We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
Published online by Cambridge University Press: 06 October 2020
THERAPEUTICS
Brands
• Sibelium
Generic?
• Yes
Class
• Calcium channel blocker, antihistamine
Commonly Prescribed for
(FDA approved in bold)
• Migraine prophylaxis
• Hemiplegic migraine prophylaxis
• Vasospasm in subarachnoid hemorrhage
• Adjunctive drug for epilepsy
• Vertigo
• Alternating hemiplegia of childhood
• Gilles de la Tourette syndrome
• Tinnitus
How the Drug Works
• Migraine/cluster: proposed prior mechanisms included inhibition of smooth muscle contraction preventing arterial spasm and hypoxia, prevention of vasoconstriction or platelet aggregation, and alterations of serotonin release and uptake.
• Prevention of cortical spreading depression may be one mechanism of action for all migraine preventives
• May also interact with other neurotransmitters, and may inhibit the synthesis and release of nitric oxide
• The drug also appears to act by blocking dopamine D2 receptors in a manner similar to antipsychotics
How Long Until It Works
• Migraines may decrease in as little as 2 weeks, but can take up to 2 months to see full effect
If It Works
• Migraine: goal is a 50% or greater decrease in migraine frequency or severity. Consider tapering or stopping if headaches remit for more than 6 months or if patient considering pregnancy
If It Doesn't Work
• Increase to highest tolerated dose
• Migraine: address other issues, such as medication overuse, other coexisting medical disorders, such as anxiety, and consider changing to another agent or adding a second agent
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Migraine: for some patients with migraine, low-dose polytherapy with 2 or more drugs may be better tolerated and more effective than high-dose monotherapy. May use in combination with AEDs, antidepressants, natural products, and non-medication treatments, such as biofeedback, to improve headache control
Tests
• Monitor ECG for PR interval
ADVERSE EFFECTS (AEs)
How the Drug Causes AEs
• Direct effects of calcium receptor antagonism and other CNS receptors. Antihistaminic properties likely cause weight gain and sedation. D2 blockade can cause movement disorders
Notable AEs
• Sedation, depression, weight gain are most problematic
• Nausea, dry mouth, gingival hyperplasia, weakness, muscle aches, and abdominal pain can occur
To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
