Fixed‐Dose Sumatriptan and Naproxen in Poor Responders to Triptans With a Short Half‐Life

Mathew, Ninan T.; Landy, Stephen H.; Stark, Stuart R.; Tietjen, Gretchen E.; Derosier, Frederick J.; White, J. D.; Lener, Shelly E.; Bukenya, Deo

doi:10.1111/j.1526-4610.2009.01458.x

Cited by 41 publications

(31 citation statements)

References 43 publications

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“…In a Class I 2‐attack, crossover study of sumatriptan 85 mg/naproxen sodium 500 mg against placebo in persons with poor response to short‐acting triptans (almotriptan, eletriptan, rizatriptan, sumatriptan, or zolmitriptan), sumatriptan/naproxen sodium treatment was superior to placebo for 2‐ to 24‐hour sustained headache‐free response (study 1: 26% vs 8%; study 2: 31% vs 8%; P < .001 for both comparisons) . Headache‐free rates at 2 hours were also superior in the sumatriptan/naproxen sodium group (study 1: 40% vs 17%; study 2: 44% vs 14%; P < .001).…”

Section: Resultsmentioning

confidence: 99%

The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies

2015

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The study aims to provide an updated assessment of the evidence for individual pharmacological therapies for acute migraine treatment. Pharmacological therapy is frequently required for acutely treating migraine attacks. The American Academy of Neurology Guidelines published in 2000 summarized the available evidence relating to the efficacy of acute migraine medications. This review, conducted by the members of the Guidelines Section of the American Headache Society, is an updated assessment of evidence for the migraine acute medications. A standardized literature search was performed to identify articles related to acute migraine treatment that were published between 1998 and 2013. The American Academy of Neurology Guidelines Development procedures were followed. Two authors reviewed each abstract resulting from the search and determined whether the full manuscript qualified for review. Two reviewers studied each qualifying full manuscript for its level of evidence. Level A evidence requires at least 2 Class I studies, and Level B evidence requires 1 Class I or 2 Class II studies. The specific medications - triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan [oral, nasal spray, injectable, transcutaneous patch], zolmitriptan [oral and nasal spray]) and dihydroergotamine (nasal spray, inhaler) are effective (Level A). Ergotamine and other forms of dihydroergotamine are probably effective (Level B). Effective nonspecific medications include acetaminophen, nonsteroidal anti-inflammatory drugs (aspirin, diclofenac, ibuprofen, and naproxen), opioids (butorphanol nasal spray), sumatriptan/naproxen, and the combination of acetaminophen/aspirin/caffeine (Level A). Ketoprofen, intravenous and intramuscular ketorolac, flurbiprofen, intravenous magnesium (in migraine with aura), and the combination of isometheptene compounds, codeine/acetaminophen and tramadol/acetaminophen are probably effective (Level B). The antiemetics prochlorperazine, droperidol, chlorpromazine, and metoclopramide are probably effective (Level B). There is inadequate evidence for butalbital and butalbital combinations, phenazone, intravenous tramadol, methadone, butorphanol or meperidine injections, intranasal lidocaine, and corticosteroids, including dexamethasone (Level C). Octreotide is probably not effective (Level B). There is inadequate evidence to refute the efficacy of ketorolac nasal spray, intravenous acetaminophen, chlorpromazine injection, and intravenous granisetron (Level C). There are many acute migraine treatments for which evidence supports efficacy. Clinicians must consider medication efficacy, potential side effects, and potential medication-related adverse events when prescribing acute medications for migraine. Although opioids, such as butorphanol, codeine/acetaminophen, and tramadol/acetaminophen, are probably effective, they are not recommended for regular use.

