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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Donna Louise on May 8, 2006, at 6:25:43
Hi fellow sufferers, so sorry if you are sinking in this same boat with me. But if you have found a med to plug the leak I surely need to know what it is. Since starting the patch I have been unable to take the triptans that stop my migraines and I have never found anything else that will. Last night I almost had my husband take me to the ER so they could at least knock me unconscious before I did it myself. I am better this morning, but I feel it,just biding its time waiting to pounce on me again. These things can go 3-5 days. I see the neuro surgeon on Thurs. as I have some neck stuff happening and my pdoc on Friday. She will want to put me on a mood stabilizer preventive and we have had tried topamax but that cause leakage problems and I am not pregnant if you know what I mean. Anyway, what took me so long to ask? (Besides being incapicited) Babblers are the ones who know.
Thanks for any help,
donna
Posted by gardenergirl on May 8, 2006, at 8:29:20
In reply to MAOI's and Migraine Medications-Big Help Needed, posted by Donna Louise on May 8, 2006, at 6:25:43
I'm sorry about the complication with your migraine meds, and I wish I had some specific advice to offer. Just empathy, really. I used to get them fairly regularly. They're just awful. Strangely, after going on Nardil, they have pretty much disappeared. I think I've had two, maybe three full blown ones in the last two years, and only a couple other milder ones.
I have no idea if Ensam might have a similar effect, but I hope you find a good approach to relief. They're so debilitating.
Take care,
gg
Posted by Donna Louise on May 8, 2006, at 10:15:02
In reply to Re: MAOI's and Migraine Medications-Big Help Needed » Donna Louise, posted by gardenergirl on May 8, 2006, at 8:29:20
> I'm sorry about the complication with your migraine meds, and I wish I had some specific advice to offer. Just empathy, really. I used to get them fairly regularly. They're just awful. Strangely, after going on Nardil, they have pretty much disappeared. I think I've had two, maybe three full blown ones in the last two years, and only a couple other milder ones.
>
> I have no idea if Ensam might have a similar effect, but I hope you find a good approach to relief. They're so debilitating.
>
> Take care,
>
> ggThanks for the empathey! That helps too. I have read that sometimes and MAOI is prescribed for migrains. Maybe after I am on this patch for awhile that will take care of it.
Thanks again gg,
Donna
Posted by ed_uk on May 8, 2006, at 12:56:19
In reply to MAOI's and Migraine Medications-Big Help Needed, posted by Donna Louise on May 8, 2006, at 6:25:43
Hi
Here is some useful information by Stewart J. Tepper, MD...........
Triptans and MAOIs
The enzyme monoamine oxidase (MAO) breaks down some or all of four triptans: almotriptan (Axert), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). At the same time, some antidepressants can be used as anti-migraine drugs and work by inhibiting MAO (MAOIs). These MAOI antidepressants include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). If you are taking one of these drugs, it inhibits the very enzyme your body needs to break down certain triptans.
As a result, the FDA recommends not using three triptans with MAOIs: rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). Instead, it seems prudent to use triptans that are not broken down by MAO: eletriptan (Relpax), frovatriptan (Frova), and naratriptan (Amerge). Another option is almotriptan (Axert). Because almotriptan can be eliminated in several ways, its interaction with an MAOI is not of consequence.
Ed
Posted by Phillipa on May 8, 2006, at 19:11:43
In reply to Triptans and MAOIs » Donna Louise, posted by ed_uk on May 8, 2006, at 12:56:19
Ed where did you learn all that? Love PJO
Posted by Donna Louise on May 8, 2006, at 20:45:06
In reply to Triptans and MAOIs » Donna Louise, posted by ed_uk on May 8, 2006, at 12:56:19
> Hi
>
> Here is some useful information by Stewart J. Tepper, MD...........
>
> Triptans and MAOIs
>
> The enzyme monoamine oxidase (MAO) breaks down some or all of four triptans: almotriptan (Axert), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). At the same time, some antidepressants can be used as anti-migraine drugs and work by inhibiting MAO (MAOIs). These MAOI antidepressants include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). If you are taking one of these drugs, it inhibits the very enzyme your body needs to break down certain triptans.
>
> As a result, the FDA recommends not using three triptans with MAOIs: rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). Instead, it seems prudent to use triptans that are not broken down by MAO: eletriptan (Relpax), frovatriptan (Frova), and naratriptan (Amerge). Another option is almotriptan (Axert). Because almotriptan can be eliminated in several ways, its interaction with an MAOI is not of consequence.
