Propranolol and migraine

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  1. kiril-lavrov Well-Known Member

    Propranolol and migraine


    Propranolol is a beta blocker medication which is helpful in preventing migraine attacks in some patients. If a patient is having frequent attacks or severe, long-lasting attacks, it may be of help in cutting down the frequency of the attacks. However, it should be taken only under the careful supervision of a physician familiar with its use. A dose of propranolol up to 240 mg may be necessary. Inderal LA (60-80-120-160 mg) is a convenient one-a-day way to take the medicine. Inderal® can diminish endurance and tolerance to running and exercise, and it may take longer to accomplish previous goals. Immediate side effects can include diarrhea, tiredness, slowed pulse, and/or lowered blood pressure. Patients with bronchial asthma or other similar lung conditions, congestive heart failure or heart block should not use this agent. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Migraine, a significantly disabling condition, is treated with acute and preventive medications. However, some individuals are refractory to standard treatments. Although there is a host of alternative management options available, these are not always backed by strong evidence. In fact, most of the drugs used in migraine were initially designed for other purposes. Whilst effective, the benefits from these medications are modest, reflecting the need for newer and migraine-specific therapeutic agents. In recent years, we have witnessed the emergence of novel treatments, of which noninvasive neuromodulation appears to be the most attractive given its ease of use and excellent tolerability profile.

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    INTRODUCTION. The hallmark of hemiplegic migraine is unilateral weakness that accompanies a migraine headache attack. The weakness is a manifestation of motor aura and occurs with other forms of aura that impair vision, speech, or sensation. Migraine headache is a type of headache with signs and symptoms of sensitivity to light, smells, or sounds, eye pain, and sometimes nausea and vomiting. Migraine triggers include foods, stress, and oversleeping. Objectives.—To determine if the effectiveness of propranolol hydrochloride and amitriptyline hydrochloride are correlated with blood levels and/or with standa.

