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Question About Migraines I Suffer From Occasional Migraines - With
Question: Question about migraines
I suffer from occasional migraines - with signals of flashing lights and wavy lines before my eyes and slight headache.
They have been more frequent recently but I find the drug Rizatriptan ODT 5 mg to be effective within 10 minutes so I can live with it.
Unfortunately, I am currently living in a country where Rizatriptan is not available. I have old stock but it was issued in 2014 and theoretically
expired in 2016. That is 5 years since it was issued and 3 years since it was supposed to be discarded. But I am completely incapacitated
when I get the migraine symptoms so wish to take a chance on using the expired stock. What is your opinion of its potential effectiveness or problem
if I do so.
Thanks
I suffer from occasional migraines - with signals of flashing lights and wavy lines before my eyes and slight headache.
They have been more frequent recently but I find the drug Rizatriptan ODT 5 mg to be effective within 10 minutes so I can live with it.
Unfortunately, I am currently living in a country where Rizatriptan is not available. I have old stock but it was issued in 2014 and theoretically
expired in 2016. That is 5 years since it was issued and 3 years since it was supposed to be discarded. But I am completely incapacitated
when I get the migraine symptoms so wish to take a chance on using the expired stock. What is your opinion of its potential effectiveness or problem
if I do so.
Thanks
Question about migraines
I suffer from occasional migraines - with signals of flashing lights and wavy lines before my eyes and slight headache.
They have been more frequent recently but I find the drug Rizatriptan ODT 5 mg to be effective within 10 minutes so I can live with it.
Unfortunately, I am currently living in a country where Rizatriptan is not available. I have old stock but it was issued in 2014 and theoretically
expired in 2016. That is 5 years since it was issued and 3 years since it was supposed to be discarded. But I am completely incapacitated
when I get the migraine symptoms so wish to take a chance on using the expired stock. What is your opinion of its potential effectiveness or problem
if I do so.
Thanks
I suffer from occasional migraines - with signals of flashing lights and wavy lines before my eyes and slight headache.
They have been more frequent recently but I find the drug Rizatriptan ODT 5 mg to be effective within 10 minutes so I can live with it.
Unfortunately, I am currently living in a country where Rizatriptan is not available. I have old stock but it was issued in 2014 and theoretically
expired in 2016. That is 5 years since it was issued and 3 years since it was supposed to be discarded. But I am completely incapacitated
when I get the migraine symptoms so wish to take a chance on using the expired stock. What is your opinion of its potential effectiveness or problem
if I do so.
Thanks
Brief Answer:
I DO NOT RECOMMEND using medication beyond expiration date BECAUSE
Detailed Answer:
Thank you for posing your somewhat complex but THOUGHT PROVOKING question because you raise a common query and dilemma that doctors, patients, and government officials face all the time.
The short answer is this....as a DOCTOR OF MEDICINE who has been sworn to FIRST DO NO HARM to his patients I cannot in good conscience recommend to any patient of mine that they voluntarily take or use medications beyond their expiration because as a matter of ethics and LAW I will be held fully responsible and accountable in the event an adverse effect were to occur in this patient (whether it was directly related to taking the medication or not). Unfortunately, the Oath of a Medical Doctor does not recognize or take into any account the financial aspects of the extraordinarily high prices of medicines, etc. It is clearly a shame and even OBJECTIONABLE that nothing more proactive has been done by pharmaceutical companies nor medical organizations or societies to get some closure on this nagging question which has been around for decades.
But the state of affairs is that they haven't really progressed for consumers in any meaningful way in the past several decades when it comes to advising patients of whether or not they can use expired drugs.
If you'd like to read an interesting article on this topic please look up this link to the XXXXXXX Gazette published in 2005:
https://www.post-gazette.com/news/health/2005/05/30/Drugs-may-outlast-label-date/stories/0000
I can tell you that in the gamut of literature articles that mention anything about using expired medications there are many reports of how a particular expired drug LOST ITS EFFICACY....but there is virtually nothing written or proven on the ILL EFFECTS felt or caused due to DAMAGE coming about from the use of expired medication. For the most part the worst part of taking such medications is that they simply don't work the same or not at all when expired significantly beyond their stamped dates.