>
> Edoh thank you thank you, I can't thank you enough. This info goes straight to the pdoc. Shouldn't they know?? I think mine at least knows that an MAOI can help. Maybe with more time this patch I am now on will solve the problem but in the meantime I am getting one of these pronto.
Donna
Posted by ed_uk on May 9, 2006, at 16:36:17
In reply to Re: Triptans and MAOIs » ed_uk, posted by Donna Louise on May 8, 2006, at 20:45:06
Hi DL
The information I provided was written by Stewart Tepper MD. He is the Director of the New England Center for Headache.
The major problem with combining MAOIs with triptans is that the combination has received very little study, which has lead some doctors to avoid combining the two drugs based on the possibility that an interaction might occur.
Almotriptan (Axert) seems like a suitable triptan to use with MAOIs, since it does not cross the blood brain barrier.
Ed
Posted by Donna Louise on May 9, 2006, at 23:00:15
In reply to Re: Triptans and MAOIs » Donna Louise, posted by ed_uk on May 9, 2006, at 16:36:17
I am taking all this infor to the pdoc. I will ask for Axert. Hopefully the patch itself will keep the migraines at bay.
I thought the reason you couldn't take a triptan with an MAOI is because the triptan (drug) needed the MAO to deanimate it and my brain would be rife with triptans. Like a seratonin crash would happen or something.Donna
Posted by ed_uk on May 10, 2006, at 9:43:02
In reply to Re: Triptans and MAOIs » ed_uk, posted by Donna Louise on May 9, 2006, at 23:00:15
>I thought the reason you couldn't take a triptan with an MAOI is because the triptan (drug) needed the MAO to deamimate it and my brain would be rife with triptans.
The interaction between MAOIs and rizatriptan seems to be the greatest. Nevertheless, when rizatriptan was given with moclobemide (an MAOI) in a clinical study, no unusual side effects occured, despite the increased blood levels of rizatriptan. Still, I would not recommend combining rizatriptan with an MAOI, because the blood level of rizatriptan is significantly increased.
MAOIs don't affect the metabolism of Axert very much at all. RE the interaction between moclobemide (an MAOI) and Axert, the manufacturer of Axert says:
'No clinically significant interactions were observed'
Almotriptan (Axert) seems like a good choice for two reasons:
1. The blood level of almotriptan is only slightly increased by MAOIs.
2. Almotriptan does not enter the brain in significant quantities. This might theoretically reduce the risk of a 'central' interaction between almotriptan and MAOIs, although there is no evidence that such an interaction can occur. Triptans work on the blood vessels, not on the brain itself. Some triptans (eg. sumatriptan and almotriptan) do not enter the brain. Other triptans (eg. eletriptan) enter the brain much more readily.
Ed
Posted by Donna Louise on May 10, 2006, at 21:41:30
In reply to Re: Triptans and MAOIs » Donna Louise, posted by ed_uk on May 10, 2006, at 9:43:02
> >I thought the reason you couldn't take a triptan with an MAOI is because the triptan (drug) needed the MAO to deamimate it and my brain would be rife with triptans.
>
> The interaction between MAOIs and rizatriptan seems to be the greatest. Nevertheless, when rizatriptan was given with moclobemide (an MAOI) in a clinical study, no unusual side effects occured, despite the increased blood levels of rizatriptan. Still, I would not recommend combining rizatriptan with an MAOI, because the blood level of rizatriptan is significantly increased.
>
> MAOIs don't affect the metabolism of Axert very much at all. RE the interaction between moclobemide (an MAOI) and Axert, the manufacturer of Axert says:
>
> 'No clinically significant interactions were observed'
>
> Almotriptan (Axert) seems like a good choice for two reasons:
>
> 1. The blood level of almotriptan is only slightly increased by MAOIs.
>
> 2. Almotriptan does not enter the brain in significant quantities. This might theoretically reduce the risk of a 'central' interaction between almotriptan and MAOIs, although there is no evidence that such an interaction can occur. Triptans work on the blood vessels, not on the brain itself. Some triptans (eg. sumatriptan and almotriptan) do not enter the brain. Other triptans (eg. eletriptan) enter the brain much more readily.
>
> Edok, so if it is ok to take Axert as it does not enter the brain, does it follow that it is ok to imitrex also since it does not enter the brain either? I also noticed on your original list of triptans ok to take was eletriptan but now you say it enters the brain more quickly than the other. Can I assume that I can't take that one either even though it is on the ok to take list? I should look each one up individually although I already did that with Axert and I could just start with that one and see if it is effective. I haven't had a headace in a few days now, maybe the patch will solve the problem..but I have gone weeks without one before just to get hit with a wave of them that just won't quit.
