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Updates: Migraine, Depression, Hypertension Drugs

Worst Pills, Best Pills Newsletter article December, 2012

In this issue of Worst Pills, Best Pills News, we include a few of the most important recent updates to the website.

Migraine

Drug name: almotriptan (AXERT), eletriptan (RELPAX), frovatriptan (FROVA), naratriptan (AMERGE), rizatriptan (MAXALT, MAXALT MLT), sumatriptan (IMITREX) and zolmitriptan (ZOMIG, ZOMIG ZMT)
Mechanism of action: These drugs, called triptans, are thought to work by narrowing swollen blood vessels in the brain that, when overdilated,...

In this issue of Worst Pills, Best Pills News, we include a few of the most important recent updates to the website.

Migraine

Drug name: almotriptan (AXERT), eletriptan (RELPAX), frovatriptan (FROVA), naratriptan (AMERGE), rizatriptan (MAXALT, MAXALT MLT), sumatriptan (IMITREX) and zolmitriptan (ZOMIG, ZOMIG ZMT)
Mechanism of action: These drugs, called triptans, are thought to work by narrowing swollen blood vessels in the brain that, when overdilated, cause migraine pain.
Indications: Triptans are the newest family of drugs used to treat migraine headaches in adults.
Latest update: In March 2012, the FDA issued an advisory that overuse (use for 10 or more days per month) of acute migraine drugs, including triptans, may lead to an exacerbation of headache known as medication overuse headache (MOH). Patients using these drugs for migraine headaches should be aware of MOH and are advised to keep records of headache frequency.


Depression

Drug name: citalopram (CELEXA)
Mechanism of action: Citalopram is a member of the family of drugs known as selective serotonin reuptake inhibitors (SSRIs).
Indications: The FDA has approved SSRIs for major depressive disorder, and some are approved to treat obsessive-compulsive disorder, bulimia, panic disorder, social anxiety disorder and post-traumatic stress disorder.
Latest update: The FDA issued an August 2011 advisory that citalopram should not be used at doses greater than 40 milligrams per day. At this dosage, the drug could cause abnormal changes in the electrical activity of the heart (prolongation of the “QT interval”), possibly leading to an abnormal heart rhythm, which could be fatal. Patients who were born with long QT syndrome may be at risk for increased heart rate and sudden death. The advisory also stated that studies have not shown that doses greater than 40 mg benefit patients being treated for depression.
A March 2012 revision to the FDA label indicates that patients older than 60 years, those taking cimetidine and those with liver impairment should not take doses greater than 20 mg.
Patients should notify a health care professional immediately if they experience dizziness, palpitations or fainting.

Drug name: mirtazapine (REMERON, REMERON SOLTAB)
Mechanism of action: Mirtazapine works by blocking receptors of the neurotransmitters serotonin and norepinephrine.
Indication: Mirtazapine is indicated to treat major depressive disorders.
Latest update: In December 2011, the FDA updated mirtazapine’s product label to include information on neuroleptic malignant syndrome (NMS). The agency stated that NMS has been reported in patients using certain drugs as their sole therapy (e.g., SSRIs, selective norepinephrine reuptake inhibitors, monoamine oxidase inhibitors [MAOIs] or other serotonergic drugs), but particularly when used at the same time as serotonergic drugs that impair metabolism of serotonin, such as MAOIs, antipsychotics or other dopamine antagonists.
NMS is a life-threatening condition. Symptoms can include:
  • extremely high body temperature
  • heavy sweating
  • fast heart rate
  • rapidly fluctuating blood pressure
  • impaired consciousness
  • tremor
  • rigid, stiff muscles
  • mental changes (agitation, hallucination, coma)
  • nausea, vomiting, diarrhea


Hypertension

Drug name: olmesartan (BENICAR)
Mechanism of action: Olmesartan is one of seven angiotensin receptor blockers on the market in the U.S.
Indications: Olmesartan is used to lower high blood pressure.
Latest update: In February 2012, the FDA updated the product information for olmesartan to include data on pediatric use, stating that olmesartan should not be used to treat hypertension in children younger than 1 year old because it can affect the development of immature kidneys.