Coronary Side-Effect Potential of Current and Prospective Antimigraine Drugs

MaassenVanDenBrink, Antoinette; Reekers, Marije; Bax, Willem A.; Ferrari, Michel D.; Saxena, Pramod R.

doi:10.1161/01.cir.98.1.25

Cited by 297 publications

(233 citation statements)

References 39 publications

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“…A major disadvantage of triptans is the threat of coronary vasoconstriction (MaassenVanDenBrink et al 1998), implying that these drugs should not be administered to patients with coronary or cerebrovascular disease (Dodick et al 2004;Tepper 2001).…”

Section: -Ht 1 Receptor Subtypesmentioning

confidence: 99%

“…Thus, these subtypes should not be explored for the development of novel antimigraine drugs, although such subtype-selective antagonists might be desirable antihypertensive agents. Therefore, a selective α 1B -adrenoceptor agonist could have advantages over the currently available acute antimigraine drugs, which all constrict the human isolated coronary artery (MaassenVanDenBrink et al 1998;MaassenVanDenBrink et al 2000).…”

Section: Adrenoceptorsmentioning

confidence: 99%

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Current and prospective pharmacological targets in relation to antimigraine action

Mehrotra

Gupta

Chan

et al. 2008

Naunyn-Schmied Arch Pharmacol

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Migraine is a recurrent incapacitating neurovascular disorder characterized by unilateral and throbbing headaches associated with photophobia, phonophobia, nausea, and vomiting. Current specific drugs used in the acute treatment of migraine interact with vascular receptors, a fact that has raised concerns about their cardiovascular safety. In the past, α-adrenoceptor agonists (ergotamine, dihydroergotamine, isometheptene) were used. The last two decades have witnessed the advent of 5-HT 1B/1D receptor agonists (sumatriptan and second-generation triptans), which have a well-established efficacy in the acute treatment of migraine. Moreover, current prophylactic treatments of migraine include 5-HT 2 receptor antagonists, Ca 2+ channel blockers, and β-adrenoceptor antagonists. Despite the progress in migraine research and in view of its complex etiology, this disease still remains underdiagnosed, and available therapies are underused. In this review, we have discussed pharmacological targets in migraine, with special emphasis on compounds acting on 5-HT (5-HT 1-7 ), adrenergic (α 1 , α 2, and β), calcitonin gene-related peptide (CGRP 1 and CGRP 2 ), adenosine (A 1 , A 2 , and A 3 ), glutamate (NMDA, AMPA, kainate, and metabotropic), dopamine, endothelin, and female hormone (estrogen and progesterone) receptors. In addition, we have considered some other targets, including gamma-aminobutyric acid, angiotensin, bradykinin, histamine, and ionotropic receptors, in relation to antimigraine therapy. Finally, the cardiovascular safety of current and prospective antimigraine therapies is touched upon.

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Section: -Ht 1 Receptor Subtypesmentioning

confidence: 99%

Section: Adrenoceptorsmentioning

confidence: 99%

Current and prospective pharmacological targets in relation to antimigraine action

Mehrotra

Gupta

Chan

et al. 2008

Naunyn-Schmied Arch Pharmacol

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“…[15][16][17] In order to overcome this problem of "confounding by contraindication," we included ASA users as the control group. Despite these limitations, we feel that the observed reduction in therapeutic intensity of abortive migraine drug use during coumarin therapy is a true phenomenon and unbiased.…”

Section: Commentsmentioning

confidence: 99%

Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy

et al. 2001

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Objective.-To investigate the impact of coumarin therapy on migraine attack frequency. Background.-Sporadic case reports and clinical studies have described beneficial effects of coumarin therapy on migraine severity.Design and Methods.-A retrospective follow-up study based on a prescription database covering a population of 450000 was conducted. All patients using an abortive migraine drug (ergotamine or sumatriptan) and subsequently treated with either coumarin (index group) or low-dose acetylsalicylic acid (control group) were analyzed. The impact of coumarin and low-dose acetylsalicylic acid on the frequency of migraine attacks was assessed by measuring the intensity of ergotamine and sumatriptan use, in defined daily doses per month per patient, before and during coumarin or acetylsalicylic acid treatment. In addition, a "therapeutic intensity reduction" was determined for each patient.Results.-The study population consisted of 92 patients; 35% had been prescribed coumarin and 65% had been prescribed low-dose acetylsalicylic acid after the initiation of ergotamine or sumatriptan. Two thirds of the study population was treated with ergotamine. Overall, ergotamine and sumatriptan use for the coumarin cohort decreased from 6.4 defined daily doses per month prior to coumarin treatment to 3.0 defined daily doses during coumarin treatment, compared with a reduction from 5.2 defined daily doses per month to 4.4 defined daily doses per month for the lowdose acetylsalicylic acid cohort ( P Ͼ .05). The therapeutic intensity of ergotamine and sumatriptan use was significantly decreased by 40% for the coumarin cohort, compared with 4.7% for the low-dose acetylsalicylic acid cohort (P ϭ .004).Conclusions.-We observed that coumarin treatment was clearly associated with a reduction in the therapeutic intensity of abortive migraine drug use in comparison with low-dose aspirin treatment. This suggests that, overall, the coumarin cohort had experienced a substantial reduction in the frequency of migraine attacks during anticoagulation treatment. Our findings, as well as those of others, justify a controlled clinical trial to further establish the effects of coumarin therapy on migraine severity and its possible role in the prophylactic management of patients suffering from migraine. Key words: anticoagulation, impact, migraine, ergotamine, sumatriptan, consumption Abbreviations: DDDs defined daily doses, OAC oral anticoagulation with coumarin derivatives, ASA acetylsalicylic acid ( Headache 2001;41:768-773) A few case reports have described a complete resolution of migraine or a substantial reduction in frequency and intensity of migraine attacks in migraineurs with or without aura during treatment with oral anticoagulant drugs, such as warfarin or acenocoumarol. [1][2][3][4] In addition, a recent patient questionnaire study in 400 subjects treated with acenocoumarol for nonneurological indications revealed that oral anticoagulation produced improvement of headache in 63% of patients with migraine versus 38% of patients w...

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“…There is obviously a concern about the contractile effect of triptans on the human coronary artery (reviewed by MaassenVanDenBrink et al [30]). However, this effect of triptans is fortunately much weaker than that on human cerebral vessels [5,6].…”

Section: Chest Symptoms and Coronary Artery Constrictionmentioning

confidence: 99%

“…However, these drugs must remain contraindicated in patients with stenosed or hyperreactive coronary arteries [30,31].…”

Section: Chest Symptoms and Coronary Artery Constrictionmentioning

confidence: 99%

Success and failure of triptans

Saxena¹,

Tfelt‐Hansen

2001

J Headache Pain

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Coronary Side-Effect Potential of Current and Prospective Antimigraine Drugs

Cited by 297 publications

References 39 publications

Current and prospective pharmacological targets in relation to antimigraine action

Current and prospective pharmacological targets in relation to antimigraine action

Reduction in the Intensity of Abortive Migraine Drug Use During Coumarin Therapy

Success and failure of triptans

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