pain control while
reducing opioid use and adverse effects.
Orphengesic Forte - An Old Analgesic Combination Returns
The Medical Letter on Drugs and Therapeutics • November 16, 2020; (Issue 1611)
A fixed-dose combination of orphenadrine citrate, aspirin,
and caffeine (Orphengesic Forte – Galt; previously
available as Norgesic Forte) has been approved as
a prescription drug by the FDA for treatment...
A fixed-dose combination of orphenadrine citrate, aspirin,
and caffeine (Orphengesic Forte – Galt; previously
available as Norgesic Forte) has been approved as
a prescription drug by the FDA for treatment of mild
to moderate pain caused by acute musculoskeletal
disorders. Single-ingredient generic orphenadrine
citrate is available by prescription in oral and injectable
formulations and has been used for years as an adjunct
for treatment of acute musculoskeletal pain. Orphengesic
Forte is being marketed as a non-opioid alternative for
pain relief.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • October 5, 2020; (Issue 1608)
An oral nonopioid analgesic is often sufficient for acute
treatment of mild to moderate migraine headache
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to...
An oral nonopioid analgesic is often sufficient for acute
treatment of mild to moderate migraine headache
without severe nausea or vomiting. A triptan is the
drug of choice for treatment of moderate to severe
migraine headache pain in most patients without
vascular disease. Early treatment of pain when it is
still mild to moderate in intensity improves headache
response and reduces the risk of recurrence.
Nonopioid Drugs for Pain
The Medical Letter on Drugs and Therapeutics • February 12, 2018; (Issue 1540)
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future...
Nonopioid drugs can be used in the treatment of many
nociceptive and neuropathic pain conditions. Use of
opioids for pain will be reviewed in a future issue.
FDA Warns Against Use of Codeine and Tramadol in Children and Breastfeeding Women
The Medical Letter on Drugs and Therapeutics • May 22, 2017; (Issue 1521)
The FDA has issued new warnings about the use of the
opioid analgesics codeine and tramadol in children,
particularly those...
The FDA has issued new warnings about the use of the
opioid analgesics codeine and tramadol in children,
particularly those <12 years old, and in breastfeeding
women due to concerns about the risk of respiratory
depression and death. The FDA previously issued
warnings about these drugs in 2013 and 2015.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • February 13, 2017; (Issue 1514)
An oral nonopioid analgesic may be sufficient for
treatment of mild to moderate migraine without severe
nausea or vomiting. A triptan is the drug of choice for
treatment of moderate to severe migraine. Use...
An oral nonopioid analgesic may be sufficient for
treatment of mild to moderate migraine without severe
nausea or vomiting. A triptan is the drug of choice for
treatment of moderate to severe migraine. Use of
a triptan early in an attack when pain is still mild to
moderate in intensity improves headache response
and reduces recurrence rates.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • December 1, 2013; (Issue 136)
Treatment of migraine in the emergency department,
which may involve use of intravenous drugs, is not
discussed...
Treatment of migraine in the emergency department,
which may involve use of intravenous drugs, is not
discussed here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2013; (Issue 128)
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. The two major types of
chronic pain are nociceptive pain and neuropathic
pain. Nociceptive pain can be treated with nonopioid
analgesics or opioids. Neuropathic pain is less responsive
to opioids and is often treated with adjuvant drugs
such as antidepressants and antiepileptics. Combining
different types of analgesics may provide an additive
analgesic effect without increasing adverse effects.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • February 1, 2011; (Issue 102)
Drugs for treatment of migraine are listed in Table 2
on page 9. Drugs for prevention of migraine are listed
in Table 3 on page 10. Treatment of migraine in the
emergency room, which may involve use of...
