Sumatriptan Delays Paracetamol Absorption in Migraine Patients

Rani, P. Usha; Naidu, M. U. R.; Rao, T Ramesh Kumar; Das, Shampa; Shobha, J. C.; Sekhar, K. Ravi; Sekhar, E. Chandra; Kumar, TN

doi:10.2165/00044011-199611050-00006

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…In one study in migraine patients outside attacks oral sumatriptan 100 mg delayed the absorption of paracetamol 1000 mg: T max was 1. 4 hours without sumatriptan vs 2.8 hours with sumatriptan (34).…”

Section: The Effect Of Sumatriptan On Gastric Emptying In Normal Indimentioning

confidence: 98%

“…Despite the fact that both subcutaneous and oral sumatriptan in therapeutic doses delays gastric emptying in healthy volunteers (28)(29)(30)(31) or delays absorption of paracetamol in migraine patients (34), there was no delayed absorption of oral sumatriptan in doses of 50 mg, 85 mg and 100 mg during migraine attacks (11,18). This apparent lack of an effect of sumatriptan on its own absorption during migraine attacks remains unexplained.…”

Section: The Effect Of Sumatriptan On Gastric Emptying In Humansmentioning

confidence: 98%

“…Several studies (2)(3)(4)34) reported a considerable delay in gastric emptying of the barium test meal whereas the examination was normal when repeated between attacks. Most likely the most extreme examples, e.g.…”

Section: Possible Delay Of Absorption Of Drugs During Migraine Attacksmentioning

confidence: 99%

“…Most likely the most extreme examples, e.g. the large residue found in the stomach six hours after an opaque meal (34), and in the reports on gastric stasis during X-ray examination (2)(3)(4)34), were published. Whether this was a more general problem during migraine attacks was unknown.…”

Section: Possible Delay Of Absorption Of Drugs During Migraine Attacksmentioning

confidence: 99%

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Delayed absorption of many (paracetamol, aspirin, other NSAIDs and zolmitriptan) but not all (sumatriptan, rizatriptan) drugs during migraine attacks and most likely normal gastric emptying outside attacks. A review

Tfelt‐Hansen

2016

Cephalalgia

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Background In most pharmacokinetic studies, the oral absorption of drugs is impaired during migraine attacks but exceptions occur. A study on gastric emptying using gastric scintigraphy indicated that gastric stasis also occurs interictally in migraine. These studies were reviewed critically. Results In seven studies, mainly investigating NSAIDs and analgesics, the early absorption of the drugs during 112 migraine attacks was delayed. The absorption of sumatriptan is usual in therapeutic doses, and rizatriptan was normal during 131 migraine attacks. The interictal gastric stasis observed using gastric emptying scintigraphy (GES) with solids ( n = 13) could not be confirmed in a larger study ( n = 27) using the same method. Also gastric emptying measured with GES with liquids ( n = 7) and epigastric impedance ( n = 64) was normal outside migraine attacks. Conclusions and possible clinical implications Drug absorption is not generally impaired during migraine attacks. Gastric emptying is most likely normal in the majority of migraine patients outside attacks. Prokinetic and antiemetic drugs such as metoclopramide and domperidone should not be routinely combined with oral analgesics or oral triptans. If, however, nausea is severe or vomiting occurs, treatment with an antiemetic with proven efficacy on the nausea of migraine can be indicated.

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Section: The Effect Of Sumatriptan On Gastric Emptying In Normal Indimentioning

confidence: 98%

Section: The Effect Of Sumatriptan On Gastric Emptying In Humansmentioning

confidence: 98%

Section: Possible Delay Of Absorption Of Drugs During Migraine Attacksmentioning

confidence: 99%

Section: Possible Delay Of Absorption Of Drugs During Migraine Attacksmentioning

confidence: 99%

See 2 more Smart Citations

Delayed absorption of many (paracetamol, aspirin, other NSAIDs and zolmitriptan) but not all (sumatriptan, rizatriptan) drugs during migraine attacks and most likely normal gastric emptying outside attacks. A review

Tfelt‐Hansen

2016

Cephalalgia

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The novel anti-migraine compound zolmitriptan (Zomig 311C90) has no clinically significant interactions with paracetamol or metoclopramide

Seaber

Ridout

Layton

et al. 1997

European Journal of Clinical Pharmacology

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Drug Interactions with Triptans

Rolan

2012

CNS Drugs

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The triptans are a group of compounds with high efficacy for the acute treatment of migraine and cluster headache. They have a relatively wide therapeutic index, and although a number of minor pharmacokinetic interactions have been observed, few are likely to be clinically significant. Given the differences in principal elimination pathways, potentially interacting drugs on a pharmacokinetic basis are not common across all compounds. Of more concern than pharmacokinetic interactions are pharmacodynamic interactions. Of most concern, additive vasoconstrictor effects are likely to occur with other vasoconstrictors, especially the ergots used for migraine. Serotonin syndrome has been observed due to coadministration of triptans with selective serotonin reuptake inhibitors (SSRIs), but the absolute rate of such a clinical response to coadministration is probably low. Most patients can take triptans with other medications without dose alteration, although vigilance is required for pharmacodynamic interactions.

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Sumatriptan Delays Paracetamol Absorption in Migraine Patients

Cited by 7 publications

References 20 publications

Delayed absorption of many (paracetamol, aspirin, other NSAIDs and zolmitriptan) but not all (sumatriptan, rizatriptan) drugs during migraine attacks and most likely normal gastric emptying outside attacks. A review

Delayed absorption of many (paracetamol, aspirin, other NSAIDs and zolmitriptan) but not all (sumatriptan, rizatriptan) drugs during migraine attacks and most likely normal gastric emptying outside attacks. A review

The novel anti-migraine compound zolmitriptan (Zomig 311C90) has no clinically significant interactions with paracetamol or metoclopramide

Drug Interactions with Triptans

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