I have patients who have told me they've taken medications for their headaches that were up to 4 years out of date and that the medication seemed to work as effectively as in the original fresh state. Now, mind you that these medications I'm talking about were stored in NEAR PRISTINE AND PERFECT conditions for all that time which is generally NOT the case with something that has been held onto and not used for so long....but anyhow....this is what some of my patients have told me after bolding using their stashes! HOWEVER, this still doesn't allow me as a DOCTOR of Medicine and a HEADACHE SPECIALIST to condone the use of these medications and I always will offer and even try and switch the medication for a new prescription.
Therefore, to once again answer your question as to whether I believe it is acceptable to use expired medications for headaches my answer is that it is NOT acceptable. Furthermore, I don't believe you'll find any other doctor or pharmacist giving the nod on such a request for all the issues I mentioned up top. However, I am also a scientist who believes that telling patients the truth (as we know it) is part of my job when asked the proper questions. And so, there are data to support the use of EXPIRED MEDICATIONS for rather lengthy time frames after the expiration date (ASSUMING THE DRUG HAS BEEN KEPT AND STORED IN IDEAL CONDITIONS). The military actually did a GIGANTIC study on the integrity of medications expired and found that on average for all medications under discussion that drugs expiration dates were premature by as much as 4-5 years. But that is also talking about very specific circumstances and assuming the medications have been kept in the best conditions.
I would suggest you replace those medications with up to date tablets because even if you be having to pay for new medication...what's the down side? You spent money....and it may be expensive.....got it.
Now, What's the UP side? You purchased the HIGHEST QUALITY of substance possible to treat your headaches....and isn't that what you REALLY WANT? Do you really WANT to "take a chance?" on messing up anything in your body or just not getting any relief from your headaches due to not spending money? I don't think so....nevertheless, as I said up top when you first asked the question.....you bring up an excellent question and point that really should be formally studied and addressed with some type of leadership or consensus statement for both DOCTORS as well as PATIENTS.
If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm also very interested in knowing how things turn out for you if you get any testing or evaluations done so drop me a line please :0
This query has utilized a total of 50 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
I DO NOT RECOMMEND using medication beyond expiration date BECAUSE
Detailed Answer:
Thank you for posing your somewhat complex but THOUGHT PROVOKING question because you raise a common query and dilemma that doctors, patients, and government officials face all the time.
The short answer is this....as a DOCTOR OF MEDICINE who has been sworn to FIRST DO NO HARM to his patients I cannot in good conscience recommend to any patient of mine that they voluntarily take or use medications beyond their expiration because as a matter of ethics and LAW I will be held fully responsible and accountable in the event an adverse effect were to occur in this patient (whether it was directly related to taking the medication or not). Unfortunately, the Oath of a Medical Doctor does not recognize or take into any account the financial aspects of the extraordinarily high prices of medicines, etc. It is clearly a shame and even OBJECTIONABLE that nothing more proactive has been done by pharmaceutical companies nor medical organizations or societies to get some closure on this nagging question which has been around for decades.
But the state of affairs is that they haven't really progressed for consumers in any meaningful way in the past several decades when it comes to advising patients of whether or not they can use expired drugs.
If you'd like to read an interesting article on this topic please look up this link to the XXXXXXX Gazette published in 2005:
https://www.post-gazette.com/news/health/2005/05/30/Drugs-may-outlast-label-date/stories/0000
I can tell you that in the gamut of literature articles that mention anything about using expired medications there are many reports of how a particular expired drug LOST ITS EFFICACY....but there is virtually nothing written or proven on the ILL EFFECTS felt or caused due to DAMAGE coming about from the use of expired medication. For the most part the worst part of taking such medications is that they simply don't work the same or not at all when expired significantly beyond their stamped dates.
I have patients who have told me they've taken medications for their headaches that were up to 4 years out of date and that the medication seemed to work as effectively as in the original fresh state. Now, mind you that these medications I'm talking about were stored in NEAR PRISTINE AND PERFECT conditions for all that time which is generally NOT the case with something that has been held onto and not used for so long....but anyhow....this is what some of my patients have told me after bolding using their stashes! HOWEVER, this still doesn't allow me as a DOCTOR of Medicine and a HEADACHE SPECIALIST to condone the use of these medications and I always will offer and even try and switch the medication for a new prescription.
