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Bob Johnson

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Sumatriptan: Excessive dosing
Dec 21^st, 2011 at 12:05pm

Headache. 2011 Nov;51(10):1546-8.
Sumatriptan in excessive doses over 15 years in a patient with chronic cluster headache.
Kallweit U, Sándor PS.
SourceFrom the Department of Neurology, University Hospital Zurich, Zurich, Switzerland (U. Kallweit and P.S. Sándor); Department of Neurology, Kamillus-Klinik, Asbach/Ww., Germany (U. Kallweit); Department of Neurology, ANNR RehaClinic Cantonal Hospital, Baden, Switzerland (P.S. Sándor).

Abstract
We report the case of a 49-year-old lady with cluster headache, who had received sumatriptan s.c. treatment for 15 years with daily dosages between 12 and 222 mg (average of 150 mg during the last year). The therapy was successful in aborting CH attacks. Long-term overdosage of sumatriptan was well tolerated, without adverse events.

© 2011 American Headache Society.

PMID:22082424[PubMed]

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Bob Johnson

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wimsey1 CH.com Alumnus Offline I Love CH.com! Posts: 2457 MA Gender:	Re: Sumatriptan: Excessive dosing Reply #1 - Dec 22^nd, 2011 at 7:48am Hey Bob, are we talking the same amounts of suma as compared to the auto injectors of 6mg? That would be like 20 shots per day? lance
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Bob Johnson CH.com Alumnus Offline "Only the educated are free." -Epictetus Posts: 5965 Kennett Square, PA (USA) Gender:	Re: Sumatriptan: Excessive dosing Reply #2 - Dec 22^nd, 2011 at 9:35am I take the wording to be reporting total daily dosing ranging from 12 to 222mg No mention of the individual SC dose.
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Eroc

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Re: Sumatriptan: Excessive dosing
Reply #3 - Dec 23^rd, 2011 at 8:02am

I personally have taken as much as 20 MG sc in 24 hours with no harmfull side effects that I am aware of. This was authorized by my neuro.

I also only use the 4 MG SC and now have vials and syringes to dose down to 2 MG. I also have found a better way to dose down the 6 MG sc injections that is a little more exact than is described in the imitrex tip section. However you do need to get some syringes with 1" needles from your pharmacy.

Thanks,

Eric

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Imitrex4Breakfast

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Re: Sumatriptan: Excessive dosing
Reply #4 - Dec 23^rd, 2011 at 2:12pm

They can NOT be talking about injections. 222mg is a ridiculous amount injected. They MUST be talking about the oral form. Injecting 222mg in a day would cause your heart to be 'squeezed' until a cardiac event.

I've used as much as 10 injections in 1 day, but never had more than that in a 24 hr period.

Lastly, if you have Imitrex in vials that you must prepare yourself, a 1" needle is MUCH too long as Imitrex is supposed to be taken SUBQ (Just under the skin) and NOT IM.

Edited to add: Regardless of what this report says, I am convinced that Imitrex will CAUSE more attacks. Call them 'rebounds' or whatever you want, but I know that the more I take, the more I HAVE TO take.

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« Last Edit: Dec 23^rd, 2011 at 2:14pm by Imitrex4Breakfast »

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Eroc

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Re: Sumatriptan: Excessive dosing
Reply #5 - Dec 23^rd, 2011 at 8:18pm

In response to the 1" needles comment they are multi purpose in that they are long enough to pierce through the rubber stopper in a 6MG stat dose inject to draw the fluid out. Then you simply do not push the needle all the way into your arm, I guage the depth based on how deep the stat dose needle goes in which is about a quarter inch.

To stop the stat dose inject from injecting out of its own needle I insert it into a sterile rubber stopper. A wine bottle cork works well also.

Another option recomended by my neuro is to inject the stat dose syringe into the single dose vial and then dose with a syringe out of that. He said just make sure you clean it with alcohol frequently.

