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A recent report has questioned the safety of sumatriptan in asthmatic migraineurs. To investigate this, we have reviewed the sumatriptan clinical trial safety database of over 75 completed trials. Within the clinical trial database, 375 asthmatic patients were identified who treated 1214 migraine attacks with sumatriptan. The incidence and nature of adverse events in the asthmatic patient subgroup who received sumatriptan was similar to that in the complete clinical trial population. Six reports of asthma were recorded as adverse events, but only one case was classified by the investigator as related to treatment. There is no clinical or pharmacological evidence to suggest that the safety profile of sumatriptan is altered in asthmatic patients compared to other migraine sufferers.

EDITOR,-John A Henry's editorial' and Ibrahim H Fahal and colleagues' drug point2 highlight a growing medical problem arising from the recreational misuse of ecstasy (3,4-methylenedioxymethamphetamine or MDMA). For each relatively rare and major complication of ecstasy, however, we suspect that many lesser events will go unrecorded. These will take their silent toll of the people concerned and consume valuable resources in medical institutions.Two young men were brought to the accident and emergency department at this hospital by ambulance. The first was aged 18 and had suffered a fit after taking ecstasy. He admitted to having had a fit one month earlier, also after misuse of ecstasy. Examination showed a sinus tachycardia but no other abnormality. He discharged himself from casualty. The second patient collapsed after complaining of a headache and was carried in on a stretcher. We suspected that he had had a fit, but no eye witnesses accompanied him. He was drowsy but scored 15 on the Glasgow coma scale. He had a tachycardia and both biochemical and electrocardiographic evidence of hyperkalaemia. He was given activated charcoal and admitted for overnight observation. On discharge the next morning he stated that his experience would not stop him using ecstasy again.We suspect that many acute hospitals throughout the country could relate similar stories. Although reports of chronic psychosis and acute rhabdomyolysis associated with misuse of ecstasy give cause for concern, we believe that the main burden for hospital and ambulance services will be the more mundane and often unreported effects of acute intoxication.

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