Therefore, to once again answer your question as to whether I believe it is acceptable to use expired medications for headaches my answer is that it is NOT acceptable. Furthermore, I don't believe you'll find any other doctor or pharmacist giving the nod on such a request for all the issues I mentioned up top. However, I am also a scientist who believes that telling patients the truth (as we know it) is part of my job when asked the proper questions. And so, there are data to support the use of EXPIRED MEDICATIONS for rather lengthy time frames after the expiration date (ASSUMING THE DRUG HAS BEEN KEPT AND STORED IN IDEAL CONDITIONS). The military actually did a GIGANTIC study on the integrity of medications expired and found that on average for all medications under discussion that drugs expiration dates were premature by as much as 4-5 years. But that is also talking about very specific circumstances and assuming the medications have been kept in the best conditions.
I would suggest you replace those medications with up to date tablets because even if you be having to pay for new medication...what's the down side? You spent money....and it may be expensive.....got it.
Now, What's the UP side? You purchased the HIGHEST QUALITY of substance possible to treat your headaches....and isn't that what you REALLY WANT? Do you really WANT to "take a chance?" on messing up anything in your body or just not getting any relief from your headaches due to not spending money? I don't think so....nevertheless, as I said up top when you first asked the question.....you bring up an excellent question and point that really should be formally studied and addressed with some type of leadership or consensus statement for both DOCTORS as well as PATIENTS.
If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm also very interested in knowing how things turn out for you if you get any testing or evaluations done so drop me a line please :0
This query has utilized a total of 50 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
I DO NOT RECOMMEND using medication beyond expiration date BECAUSE
Detailed Answer:
Thank you for posing your somewhat complex but THOUGHT PROVOKING question because you raise a common query and dilemma that doctors, patients, and government officials face all the time.
The short answer is this....as a DOCTOR OF MEDICINE who has been sworn to FIRST DO NO HARM to his patients I cannot in good conscience recommend to any patient of mine that they voluntarily take or use medications beyond their expiration because as a matter of ethics and LAW I will be held fully responsible and accountable in the event an adverse effect were to occur in this patient (whether it was directly related to taking the medication or not). Unfortunately, the Oath of a Medical Doctor does not recognize or take into any account the financial aspects of the extraordinarily high prices of medicines, etc. It is clearly a shame and even OBJECTIONABLE that nothing more proactive has been done by pharmaceutical companies nor medical organizations or societies to get some closure on this nagging question which has been around for decades.
But the state of affairs is that they haven't really progressed for consumers in any meaningful way in the past several decades when it comes to advising patients of whether or not they can use expired drugs.
If you'd like to read an interesting article on this topic please look up this link to the XXXXXXX Gazette published in 2005:
https://www.post-gazette.com/news/health/2005/05/30/Drugs-may-outlast-label-date/stories/0000
I can tell you that in the gamut of literature articles that mention anything about using expired medications there are many reports of how a particular expired drug LOST ITS EFFICACY....but there is virtually nothing written or proven on the ILL EFFECTS felt or caused due to DAMAGE coming about from the use of expired medication. For the most part the worst part of taking such medications is that they simply don't work the same or not at all when expired significantly beyond their stamped dates.
I have patients who have told me they've taken medications for their headaches that were up to 4 years out of date and that the medication seemed to work as effectively as in the original fresh state. Now, mind you that these medications I'm talking about were stored in NEAR PRISTINE AND PERFECT conditions for all that time which is generally NOT the case with something that has been held onto and not used for so long....but anyhow....this is what some of my patients have told me after bolding using their stashes! HOWEVER, this still doesn't allow me as a DOCTOR of Medicine and a HEADACHE SPECIALIST to condone the use of these medications and I always will offer and even try and switch the medication for a new prescription.
