Availability of triptans over-the-counter (OTC) for the treatment of migraine has advantages and disadvantages
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Availability of triptans over-the-counter (OTC) for the treatment of migraine has advantages and disadvantages Table I. Implications of the over-the-counter (OTC) availability of triptans for migraine[1] Advantages Removes the need to consult a physician, which may be a barrier to care Easier access may encourage more patients to use triptans and, thereby, improve migraine management May lead to more frequent use among patients who do not respond to other OTC pain medications May lead to more frequent use among patients less severely afflicted with migraine who are less likely to receive these drugs on prescription, but who still have a considerable burden of attacks May encourage patients to medicate early when their headache is still mild, which may improve efficacy May reduce costs relating to consultations with physicians May reduce costs associated with lost productivity Disadvantages May increase the use of triptans to treat headache for which efficacy cannot be expected (e.g. non-migrainous or tension-type headache) May increase the use of triptans during the aura phase of the migraine attack, despite a lack of efficacy during this phase May lead to the use of triptans in patients with contraindications to their use (e.g. coronary heart disease), resulting in potentially serious consequences May increase the overuse of triptans, resulting in an increase in ‘medication-overuse headache’ Triptans may not be more efficacious than other OTC drugs (e.g. aspirin [acetylsalicylic acid])[6] Naratriptan 2.5 mg may not be suitable for the treatment of severe migraine[7,8] Increases the pharmacist’s responsibility to correctly diagnose migraine, and to distinguish triptan-appropriate migraine
The recent approval of triptans as over-the-counter medications for the treatment of migraine in some countries has potential advantages and disadvantages.
Triptans effective and safe Since 2006, the range of over-the-counter (OTC) medications for migraine (in addition to generic drugs such as paracetamol [acetaminophen] and aspirin [acetylsalicylic acid]) now include sumatriptan 50 mg in the UK and naratriptan 2.5 mg in Germany, both for pharmacy sales only.[1] As other countries may adopt this practice and additional triptans may become available OTC, the potential implications warrant discussion and further investigation to ensure safety, proper use and benefits of triptans in the treatment of migraine. Triptans are serotonin 5-HT1B/1D receptor agonists with proven efficacy and safety in the treatment of migraine.[1-3] In clinical trials, pain-free rates are generally greater when migraine is treated early (i.e. during the mild-pain phase) than when treatment is delayed until the pain is moderate or severe.[1,3] However, randomized studies with both early and late treatment arms are required to determine whether or not early treatment is advisable.[4] Switching any drug to OTC use requires consideration of the safety of the agent.[1] Although there were early concerns about the potential cardiovascular risks of triptans due t
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