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Joshi S, Tepper SJ, Lucas S, et al. A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management. Headache. 2021;61(6):838-853doi: 10.1111/head.14135.
Joshi, S., Tepper, S. J., Lucas, S., Rasmussen, S., & Nelson, R. (2021). A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management. Headache, 61(6), 838-853. https://doi.org/10.1111/head.14135
Joshi, Shivang, et al. "A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management." Headache vol. 61,6 (2021): 838-853. doi: https://doi.org/10.1111/head.14135
Joshi S, Tepper SJ, Lucas S, Rasmussen S, Nelson R. A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management. Headache. 2021 Jun;61(6):838-853. doi: 10.1111/head.14135. PMID: 34214182; PMCID: PMC8361687.
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Headache. 2021 Jun;61(6):838-853. doi: 10.1111/head.14135.

A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management.

Headache

Shivang Joshi, Stewart J Tepper, Sylvia Lucas, Soeren Rasmussen, Rob Nelson

Affiliations

  1. Neurology/Headache Medicine, DENT Neurologic Institute, Amherst, NY, USA.
  2. Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
  3. Department of Neurology, University of Washington Medical Centers, Seattle, WA, USA.
  4. Global Medical, Amgen Inc., Thousand Oaks, CA, USA.
  5. US Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA.

PMID: 34214182 PMCID: PMC8361687 DOI: 10.1111/head.14135

Abstract

OBJECTIVE: To review the pharmacokinetics of major classes of migraine preventives and the clinical implications of drug-drug interactions (DDIs) with the use of these therapies in migraine management.

BACKGROUND: Preventive treatments for migraine are recommended for a large proportion of patients with frequent migraine attacks. These patients often exhibit a number of comorbidities, which may lead to the introduction of multiple concomitant therapies. Potential DDIs must be considered when using polytherapy to avoid increased risk of adverse events (AEs) or inadequate treatment of comorbid conditions.

METHODS: A literature search was performed to identify pharmacokinetic properties and potential DDIs of beta-blockers, antiepileptic drugs, antidepressants, calcium channel blockers, gepants, and monoclonal antibody therapies targeting the calcitonin gene-related peptide pathway with medications that may be used for comorbid conditions.

RESULTS: Most DDIs occur through alterations in cytochrome P450 isoenzyme activity and may be complicated by genetic polymorphism for metabolic enzymes. Additionally, drug metabolism may be altered by grapefruit juice ingestion and smoking. The use of migraine preventive therapies may exacerbate symptoms of comorbid conditions or increase the risk of AEs associated with comorbid conditions as a result of DDIs.

CONCLUSIONS: DDIs are important to consider in patients with migraine who use multiple medications. The development of migraine-specific evidence-based preventive treatments allows for tailored clinical management that reduces the risk of DDIs and associated AEs in patients with comorbidities.

© 2021 Amgen Inc. Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.

Keywords: drug-drug interactions; migraine; pharmacodynamics; pharmacokinetics; polytherapy

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