Comments on: Triptans will be OTC in the UK http://www.kevinmd.com/blog/2006/05/triptans-will-be-otc-in-uk.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: NeoNurseChichttp://www.kevinmd.com/blog/2006/05/triptans-will-be-otc-in-uk.html#comment-63231 NeoNurseChic Sat, 20 May 2006 04:51:00 +0000 http://clients.emmense.com/kevinmd/2006/05/triptans-will-be-otc-in-the-uk.html#comment-63231 This seems irrational to me, given the evidence of rebound, or even simply articles that point to an increase in attack frequency of cluster headaches from imitrex injections. The fact that triptans are not always safe for people with basilar or hemiplegic migraine as well as some other cardiac conditions. I know they've come out with studies saying these meds can be safe for certain people with cardiac conditions, but if you put them over the counter, there's no way to regulate who takes what safely. I heard the chronic use of naratriptan potentially compared to the chronic use of sansert at a headache conference last year. Is this safe for OTC?<br/><br/>The real reason? Cost. In the UK, a script of 60 imigran injections (2/day) costs a very small price - I don't recall the exact amount of pounds (somewhere around 4-6, I thought), but it is definitely cheap. Compared to this new OTC price of over 7 pounds for only 2 tabs? In the US, imitrex tabs are usually only available in packs of 9. Of course, the US uses faulty FDA warnings that imitrex cannot be used more than that many times a month. The FDA has no such warning - only placing a limit on the amount of triptans/day. Yet another way formularies attempt to screw over patients and physicians, however. It's simply maddening. By making imigran OTC in the UK, glaxo will rake in one heck of a lot more money than they will via script.<br/><br/>I disagree with the safety component, however. I really don't feel that imigran is safe for everyone. This seems like a marketing ploy rather than something well thought out. What if the patient is taking 5-HTP over the counter? DHE prescribed? An ergot of some sort? And they suddenly decide that it's not working well enough and they go to buy imigran OTC. The potential for rebound alone is enormous....<br/><br/>Can't wait to hear what they say about this at the Migraine Trust conference in the UK, but I'll have to ask around now to see what some of the specialists are thinking.... Seems like a dangerous move, IMHO. This seems irrational to me, given the evidence of rebound, or even simply articles that point to an increase in attack frequency of cluster headaches from imitrex injections. The fact that triptans are not always safe for people with basilar or hemiplegic migraine as well as some other cardiac conditions. I know they’ve come out with studies saying these meds can be safe for certain people with cardiac conditions, but if you put them over the counter, there’s no way to regulate who takes what safely. I heard the chronic use of naratriptan potentially compared to the chronic use of sansert at a headache conference last year. Is this safe for OTC?

The real reason? Cost. In the UK, a script of 60 imigran injections (2/day) costs a very small price – I don’t recall the exact amount of pounds (somewhere around 4-6, I thought), but it is definitely cheap. Compared to this new OTC price of over 7 pounds for only 2 tabs? In the US, imitrex tabs are usually only available in packs of 9. Of course, the US uses faulty FDA warnings that imitrex cannot be used more than that many times a month. The FDA has no such warning – only placing a limit on the amount of triptans/day. Yet another way formularies attempt to screw over patients and physicians, however. It’s simply maddening. By making imigran OTC in the UK, glaxo will rake in one heck of a lot more money than they will via script.

I disagree with the safety component, however. I really don’t feel that imigran is safe for everyone. This seems like a marketing ploy rather than something well thought out. What if the patient is taking 5-HTP over the counter? DHE prescribed? An ergot of some sort? And they suddenly decide that it’s not working well enough and they go to buy imigran OTC. The potential for rebound alone is enormous….

Can’t wait to hear what they say about this at the Migraine Trust conference in the UK, but I’ll have to ask around now to see what some of the specialists are thinking…. Seems like a dangerous move, IMHO.

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