Therefore, to once again answer your question as to whether I believe it is acceptable to use expired medications for headaches my answer is that it is NOT acceptable. Furthermore, I don't believe you'll find any other doctor or pharmacist giving the nod on such a request for all the issues I mentioned up top. However, I am also a scientist who believes that telling patients the truth (as we know it) is part of my job when asked the proper questions. And so, there are data to support the use of EXPIRED MEDICATIONS for rather lengthy time frames after the expiration date (ASSUMING THE DRUG HAS BEEN KEPT AND STORED IN IDEAL CONDITIONS). The military actually did a GIGANTIC study on the integrity of medications expired and found that on average for all medications under discussion that drugs expiration dates were premature by as much as 4-5 years. But that is also talking about very specific circumstances and assuming the medications have been kept in the best conditions.
I would suggest you replace those medications with up to date tablets because even if you be having to pay for new medication...what's the down side? You spent money....and it may be expensive.....got it.
Now, What's the UP side? You purchased the HIGHEST QUALITY of substance possible to treat your headaches....and isn't that what you REALLY WANT? Do you really WANT to "take a chance?" on messing up anything in your body or just not getting any relief from your headaches due to not spending money? I don't think so....nevertheless, as I said up top when you first asked the question.....you bring up an excellent question and point that really should be formally studied and addressed with some type of leadership or consensus statement for both DOCTORS as well as PATIENTS.
If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm also very interested in knowing how things turn out for you if you get any testing or evaluations done so drop me a line please :0
This query has utilized a total of 50 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
I DO NOT RECOMMEND using medication beyond expiration date BECAUSE
Detailed Answer:
Thank you for posing your somewhat complex but THOUGHT PROVOKING question because you raise a common query and dilemma that doctors, patients, and government officials face all the time.
The short answer is this....as a DOCTOR OF MEDICINE who has been sworn to FIRST DO NO HARM to his patients I cannot in good conscience recommend to any patient of mine that they voluntarily take or use medications beyond their expiration because as a matter of ethics and LAW I will be held fully responsible and accountable in the event an adverse effect were to occur in this patient (whether it was directly related to taking the medication or not). Unfortunately, the Oath of a Medical Doctor does not recognize or take into any account the financial aspects of the extraordinarily high prices of medicines, etc. It is clearly a shame and even OBJECTIONABLE that nothing more proactive has been done by pharmaceutical companies nor medical organizations or societies to get some closure on this nagging question which has been around for decades.
But the state of affairs is that they haven't really progressed for consumers in any meaningful way in the past several decades when it comes to advising patients of whether or not they can use expired drugs.
If you'd like to read an interesting article on this topic please look up this link to the XXXXXXX Gazette published in 2005:
https://www.post-gazette.com/news/health/2005/05/30/Drugs-may-outlast-label-date/stories/0000
I can tell you that in the gamut of literature articles that mention anything about using expired medications there are many reports of how a particular expired drug LOST ITS EFFICACY....but there is virtually nothing written or proven on the ILL EFFECTS felt or caused due to DAMAGE coming about from the use of expired medication. For the most part the worst part of taking such medications is that they simply don't work the same or not at all when expired significantly beyond their stamped dates.
I have patients who have told me they've taken medications for their headaches that were up to 4 years out of date and that the medication seemed to work as effectively as in the original fresh state. Now, mind you that these medications I'm talking about were stored in NEAR PRISTINE AND PERFECT conditions for all that time which is generally NOT the case with something that has been held onto and not used for so long....but anyhow....this is what some of my patients have told me after bolding using their stashes! HOWEVER, this still doesn't allow me as a DOCTOR of Medicine and a HEADACHE SPECIALIST to condone the use of these medications and I always will offer and even try and switch the medication for a new prescription.
Therefore, to once again answer your question as to whether I believe it is acceptable to use expired medications for headaches my answer is that it is NOT acceptable. Furthermore, I don't believe you'll find any other doctor or pharmacist giving the nod on such a request for all the issues I mentioned up top. However, I am also a scientist who believes that telling patients the truth (as we know it) is part of my job when asked the proper questions. And so, there are data to support the use of EXPIRED MEDICATIONS for rather lengthy time frames after the expiration date (ASSUMING THE DRUG HAS BEEN KEPT AND STORED IN IDEAL CONDITIONS). The military actually did a GIGANTIC study on the integrity of medications expired and found that on average for all medications under discussion that drugs expiration dates were premature by as much as 4-5 years. But that is also talking about very specific circumstances and assuming the medications have been kept in the best conditions.