We had a brainstorming/arts and crafts session at his desk durring my last visit.

Either way you do it you can still break up a 6 MG stat dose into three different HA's.

I also don't dissagree that the trex causes rebound HA's however when at work that is typically my only option. I try to use it as sparingly as possible and the o2 when at home.

And yes they must be talking about oral imitrex.

Merry Christmas,

Eric

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Ricardo

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Re: Sumatriptan: Excessive dosing
Reply #6 - Dec 24^th, 2011 at 12:10pm

If they are talking oral dosage, it doesn't make much sense because 12 mg of trex isn't going to do anything orally....If they are talking injections it doesn't make much sense either--assuming she was taking the 6 mg shots, that would be 37 shots in a day....the whole thing is confusing. If they are are combining statistics of oral use and injection use, it seems like the actual mg amount of Imitrex would be useless information and the whole study would seem like rubbish. I actually kinda wonder if this woman was taking 37 shots in a day....That seems crazy. The whole thing actually makes me kinda sad, I have a hard time believing that this was the most effective treatment available...I mean hell, there are cases where people find one shitty treatment that works, and that's it, they have to stick to it, but.....this seems ridiculous. Sounds like a damn good candidate for some BOl-148. I really feel for this woman and I hope she has outlived her beast and is pain free now.

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Bob Johnson CH.com Alumnus Offline "Only the educated are free." -Epictetus Posts: 5965 Kennett Square, PA (USA) Gender:	Re: Sumatriptan: Excessive dosing Reply #7 - Dec 24^th, 2011 at 3:26pm The abstract is TWO sentences long. In those two sentences is the information which some of you say is missing/wrong. How can that be?
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Ricardo CH.com Veteran Offline I Love CH.com! Posts: 214 MA Gender:	Re: Sumatriptan: Excessive dosing Reply #8 - Dec 25^th, 2011 at 1:54am You're right. I didn't see the S.C. (sub-cutaneous). Scary to think of taking that much Imitrex....
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Bob Johnson CH.com Alumnus Offline "Only the educated are free." -Epictetus Posts: 5965 Kennett Square, PA (USA) Gender:	Re: Sumatriptan: Excessive dosing Reply #9 - Dec 26^th, 2011 at 9:11am Marc, I've not seen any medical reports about tolerance developing. There is a strange pattern with a fair number of folks that an effective med simply stops working--bang! Why??? But I don't define as tolerance.
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Dana CH.com Alumnus Offline The beast hater Posts: 44 Jacksonville, FL Gender:	Re: Sumatriptan: Excessive dosing Reply #10 - Dec 27^th, 2011 at 2:12am I was doing about 8 shots of the 6mg a day and had no effects from it. I was going through it so fast that I started taking the vial apart and made a home made plunger to only use half the vial to try and make it last. Will the pharmacy jsut sell needles over the counter?
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Eroc

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Re: Sumatriptan: Excessive dosing
Reply #11 - Dec 27^th, 2011 at 7:49am

Dana,

You do need a prescription for syringes. By chance my neuro prescribed me insulin syringes with a 1" needle on them. I then take the 6 mg stat dose vial, stick it into a clean wine cork, and then use the syringe to draw out 1/3 of the solution. When injecting yourself however you do not want to insert the needle more than about a 1/4" into your arm. I also was able to get a prescription for 6 mg vials however they were difficult to find once I had a scrip. I had to go to a hospital pharmacy. My local Wallgreens could not obtain them despite their best efforts. If you can get the 6 mg vials you can then inject the stat dose into the vial and draw from that just be sure to clean it with alcohol regularly.

I hope that helps and have a happy new year.

Eric

p.s. I am not a Dr this is just simply what I do to manage through the bout's.

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wildhaus

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Re: Sumatriptan: Excessive dosing
Reply #12 - Dec 27^th, 2011 at 11:26am

I know the person.....
and Dr. P. Sándor....

