- Where do migraine episodes come from?
- How do triptans work?
- Are triptans safe?
- Are triptans effective?
- When are triptans used?
- Triptans available at the pharmacy
- Forms of administration of triptans
- Triptans: side effects
- When are triptans not allowed?
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Triptans are a relatively new group of chemicals that are used to treat migraine attacks. The introduction of preparations containing triptans to the pharmaceutical market is considered a breakthrough in the treatment of migraine. Are triptans effective drugs? What are the risks of using them?
The name " triptans " derives from the structure of tryptamine contained in their chemical formulas. The appearance of preparations from this group in medicine was a huge change in the lives of many patients suffering from migraine. This was due to the fact that the number of drugs effective in the treatment of this disease, before the introduction of triptans, was small. The lack of effective drugs for this disease results from a poor understanding of the mechanism of its formation.
Where do migraine episodes come from?
It is now believed that the predisposition to migraine attacks is genetically inherited. They result from individual neurovascular hyperresponsiveness. It is believed that the underlying cause of this tendency may be the malfunctioning of receptors in the cerebral cortex or of neurons regulating cerebral flow.
According to the hypothesis of the vascular origin of migraine, attacks are associated with excessive vasoconstriction in the first stage, causing aura, and their intense relaxation in the second stage, which is responsible for pain. The cause of this process is not fully understood, but it is believed that it is associated with the increased secretion of serotonin.
How do triptans work?
The activity of triptans is mainly due to their ability to attach to serotonin receptors. As a consequence, they cause the blood vessels in the brain to contract. As previously mentioned, pain attacks in migraine are associated with the expansion of cerebral vessels. Triptans also inhibit the release of serotonin at the synapses of nerve fibers.
In addition, these drugs inhibit conduction in the part of the trigeminal nerve responsible for delivering sensory stimuli from the eye and the eye socket. As a result, triptans reduce headache and photophobia.
Are triptans safe?
Unfortunately, the action of triptans is not limited to the area of the central nervous system. The blood vessels in the lungs and the coronary vessels in the heart are also contracted by the agonist attachment of the drug to serotonin receptors.
It is estimated thatTriptans are safe drugs for people who have no heart problems. It is not recommended to use them for people suffering from cardiovascular diseases.
Triptans have been launched quite recently. Therefore, knowledge about their long-term use is limited. The safety of this group of drugs is still questionable.
It is not recommended to use triptans during aura symptoms. At this stage, vasoconstriction occurs, which will be further strengthened by these drugs. The use of the preparation will enhance unpleasant sensations, instead of weakening them.
Are triptans effective?
The introduction of triptans to the pharmaceutical market was a huge commercial and clinical success. Unfortunately, in medical practice it turned out that some patients did not respond to drugs from this group. Triptans have also shown the ability to aggravate headaches when overused.
The effectiveness of this group of drugs is debatable. On the one hand, they are widely considered to be the best-working preparations for migraine attacks, on the other hand, some specialists claim that their effectiveness is not greater than that of painkillers from the NSAID group.
Research shows that the best therapeutic effect comes from combining triptan with an NSAID type drug.
When are triptans used?
Triptans are drugs that are used to stop episodes of migraines. They are not applicable in the prevention of attacks. The highest effectiveness is achieved by using these preparations at the very beginning of the episode, when the symptoms are not obvious. The best results are achieved by administering triptans in the first hour of a migraine attack.
However, remember not to take drugs from this group during the aura symptoms, and only after they disappear.
Triptans available at the pharmacy
Currently, seven substances from the triptan group have been introduced to treatment:
- Sumatryptan
- Frowatryptan
- Almotryptan
- Zolmitryptan
- Naratryptan
- Rizatriptan
- Eletryptan
The most popular and well-studied drugs are sumatriptan and rizatriptan.
Forms of administration of triptans
Triptans can be administered in the form of tablets, injection solutions, nasal sprays and suppositories. These forms differ in terms of the speed of action and the degree of bioavailability.
For example, sumatriptan is available on the Polish pharmaceutical market in the form of tablets, coated tablets, injection solutions and nasal sprays.
In the situation where this drug is administered subcutaneously, the therapeutic effect is observed after about 15 daysminutes. After a similar amount of time, a dose in the nasal spray works. In the case of an orally administered drug, it is necessary to wait 30 minutes for the therapeutic effect.
The bioavailability of sumatriptan also varies depending on the form of administration. It is 96% when administered subcutaneously, 14% orally, and 16% when administered intranasally.
The most popular form of administration, however, are still tablets due to the ease of storage and use.
Triptans: side effects
The most common side effects of triptans are:
- nausea
- chest tightness
- dizziness
- sensory disturbance
- increase in blood pressure
- feeling hot
- flushing
When are triptans not allowed?
Triptans are contraindicated in diseases such as:
- severe hypertension
- ischemic heart disease
- Prinzmetal's gland
As well as:
- in peripheral vascular diseases
- after heart attack or stroke
- in patients with severe hepatic insufficiency
Sara Janowska, MA in pharmacyPhD student of interdisciplinary doctoral studies in the field of pharmaceutical and biomedical sciences at the Medical University of Lublin and the Institute of Biotechnology in Białystok. A graduate of pharmaceutical studies at the Medical University of Lublin with a specialization in Plant Medicine. She obtained a master's degree defending a thesis in the field of pharmaceutical botany on the antioxidant properties of extracts obtained from twenty species of mosses. Currently, in his research work, he deals with the synthesis of new anti-cancer substances and the study of their properties on cancer cell lines. For two years she worked as a master of pharmacy in an open pharmacy.