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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 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.

Med Lett Drugs Ther. 2023 Jun 12;65(1678):89-96 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 2022 Dec 12;64(1665):193-200 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 2022 Mar 7;64(1645):33-40 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 2020 Nov 16;62(1611):180-1 | Show Full Introduction Hide Full Introduction

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 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.

Med Lett Drugs Ther. 2020 Oct 5;62(1608):153-60 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 2018 Feb 12;60(1540):24-32 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 2017 May 22;59(1521):86-8 | Show Full Introduction Hide Full Introduction

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 of a triptan early in an attack when pain is still mild to moderate in intensity improves headache response and reduces recurrence rates.

Med Lett Drugs Ther. 2017 Feb 13;59(1514):27-32 | Show Full Introduction Hide Full Introduction

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.

Treat Guidel Med Lett. 2013 Dec;11(136):107-12 | Show Full Introduction Hide Full Introduction

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 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.

Treat Guidel Med Lett. 2013 Apr;11(128):31-42 | Show Full Introduction Hide Full Introduction

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...

Treat Guidel Med Lett. 2011 Feb;9(102):7-12 | Show Full Introduction Hide Full Introduction

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 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.

Treat Guidel Med Lett. 2010 Apr;8(92):25-34 | Show Full Introduction Hide Full Introduction

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 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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Med Lett Drugs Ther. 2008 Dec 15;50(1301):100-3 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 2008 Jun 16;50(1288):45-6 | Show Full Introduction Hide Full Introduction

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...

Treat Guidel Med Lett. 2008 Mar;6(67):17-22 | Show Full Introduction Hide Full Introduction

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 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.

Treat Guidel Med Lett. 2007 Apr;5(56):23-32 | Show Full Introduction Hide Full Introduction

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; 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.

Treat Guidel Med Lett. 2004 Sep;2(25):63-6 | Show Full Introduction Hide Full Introduction

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 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.

Treat Guidel Med Lett. 2004 Jul;2(23):47-54 | Show Full Introduction Hide Full Introduction

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 interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.

Med Lett Drugs Ther. 2003 Jun 8;45(1158):46-8 | Show Full Introduction Hide Full Introduction

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 unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

Med Lett Drugs Ther. 2002 Jul 8;44(1134):59-62 | Show Full Introduction Hide Full Introduction

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 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.

Med Lett Drugs Ther. 2000 Aug 21;42(1085):73-8 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 1999 Jul 2;41(1056):59-62 | Show Full Introduction Hide Full Introduction

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...

Med Lett Drugs Ther. 1998 Oct 9;40(1037):97-100 | Show Full Introduction Hide Full Introduction

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 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.

Med Lett Drugs Ther. 1998 Aug 14;40(1033):79-84 | Show Full Introduction Hide Full Introduction

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).

Med Lett Drugs Ther. 1995 Aug 18;37(955):73-4 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 1995 Jul 7;37(952):59-60 | Show Full Introduction Hide Full Introduction

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 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).

Med Lett Drugs Ther. 1995 Mar 3;37(943):17-20 | Show Full Introduction Hide Full Introduction

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 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).

Med Lett Drugs Ther. 1993 Jan 8;35(887):1-6 | Show Full Introduction Hide Full Introduction

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.

Med Lett Drugs Ther. 1990 Jun 29;32(821):63 | Show Full Introduction Hide Full Introduction

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...

Med Lett Drugs Ther. 1988 Jul 29;30(771):74-6 | Show Full Introduction Hide Full Introduction

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).

Med Lett Drugs Ther. 1988 Jan 29;30(758):11-3 | Show Full Introduction Hide Full Introduction