THERAPEUTICS

Brands

• Sanomigran

Generic?

• Yes

Class

• Antihistamine

Commonly Prescribed for

• Migraine prophylaxis (children and adults)

• Cluster headache prophylaxis

• Treatment of serotonin syndrome

• Anxiety/social phobia

How the Drug Works

• An antihistamine and 5-HT2 receptor antagonist that is structurally related to TCAs. Has weak anticholinergic effects and may act as a calcium channel blocker at high doses. The relative importance of each action in headache prophylaxis is unclear. Prevention of cortical spreading depression may be one mechanism of action for all migraine preventatives

How Long Until It Works

• Migrainesmay 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 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 weight during treatment

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Most are related to antihistamine and anticholinergic activity

Notable AEs

• Weight gain and sedation are most common

• Nausea, weakness, dry mouth, depression, sexual dysfunction, and urinary retention

Life-Threatening or Dangerous AEs

• Increased intraocular pressure

• Rare activation of mania or suicidal ideation

• Rare increase in seizures in patients with epilepsy

• Hypersensitivity reactions

Weight Gain

• Problematic