I sure appreciate all your help and info with this Ed.Donna
Posted by ed_uk on May 11, 2006, at 14:52:03
In reply to Re: Triptans and MAOIs » ed_uk, posted by Donna Louise on May 10, 2006, at 21:41:30
Hi
>ok, so if it is ok to take Axert as it does not enter the brain, does it follow that it is ok to imitrex also since it does not enter the brain either?
Sumatriptan (Imitrex) is predominantly metabolised by MAO, so it might not be the best choice. Still, in one study, no unusual side effects occured when sumatriptan was combined with an MAOI, despite the increased blood levels of sumatriptan. If you do decide to take sumatriptan with an MAOI, you should take a low dose eg. 25mg. The manufacturer of sumatriptan states that it is contra-indicated with MAOIs. It seems that they are attempting to protect themselves from litigation if a patient claimed that a serious interaction occured.
>I also noticed on your original list of triptans ok to take was eletriptan but now you say it enters the brain more quickly than the other.
MAOIs do not effect the metabolism of eletriptan. I suggested that almotriptan might be a safer choice than eletriptan because almotriptan does not readily cross the blood-brain barrier. Some doctors have suggested that combining triptans with MAOIs might cause the serotonin syndrome. There is no evidence that this actually occurs however. Unfortunately, few people have taken the MAOI/triptan combination so there is little reliable evidence.
>Can I assume that I can't take that one either even though it is on the ok to take list?
Difficult to say. I wouldn't recommend it personally.
Which triptans do you have at home?
Ed
Posted by Donna Louise on May 12, 2006, at 6:18:16
In reply to Re: Triptans and MAOIs » Donna Louise, posted by ed_uk on May 11, 2006, at 14:52:03
> Hi
>
> >ok, so if it is ok to take Axert as it does not enter the brain, does it follow that it is ok to imitrex also since it does not enter the brain either?
>
> Sumatriptan (Imitrex) is predominantly metabolised by MAO, so it might not be the best choice. Still, in one study, no unusual side effects occured when sumatriptan was combined with an MAOI, despite the increased blood levels of sumatriptan. If you do decide to take sumatriptan with an MAOI, you should take a low dose eg. 25mg. The manufacturer of sumatriptan states that it is contra-indicated with MAOIs. It seems that they are attempting to protect themselves from litigation if a patient claimed that a serious interaction occured.
>
> >I also noticed on your original list of triptans ok to take was eletriptan but now you say it enters the brain more quickly than the other.
>
> MAOIs do not effect the metabolism of eletriptan. I suggested that almotriptan might be a safer choice than eletriptan because almotriptan does not readily cross the blood-brain barrier. Some doctors have suggested that combining triptans with MAOIs might cause the serotonin syndrome. There is no evidence that this actually occurs however. Unfortunately, few people have taken the MAOI/triptan combination so there is little reliable evidence.
>
> >Can I assume that I can't take that one either even though it is on the ok to take list?
>
> Difficult to say. I wouldn't recommend it personally.
>
> Which triptans do you have at home?
>
> EdThe only one I have is Maxalt. It works really well for me but after having read some literature, I see it is probably the most likely one of them to give me trouble. I did some reading on the Axert and as you say, it apparantly is not contraindicated, that it only raises MAOI levels 27% and that no dosage adjustment would be necessary. As you say, alot of the elimination is via the PCY450 enzyme (or whatever those letter are..can't remember right at the moment). At any rate, I am going to ask my pdoc for some this afternoon. She is willing but careful dr. and I appreciate that. Some regular dr.'s I have talked to lately regarding other stuff (a neurosurgeon and family dr.) all seem to be shaming me for taking an MAOI. The ignorance is maddening to me, and I am sure my irritation is evident. I hate feeling like I know more than dr.'s about some things. Under the irritation is fear which is a good thing too I guess, makes me a very proactive patient and I don't care if they like it or not. excuse me, I am getting off an a rant, wrong board.
Hey, but back on the subject, I so appreciate you and other babblers that make my able to be proactive and get what I need to make this rocky road a littel smoother.Donna
Posted by ed_uk on May 12, 2006, at 12:57:53
In reply to Re: Triptans and MAOIs » ed_uk, posted by Donna Louise on May 12, 2006, at 6:18:16
Hi Donna
Are there any other drugs apart from triptans which have been effective in relieving your migraines? Some people respond well to NSAIDs eg. ibuprofen 800mg. Other people respond well to certain neuroleptics eg. prochlorperazine (Compazine) - both for the pain and the nausea.
Ed
This is the end of the thread.
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