It is:

SUMATRIPTAN -(I Belive) by Mepha, Subcutaneous injection, with a pen.
its 0.6mg. (Milligramm) or 0.5 ml. (Mililiter).
its an average of 20 a day and more....
or an average of every 1.2 hours an injection,
in Switzerland SFr. 23.85 per injection...
(1 Swiss franc = 1.07043 U.S. dollars)

Michael

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Imitrex4Breakfast

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Re: Sumatriptan: Excessive dosing
Reply #13 - Dec 27^th, 2011 at 6:11pm

It stated that long term overdosage was well tolerated with no adverse affects ... however, MY PERSONAL EXPERIENCE ... when the top of my shoulders and palms of my hands feel 'skinned' or like 'road rash' ... I was told that it was because the Imitrex was squeezing my heart and could cause a 'cardiac event' at that point ... but It's never hurt me. I take it whenever I feel I MUST take it. 2mg SubQ is NOT enough for me, 4mg is perfect, 6mg is too much (for me).

Also wanted to mention that I didn't know they made an oral Imitrex pill under 25mg. <?> Not sure as only the injections will abort my attacks.

The first post in this thread DID say "Sumatriptan s.c.", so should we assume the "s.c." means SubQ injections ??

I believe that an Imitrex injection via IV would be deadly. Anyone know if that would be a fact or not >??

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Bob Johnson

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Re: Sumatriptan: Excessive dosing
Reply #14 - Dec 27^th, 2011 at 7:26pm

S.C. = subcutaneous.

I.V. sumatriptan.
Recalling my neighbor's bumper sticker: "You don't have to believe every thought you have."

======This is a viable alternative to suma.

Headache 2001 Sep;41(8):813-6

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and TWO PATIENTS BECAME HEADACHE-FREE AFTER TAKING THE DRUG. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.

PMID 11576207 PubMed

--------------------------------------------------------------------------------

Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.
=====
Since this abstract was first posted Zyprexa has appeared in some lists of recommended meds for CH. [BJ]

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« Last Edit: Dec 27^th, 2011 at 7:30pm by Bob Johnson »

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Imitrex4Breakfast

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Re: Sumatriptan: Excessive dosing
Reply #15 - Dec 27^th, 2011 at 7:53pm

Again, no disrespect at all intended because you do have much valueable input, but this thread is "Re: Sumatriptan: Excessive dosing" .... Why throw in that statement about Zyprexa in this thread ??

ZYPREXA can and has caused many to develop diabetes while some others died from blood sugar levels. I've only heard of 2 people that has benefited from it, obviously BOB and I BELIEVE "Eric" (member a few yrs back)

BTW< ZYPREXA NEVER HELPED ME AT ALL. This may be a "... viable alternative to suma" FOR YOU, but certainly not for MOST

Again, no disrespect intended Bob. Maybe you should get that post in the top part of the threads so you don't have to keep pasting it in so many other non-related threads. (Just my opinion)

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jon019

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Re: Sumatriptan: Excessive dosing
Reply #16 - Dec 27^th, 2011 at 8:37pm

...about 7 yrs ago I was prescribed Imi stat dose. When I went to the pharm, they gave me 5 6mg vials...I initially objected...wrong script!. They said...."what's wrong sir, it's the same thing". Now, I'm slow, and it took a few seconds, but I finally realized I just got MANY more doses than the insurance would allow...and I SHUT up. Needing syringes...and NOT having a script for such...I nevertheless asked...response?...."sure, which do you want?"

What this all means I really don't know, of course it is logical to give syringes with vials of injectables....but I did not have a script. My point....it doesn't friggen hurt to ask for the vials vs the statdoses (it's the SAME thing!)...and the needles....well, why not?

Best,

Jon

edited to, well, edit

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« Last Edit: Dec 27^th, 2011 at 8:50pm by jon019 »

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