I would suggest you replace those medications with up to date tablets because even if you be having to pay for new medication...what's the down side? You spent money....and it may be expensive.....got it.
Now, What's the UP side? You purchased the HIGHEST QUALITY of substance possible to treat your headaches....and isn't that what you REALLY WANT? Do you really WANT to "take a chance?" on messing up anything in your body or just not getting any relief from your headaches due to not spending money? I don't think so....nevertheless, as I said up top when you first asked the question.....you bring up an excellent question and point that really should be formally studied and addressed with some type of leadership or consensus statement for both DOCTORS as well as PATIENTS.
If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating if you feel so inclined? Again, many thanks for submitting your inquiry and please let me know how things turn out.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. I'm also very interested in knowing how things turn out for you if you get any testing or evaluations done so drop me a line please :0
This query has utilized a total of 50 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I appreciate the detail you went into - but you missed one vital element in my question. I would not hesitate to buy new medicine as you suggest BUT this essential medicine is NOT AVAILABLE in the country where I now reside. That is why I am willing to try the expired medicine esp as you say studies show it may not be effective but it is unlikely to be harmful....
I appreciate the detail you went into - but you missed one vital element in my question. I would not hesitate to buy new medicine as you suggest BUT this essential medicine is NOT AVAILABLE in the country where I now reside. That is why I am willing to try the expired medicine esp as you say studies show it may not be effective but it is unlikely to be harmful....
Brief Answer:
Many alternatives to rizatriptan if not available locally
Detailed Answer:
Thank you for the clarification on the problem of availability.
So, there are exactly 7 TRIPTAN medications on the market (in the U.S.) and rizatriptan goes by the brand name MAXALT. I don't know the brand name in Canada to be truthful. However, the ultimate differences between the triptans (one to another) resides in their speed to action, their side effects per individual, and finally how each one reacts metabolically in one's system to either take the headache away or not (i.e. does it work?).
When a patient responds well to one of the triptans the chances are very good that they will respond to at least 1 if not more than 1 of the others. The original triptan that started it all is SUMATRIPTAN (Imitrex) but this one seems to also be the one that causes the most side effects in the greatest number of people. But in the injectable form (comes as nasal spray and tablets as well) it is the FASTEST ACTING of the whole bunch with some patients reporting near complete relief from their migraines and associated symptoms in 15 minutes....the average is about 30 min. It also is known to confer somewhat of a prophylactic element (preventative) to migraine headaches when used compared to the others. Eletriptan on the other hand is very similar to sumatriptan in chemical composition but not available as injection and has the convenient property of working a bit longer than 24 hrs. that sumatriptan and most of the other triptans function.
I guess the point is there should definitely be options to the triptans where you live and it would simply be a matter of finding a neurologist or headache specialist who is familiar with the various drugs in that family to recommend something to substitute. Preferable to my opinion and find something that will serve you in the longer term than using your remaining doses of a medication that is significantly outdated because at that the end of that road....you're going to be back where you started looking for an agent because you may very well be the last person in the province to have any of the Riza left! LOL!
And also, in finding a headache specialist to treat you at this point you also have the advantage of getting options even to using the triptans for your headaches. What if you are perhaps having headaches that are responsive to some of the newer modalities of treatments such as MAGNESIUM infusions, high dose MELATONIN REGIMENS.....or have you ever tried something like DHE 45 injectable (sounds like something Clint Eastwood might be carrying in his flak jacket!). Then, there's the question which I know you were not asking about but may be related to your situation which is just exactly how frequent is "occasional".....The reason that is an important question to answer is because if a person needs to take medication more than ONCE WEEKLY for migraine headaches then, the consensus and recommendations by specialists in the field is that they be given PROPHYLACTIC (preventative) treatment in addition to rescue medication.
And so, that may be something else that could be missing from the equation which would mitigate the use of abortive medications.
