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Topic: Mood-stabilizing drugs for cluster: basic info (Read 863 times) |
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Bob_Johnson
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Mood-stabilizing drugs for cluster: basic info
« on: Nov 21st, 2003, 8:07am » |
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From: HEADACHE & PAIN, November 2003
Lithium in cluster headache prophylaxis. The mechanism by which lithium is effective in cluster headaches is poorly understood. However, it is likely that this agent exerts its effects by altering sodium channels in the nervous system, thereby modifying hyperexcitability of neuronal tissues.
The typical initial dosage is 300 mg tid. The dosage can be adjusted to achieve optimal control and tolerability. In most cases, serum lithium levels are lower than that needed to control the manic phase of bipolar illness. Often, a blood level of less than 0.6 mEq/L proves adequate for cluster headache prophylaxis.
Because there is considerable individual variability in metabolism and excretion of lithium, it is important to monitor blood levels of the drug, which should be maintained at less than 1.2 mEq/L to avoid toxicity. Patients who take lithium should avoid thiazide-type diuretics and maintain adequate salt intake to minimize the risk of toxicity.
On rare occasions, lithium affects thyroid function. A baseline thyroid profile should therefore be obtained before therapy is initiated. Side effects tend to be dose-related and, in most cases, are more annoying than serious. A fine motor tremor and decreased coordination are common. These disappear after the drug is withdrawn.
Treatment. The dosage of divalproex is low compared with that needed to control seizures or mood disorders; 500 to 1000 mg given once a day with the extended-release formulation is adequate for most patients. The initial 500-mg dose may be increased incrementally based on response. Tolerability issues are not common for most patients with cluster headaches. However, tiredness and tremor (similar to that which can occur with lithium) occasionally occur. Liver function should be checked and the complete blood cell count determined before and after divalproex therapy is initiated. Blood levels of the drug should be checked if a dosage higher than 1500 mgld is contemplated; levels should be kept to less than 120 ug/mL.
Topiramate is a relative newcomer to the treatment of cluster headache. The dosage tends to be fairly modest: patients begin by taking 25 mg at bedtime. The dosage is titrated every several days thereafter based on response. Typically, 50 to 100 mg once a day is required to control the cluster cycle. Topiramate usually begins to work quickly and may exert benefit during the first week of therapy.
Incremental decreases in dosage of topiramate may be necessary to reduce side effects, such as mental slowing or sedation: these effects are usually not dose-related, but rather are related to the rate of the titration schedule. Overall, such effects are not very common. Paresthesias and altered sense of taste, especially of carbonated beverages, occur more frequently. There are rare reports of acute glaucoma developing at the start of topiramate therapy. Renal stones have also been reported in rare cases associated with long-term use of this agent.
Like divalproex, topiramate works rapidly: a response can often be seen during week 1 or 2 of treatment.
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Bob Johnson
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Paigelle
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Re: Mood-stabilizing drugs for cluster: basic info
« Reply #1 on: Nov 21st, 2003, 8:22am » |
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This is interesting! What do you know about Prozac to treat?
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Bob_Johnson
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Re: Mood-stabilizing drugs for cluster: basic info
« Reply #2 on: Nov 21st, 2003, 1:55pm » |
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Trying exploring www.headachedrugs.com & run a search for Prozac. Dr. Robbins doesn't rank it very highly for cluster.
Robbins run a headache clinic in the Chicago area. Good site worth spending some time getting to know. You will find a long list of meds for cluster ranked by effectiveness.
He has two books mentioned on the site, both of which are excellent.
You should explore the med survey (on the left of this page) as well as the OUCH site.
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Bob Johnson
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Paigelle
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Re: Mood-stabilizing drugs for cluster: basic info
« Reply #3 on: Nov 21st, 2003, 5:11pm » |
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Thank you Bob!
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