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Section: Resultsmentioning

confidence: 99%

The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies

2015

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“…Based on preclinical studies, sumatriptan and naproxen were proposed to target different pathophysiological events of migraine. 24 For example, sumatriptan is thought to function at the level of the trigeminal ganglion and nerve fibers to block release of CGRP, glutamate, and other pro-inflammatory mediators in peripheral tissues and in the spinal trigeminal nucleus. 39 In effect, inhibition of trigeminal nerves would block paracrine signaling in the ganglia and spinal cord and the subsequent activation of glial cells and hence, release of cytokines that would promote peripheral and central sensitization.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the primary targets of NSAIDs such as naproxen are the COX-1 and COX-2 enzymes that are responsible for the production of prostaglandins, lipid compounds that promote inflammation and pain. 21 Significantly, results from several studies have provided evidence that a single tablet of sumatriptan succinate and naproxen sodium (sumatriptan/naproxen) is superior to monotherapy for the treatment of migraine 22–24 . While it has been proposed that sumatriptan and naproxen are likely to function in different ways to treat the diverse symptoms of migraine, the relative contributions of each drug within the trigeminal system have not been extensively investigated.…”

Section: Introductionmentioning

confidence: 99%

Identification of Cytokines and Signaling Proteins Differentially Regulated by Sumatriptan/Naproxen

Vause

Durham

2011

Headache

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Summary Objectives The goal of this study was to use protein array analysis to investigate temporal regulation of stimulated cytokine expression in trigeminal ganglia and spinal trigeminal nuclei in response to cotreatment of sumatriptan and naproxen sodium or individual drug. Background Activation of neurons and glia in trigeminal ganglia and spinal trigeminal nuclei leads to increased levels of cytokines that promote peripheral and central sensitization, which are key events in migraine pathology. While recent clinical studies have provided evidence that a combination of sumatriptan and naproxen sodium is more efficacious in treating migraine than either drug alone, it is not well understood why the combination therapy is superior to monotherapy. Methods Male Sprague Dawley rats were left untreated (control), injected with capsaicin, or pre-treated with sumatriptan/naproxen, sumatriptan, or naproxen for 1 hour prior to capsaicin. Trigeminal ganglia and spinal trigeminal nuclei were isolated 2 and 24 hours after capsaicin or drug treatment and levels of 90 proteins were determined using a RayBio® Label-Based Rat Antibody Array. Results Capsaicin stimulated a >3-fold increase in expression of the majority of cytokines in trigeminal ganglia at 2 hours that was sustained at 24 hours. Significantly, treatment with sumatriptan/naproxen almost completely abolished the stimulatory effects of capsaicin at 2 and 24 hours. Capsaicin stimulated >3-fold expression of more proteins in spinal trigeminal nuclei at 24 hours when compared to 2 hours. Similarly, sumatriptan/naproxen abolished capsaicin stimulation of proteins in spinal trigeminal nuclei at 2 hours and greatly suppressed protein expression 24 hours post capsaicin injection. Interestingly, treatment with sumatriptan alone suppressed expression of different cytokines in trigeminal ganglia and spinal trigeminal nuclei than repressed by naproxen sodium. Conclusion We found that the combination of sumatriptan/naproxen was effective in blocking capsaicin stimulation of pro-inflammatory proteins implicated in the development of peripheral and central sensitization in response to capsaicin activation of trigeminal neurons. Based on our findings that sumatriptan and naproxen regulate expression of different proteins in trigeminal ganglia and spinal trigeminal nuclei, we propose that these drugs function on therapeutically distinct cellular targets to suppress inflammation and pain associated with migraine.

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“…New combination preparations, such as sumatriptan with naproxen sodium, have shown additive effects in improving pain relief and migraine-associated symptoms, such as phonophobia, photophobia, and nausea, when compared with monotherapy, as well as good tolerability in the acute management of migraine 138,139…”

Section: Headachementioning

confidence: 99%

Orofacial pain management: current perspectives

Romero‐Reyes¹,

Uyanik²

2014

JPR

200

121

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Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

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Fixed‐Dose Sumatriptan and Naproxen in Poor Responders to Triptans With a Short Half‐Life

Cited by 41 publications

References 43 publications

The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies

The Acute Treatment of Migraine in Adults: The American Headache Society Evidence Assessment of Migraine Pharmacotherapies

Identification of Cytokines and Signaling Proteins Differentially Regulated by Sumatriptan/Naproxen

Orofacial pain management: current perspectives

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