BTW, our family lived in Montreal and I still have friends that live (from primary school) in the DeCarrie Blvd area. I've also promised to go back one day to organize a CLASS REUNION! We'd all ride the SUBWAY starting at the ATWATER station as part of the reunion because we were all kids when the subway first opened in Montreal. I lived there during Expo 67....got lost in La Ronde but still remember many things about Montreal, the city, the school, the friends....good times. My wife also spent an exchange year in Montreal when she was 18 years old...but I was long gone by then....she also thought it was a great year and remembers a lot!......LOL.....Now, we're just across the border.. XXXXXXX OH....though that's a bit of a hike otherwise, I'd invite you to this side of the frontier.....In fact, I'm pretty sure I've still got some samples of Maxalt in the office that are NOT EXPIRED! HAHA!
In the end kind sir....it'll be your decision how you wish to proceed is yours and I fully appreciate and understand your rationale for using the medication you have and yes, according to published reports..... the medication is UNLIKELY to be harmful but nobody can guarantee point and it would be less than professional for me to do so.
I do think you have good options as stated above in obtaining very efficacious medicine notwithstanding that rizatriptan is no longer available to you. Just find yourself a good neurologist or headache specialist and they'll get you set up in no time flat....and MAYBE EVEN better than before now that you're armed with even a few more things to think about regarding your headaches and and can ask the doctor to consider a few more angles or treatment options since the science has progressed a bit more than you're probably aware.
Think about the frequency of these headaches, are there any other types of headaches aside from the MIGRAINES you may have...usually people have a mixed bag of headaches (migraines PLUS tension types, etc.) and if so, should you really be on a prophylactic agent in addition to your rescue agent? What other options are there not only to rizatriptan within the triptan class of drugs but perhaps outside of that realm to include things such as the ERGOTAMINES, HIGH DOSE NSAID's, mixtures of NSAID's with TRIPTANS (i.e. TREXIMET WHICH IS Naproxen in a mix with sumtriptan)?
Cheers to you and to Montreal ("Le Salut par La Concorde!")
Once again, if I've provided information of value to your query could you do me the favor of CLOSING THE QUERY and including some words of POSITIVE feedback and/or a 5 STAR rating if I've made the mark?
I'm definitely interested in knowing how things progress or turn out so please drop me a line in the near future at: www.bit.ly/drdariushsaghafi
This query has utilized a total of 88 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Many alternatives to rizatriptan if not available locally
Detailed Answer:
Thank you for the clarification on the problem of availability.
So, there are exactly 7 TRIPTAN medications on the market (in the U.S.) and rizatriptan goes by the brand name MAXALT. I don't know the brand name in Canada to be truthful. However, the ultimate differences between the triptans (one to another) resides in their speed to action, their side effects per individual, and finally how each one reacts metabolically in one's system to either take the headache away or not (i.e. does it work?).
When a patient responds well to one of the triptans the chances are very good that they will respond to at least 1 if not more than 1 of the others. The original triptan that started it all is SUMATRIPTAN (Imitrex) but this one seems to also be the one that causes the most side effects in the greatest number of people. But in the injectable form (comes as nasal spray and tablets as well) it is the FASTEST ACTING of the whole bunch with some patients reporting near complete relief from their migraines and associated symptoms in 15 minutes....the average is about 30 min. It also is known to confer somewhat of a prophylactic element (preventative) to migraine headaches when used compared to the others. Eletriptan on the other hand is very similar to sumatriptan in chemical composition but not available as injection and has the convenient property of working a bit longer than 24 hrs. that sumatriptan and most of the other triptans function.
I guess the point is there should definitely be options to the triptans where you live and it would simply be a matter of finding a neurologist or headache specialist who is familiar with the various drugs in that family to recommend something to substitute. Preferable to my opinion and find something that will serve you in the longer term than using your remaining doses of a medication that is significantly outdated because at that the end of that road....you're going to be back where you started looking for an agent because you may very well be the last person in the province to have any of the Riza left! LOL!
And also, in finding a headache specialist to treat you at this point you also have the advantage of getting options even to using the triptans for your headaches. What if you are perhaps having headaches that are responsive to some of the newer modalities of treatments such as MAGNESIUM infusions, high dose MELATONIN REGIMENS.....or have you ever tried something like DHE 45 injectable (sounds like something Clint Eastwood might be carrying in his flak jacket!). Then, there's the question which I know you were not asking about but may be related to your situation which is just exactly how frequent is "occasional".....The reason that is an important question to answer is because if a person needs to take medication more than ONCE WEEKLY for migraine headaches then, the consensus and recommendations by specialists in the field is that they be given PROPHYLACTIC (preventative) treatment in addition to rescue medication.