Drugs for treatment of migraine are listed in Table 2
on page 9. Drugs for prevention of migraine are listed
in Table 3 on page 10. Treatment of migraine in the
emergency room, which may involve use of intravenous
drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2010; (Issue 92)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain can be treated with nonopioid analgesics or opioids. Neuropathic pain is less responsive to opioids; adjuvant medicines such as antidepressants and anticonvulsants are often used to treat neuropathic pain. Combining different types of analgesics may provide an additive analgesic effect without increasing adverse effects.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • December 15, 2008; (Issue 1301)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
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A Fixed-Dose Combination of Sumatriptan and Naproxen for Migraine
The Medical Letter on Drugs and Therapeutics • June 16, 2008; (Issue 1288)
The FDA has approved an oral, fixed-dose combination (Treximet - GlaxoSmithKline) of the selective serotonin receptor agonist ("triptan") sumatriptan (Imitrex) and the nonsteroidal anti-inflammatory drug...
The FDA has approved an oral, fixed-dose combination (Treximet - GlaxoSmithKline) of the selective serotonin receptor agonist ("triptan") sumatriptan (Imitrex) and the nonsteroidal anti-inflammatory drug (NSAID) naproxen sodium (Anaprox, and others) for acute treatment of migraine attacks.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • March 1, 2008; (Issue 67)
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve...
Some drugs for treatment of migraine attacks are listed in table 2 on page 18. Drugs for prevention of migraine are listed in table 3 on page 20. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • April 1, 2007; (Issue 56)
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain is generally treated with nonopioid analgesics and opioids. Antidepressants...
Pain can be acute or chronic. Chronic pain has been broadly classified into two types: nociceptive and neuropathic. Nociceptive pain is generally treated with nonopioid analgesics and opioids. Antidepressants and anticonvulsants have been used to treat neuropathic pain. Combining two different types of analgesics may nprovide an additive analgesic effect without increasing adverse effects.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • September 1, 2004; (Issue 25)
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004;...
Drugs for treatment of migraine attacks are listed in the table on page 64. All of the oral drugs are most effective if taken early in an attack when the pain is mild (H Christoph-Diener et al, Neurology 2004; 63:520). Drugs for prevention of migraine are listed in the table on page 65. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • July 1, 2004; (Issue 23)
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of...
Three types of analgesic drugs are available: non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; opioids; and adjuvant drugs that are not usually thought of as analgesics, such as antidepressants, which can act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Combining two different types of analgesics may provide an additive analgesic effect without necessarily increasing adverse effects.
Drug Interactions
The Medical Letter on Drugs and Therapeutics • June 8, 2003; (Issue 1158)
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug...
Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.
Drugs That May Cause Psychiatric Symptoms
The Medical Letter on Drugs and Therapeutics • July 8, 2002; (Issue 1134)
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously...
Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment may also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 21, 2000; (Issue 1085)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. Non-opioids can be given concurrently with opioids for an additive analgesic effect.
Drug Interactions
The Medical Letter on Drugs and Therapeutics • July 2, 1999; (Issue 1056)
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new...
Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new drugs.
New "Triptans" and Other Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • October 9, 1998; (Issue 1037)
Three new 5-HT1 receptors agonissts ('triptans') have been marketed recently for treatment of migraine. Some drugs for prevention of migraine are listed in the table on page 99. Treatment of migraine in the...
Three new 5-HT1 receptors agonissts ('triptans') have been marketed recently for treatment of migraine. Some drugs for prevention of migraine are listed in the table on page 99. Treatment of migraine in the emergency room, which may involve use of intravenous drugs, is not included here.
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • August 14, 1998; (Issue 1033)
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually...
Three types of analgesic drugs are available: first, non-opioids, including aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, some drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain.
Grapefruit Juice Interactions With Drugs
The Medical Letter on Drugs and Therapeutics • August 18, 1995; (Issue 955)
In a study of the interaction between alcohol and the calcium-channel blocker felodipine (Plendil), the grapefruit juice vehicle for the alcohol appeared to increase felodipine plasma concentrations....