    Sufficient evidence and consensus exist to recommend propranolol, timolol, amitriptyline, divalproex, sodium valproate, and topiramate as first-line agents for migraine prevention. There is fair evidence of effectiveness with gabapentin and naproxen sodium. Botulinum toxin also has demonstrated fair effectiveness, but further studies are needed to define its role in migraine prevention. Limited evidence is available to support the use of candesartan, lisinopril, atenolol, metoprolol, nadolol, fluoxetine, magnesium, vitamin B (riboflavin), coenzyme Q10, and hormone therapy in migraine prevention. Data and expert opinion are mixed regarding some agents, such as verapamil and feverfew; these can be considered in migraine prevention when other medications cannot be used. Evidence supports the use of timed-release dihydroergotamine mesylate, but patients should be monitored closely for adverse effects. 2 Preventive therapy, which can reduce the frequency of migraines by 50 percent or more, is used by less than one half of persons with migraine headache.3Following appropriate management of acute migraine, patients should be evaluated for initiation of preventive therapy. Prophylaxis 80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day Withdraw therapy if satisfactory response not seen after 6 weeks Hemangeol: Indicated for treatment of proliferating hemangioma requiring systemic therapy Initiate treatment at aged 5 weeks to 5 months Starting dose: 0.6 mg/kg (0.15 m L/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 m L/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 m L/kg) BID PO: 0.5-1 mg/kg/day divided q6-8hr; may be increased every 3-7 days; usual range: 2-6 mg/kg/day; not to exceed 16 mg/kg/day or 60 mg/day IV: 0.01-0.1 mg/kg over 10 minutes; repeat q6-8hr PRN; not to exceed 1 mg for infants or 3 mg for children PO: 1 mg/kg/day divided q6hr; after 1 week, may be increased by 1 mg/kg/day to maximum of 10-15 mg/kg/day if patient refractory; allow 24 hours between dosing changes IV: 0.01-0.2 mg/kg over 10 minutes; not to exceed 5 mg Immediate-release: 40 mg PO q12hr initially, increased every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day Inno Pran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO Consider lower initial dose PO: 10 mg q6-8hr; may be increased every 3-7 days IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg Once response or maximum dose achieved, do not give additional dose for at least 4 hours Aggravated congestive heart failure Bradycardia Hypotension Arthropathy Raynaud phenomenon Hyper/hypoglycemia Depression Fatigue Insomnia Paresthesia Psychotic disorder Pruritus Nausea Vomiting Hyperlipidemia Hyperkalemia Cramping Bronchospasm Dyspnea Pulmonary edema Respiratory distress Wheezing Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid; agranulocytosis, erythematous rash, fever with sore throat Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria Musculoskeletal: Myopathy, myotonia May exacerbate ischemic heart disease after abrupt withdrawal Hypersensitivity to catecholamines has been observed during withdrawal Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuance When discontinuing long-term administration of beta blockers (particularly with ischemic heart disease), gradually reduce dose over 1-2 weeks and carefully monitor If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina) Warn patients against interruption or discontinuance of beta-blocker therapy without physician advice Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension Asthma, COPD Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker) Cardiogenic shock Uncompensated congestive heart failure Hypersensitivity Overt heart failure Sick sinus syndrome without permanent pacemaker Do not use Inno Pran XL in pediatric patients Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions Sudden discontinuance can exacerbate angina and lead to myocardial infarction Use in pheochromocytoma Increased risk of stroke after surgery Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported Exacerbation of myopathy and myotonia has been reported Less effective than thiazide diuretics in black and geriatric patients May worsen bradycardia or hypotension; monitor HR and BP Avoid beta blockers without alpha1-adrenergic receptor blocking activity in patients with prinzmetal variant angina; unopposed alpha-1 adrenergic receptors may worsen anginal symptoms May induce or exacerbate psoriasis; cause and effect not established Prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations, and sweating May cause or worsen bradycardia or hypotension Pregnancy category: C; intrauterine growth retardation, small placentas, and congenital abnormalities reported, but no adequate and well-controlled studies conducted Lactation: Use is controversial; an insignificant amount is excreted in breast milk Nonselective beta adrenergic receptor blocker; competitive beta1 and beta2 receptor inhibition results in decreases in heart rate, myocardial contractility, myocardial oxygen demand, and blood pressure Class 2 antidysrhythmic Bioavailability: 30-70% (food increases bioavailability) Onset: Hypertension, 2-3 wk; beta blockade, 2-10 min (IV) or 1-2 hr (PO) Duration: 6-12 hr (immediate release); 24-27 hr (extended release) Peak plasma time: 1-4 hr (immediate release); 6-14 hr (extended release) Solution: Most common solvents Additive: Dobutamine, verapamil Syringe: Inamrinone, milrinone Y-site: Alteplase, fenoldopam, gatifloxacin, heparin, hydrocortisone, sodium succinate, inamrinone, linezolid, meperidine, milrinone, morphine, potassium chloride, propofol, tacrolimus, tirofiban, vitamins B and C IV administration rate should not exceed 1 mg/min IV dose is much smaller than oral dose Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution Continuous IV infusion generally is not recommended The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

    Propranolol and migraine

    Migraine Womenshealth.gov, Migraine Headache Symptoms, Causes, Treatment, Types

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  4. Apr 1, 1972. The treatment of migraine with propranolol. Ronald B. Weber, M. D. and Oscar M. Reinmuth, M. D. Within recent years a variety of agents have.

    • The treatment of migraine with propranolol - Neurology.
    • Propranolol and Amitriptyline in Prophylaxis of Migraine..
    • What are the best prophylactic drugs for migraine? MDedge Family..

    NHS medicines information on propranolol - what it's used for, side effects, dosage and who can take it. Oct 25, 2007. Propranolol is a beta blocker medication which is helpful in preventing migraine attacks in some patients. If a patient is having frequent attacks. Migraine prophylactic therapy should be considered in patients whose migraine. migraine. ii. For propranolol the usual starting dose is 20 to 40 mg twice daily.

     
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