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Gastrokinetic Drug Improves Efficacy of Triptan Therapy for Migraines
Adding trimebutine, a drug that promotes gastric emptying, to rizatriptan therapy appears to hasten the resolution of migraine attacks, according to a recent report.
Gastric paralysis, which is common during migraine attacks, can delay the onset of action for orally administered agents. This is particularly relevant for triptans, which seem to work best during the early stages of an attack. Therefore, use of a gastrokinetic agent could potentially improve the efficacy of triptan therapy.
Trimebutine, which is used to treat irritable bowel syndrome, is an opioid derivative with effects on Meissner and Auerbach plexus receptors throughout the GI tract. The drug is not absorbed.
In a crossover study, Dr. Abouch V. Krymchantowski, from Hospital Pasteur in Rio de Janeiro, Brazil, and colleagues assessed the outcomes of 40 patients who were randomized to treat two consecutive migraine attacks with rizatriptan (10 mg) plus either trimebutine (200 mg) or placebo.
A total of 64 attacks were treated with each of the regimens, the report in the July issue of Cephalalgia indicates. Within 1 hour of dosing, 30 (46.8%) of the attacks treated with the drug combination had resolved compared with just 8 (12.5%) of the attacks treated with rizatriptan monotherapy (p < 0.01). At 2 hours, the difference persisted with corresponding resolution rates of 73.4% and 31.2% (p < 0.001).
Rizatriptan plus trimebutine was also significantly better than rizatriptan alone at resolving the nausea and photophobia accompanying the migraines. Migraine recurrence and adverse events were similar with each of the regimens.
Regarding trimebutine, the authors comment, "We believe that this well-tolerated opioid peripheral agonist may represent an additional resource in the available arsenal to treat migraine attacks. In an era of potential new agents for the acute treatment of migraine, raising the efficacy of already safe and available drugs through the combination of traditional medications may represent an attractive option."