In a study of the interaction between alcohol and the calcium-channel blocker felodipine (Plendil), the grapefruit juice vehicle for the alcohol appeared to increase felodipine plasma concentrations. Subsequent studies have found that grapefruit juice increases plasma concentrations of several calcium-channel blockers and of some other drugs as well (DG Bailey et al, Clin Pharmacokinet, 26:91, 1994).
Tramadol - A New Oral Analgesic
The Medical Letter on Drugs and Therapeutics • July 7, 1995; (Issue 952)
Tramadol hydrochloride (Ultram - Ortho-McNeil), a centrally-acting analgesic marketed in Germany since 1977, was recently approved by the US Food and Drug Administration for oral treatment of moderate to...
Tramadol hydrochloride (Ultram - Ortho-McNeil), a centrally-acting analgesic marketed in Germany since 1977, was recently approved by the US Food and Drug Administration for oral treatment of moderate to moderately severe pain. Despite some opioid activity, tramadol has not been scheduled as a controlled substance.
Drugs for Migraine
The Medical Letter on Drugs and Therapeutics • March 3, 1995; (Issue 943)
Drugs are used both to prevent and treat migraine symptoms. The effectiveness of such use can be difficult to evaluate, even with double-blind controlled trials, because migraine is episodic, response to...
Drugs are used both to prevent and treat migraine symptoms. The effectiveness of such use can be difficult to evaluate, even with double-blind controlled trials, because migraine is episodic, response to placebo is frequent, and patients vary in response to a given agent (KMA Welch, N Engl J Med, 329:1476, 1993; SD Silberstein and RB Lipton, Neurology, 44 suppl 7:S6, Oct 1994).
Drugs for Pain
The Medical Letter on Drugs and Therapeutics • January 8, 1993; (Issue 887)
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as...
Three types of analgesic drugs are available in the USA: first, aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; second, opioids; and third, drugs not usually thought of as analgesics, which act as adjuvants when given with NSAIDs or opioids, or have analgesic activity of their own in some types of pain. (American Pain Society, Principles of analgesic Use, 3rd ed, Skokie, illinois: American pain society, 1992).
Adenosine
The Medical Letter on Drugs and Therapeutics • June 29, 1990; (Issue 821)
Adenosine (Adenocard - Fujisawa), an endogenous purine nucleoside, was recently approved by the US Food and Drug Administration for intravenous treatment of paroxysmal supraventricular tachycardia, including...
Adenosine (Adenocard - Fujisawa), an endogenous purine nucleoside, was recently approved by the US Food and Drug Administration for intravenous treatment of paroxysmal supraventricular tachycardia, including Wolff-Parkinson-White (WPW) syndrome. Adenosine is not approved for and has not been effective in treating atrial flutter, atrial fibrillation, or ventricular tachycardias.
Treatment of Xerostomia
The Medical Letter on Drugs and Therapeutics • July 29, 1988; (Issue 771)
Xerostomia, dry mouth due to decreased or absent saliva, is a common problem, particularly among elderly patients. Decreased salivary flow can be due to many different conditions, including drug therapy, Sj...
Xerostomia, dry mouth due to decreased or absent saliva, is a common problem, particularly among elderly patients. Decreased salivary flow can be due to many different conditions, including drug therapy, Sj gren's syndrome (keratoconjunctivitis sicca) or radiation of the salivary glands.
Ciprofloxacin
The Medical Letter on Drugs and Therapeutics • January 29, 1988; (Issue 758)
Ciprofloxacin hydrochloride (Cipro - Miles), a synthetic antibacterial agent, was recently marketed in the USA for oral treatment of a wide variety of infections. Ciprofloxacin is the second fluoroquinolone...
Ciprofloxacin hydrochloride (Cipro - Miles), a synthetic antibacterial agent, was recently marketed in the USA for oral treatment of a wide variety of infections. Ciprofloxacin is the second fluoroquinolone to become available in this country; norfloxacin (Noroxin - Medical Letter, 29:25, 1987) is marketed only for treatment of urinary tract infections. Fluoroquinolones are more potent and have a much broader spectrum of activity than older quinolones such as nalidixic acid (NegGram).