And so, that may be something else that could be missing from the equation which would mitigate the use of abortive medications.
BTW, our family lived in Montreal and I still have friends that live (from primary school) in the DeCarrie Blvd area. I've also promised to go back one day to organize a CLASS REUNION! We'd all ride the SUBWAY starting at the ATWATER station as part of the reunion because we were all kids when the subway first opened in Montreal. I lived there during Expo 67....got lost in La Ronde but still remember many things about Montreal, the city, the school, the friends....good times. My wife also spent an exchange year in Montreal when she was 18 years old...but I was long gone by then....she also thought it was a great year and remembers a lot!......LOL.....Now, we're just across the border.. XXXXXXX OH....though that's a bit of a hike otherwise, I'd invite you to this side of the frontier.....In fact, I'm pretty sure I've still got some samples of Maxalt in the office that are NOT EXPIRED! HAHA!
In the end kind sir....it'll be your decision how you wish to proceed is yours and I fully appreciate and understand your rationale for using the medication you have and yes, according to published reports..... the medication is UNLIKELY to be harmful but nobody can guarantee point and it would be less than professional for me to do so.
I do think you have good options as stated above in obtaining very efficacious medicine notwithstanding that rizatriptan is no longer available to you. Just find yourself a good neurologist or headache specialist and they'll get you set up in no time flat....and MAYBE EVEN better than before now that you're armed with even a few more things to think about regarding your headaches and and can ask the doctor to consider a few more angles or treatment options since the science has progressed a bit more than you're probably aware.
Think about the frequency of these headaches, are there any other types of headaches aside from the MIGRAINES you may have...usually people have a mixed bag of headaches (migraines PLUS tension types, etc.) and if so, should you really be on a prophylactic agent in addition to your rescue agent? What other options are there not only to rizatriptan within the triptan class of drugs but perhaps outside of that realm to include things such as the ERGOTAMINES, HIGH DOSE NSAID's, mixtures of NSAID's with TRIPTANS (i.e. TREXIMET WHICH IS Naproxen in a mix with sumtriptan)?
Cheers to you and to Montreal ("Le Salut par La Concorde!")
Once again, if I've provided information of value to your query could you do me the favor of CLOSING THE QUERY and including some words of POSITIVE feedback and/or a 5 STAR rating if I've made the mark?
I'm definitely interested in knowing how things progress or turn out so please drop me a line in the near future at: www.bit.ly/drdariushsaghafi
This query has utilized a total of 88 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Many alternatives to rizatriptan if not available locally
Detailed Answer:
Thank you for the clarification on the problem of availability.
So, there are exactly 7 TRIPTAN medications on the market (in the U.S.) and rizatriptan goes by the brand name MAXALT. I don't know the brand name in Canada to be truthful. However, the ultimate differences between the triptans (one to another) resides in their speed to action, their side effects per individual, and finally how each one reacts metabolically in one's system to either take the headache away or not (i.e. does it work?).
When a patient responds well to one of the triptans the chances are very good that they will respond to at least 1 if not more than 1 of the others. The original triptan that started it all is SUMATRIPTAN (Imitrex) but this one seems to also be the one that causes the most side effects in the greatest number of people. But in the injectable form (comes as nasal spray and tablets as well) it is the FASTEST ACTING of the whole bunch with some patients reporting near complete relief from their migraines and associated symptoms in 15 minutes....the average is about 30 min. It also is known to confer somewhat of a prophylactic element (preventative) to migraine headaches when used compared to the others. Eletriptan on the other hand is very similar to sumatriptan in chemical composition but not available as injection and has the convenient property of working a bit longer than 24 hrs. that sumatriptan and most of the other triptans function.
I guess the point is there should definitely be options to the triptans where you live and it would simply be a matter of finding a neurologist or headache specialist who is familiar with the various drugs in that family to recommend something to substitute. Preferable to my opinion and find something that will serve you in the longer term than using your remaining doses of a medication that is significantly outdated because at that the end of that road....you're going to be back where you started looking for an agent because you may very well be the last person in the province to have any of the Riza left! LOL!
And also, in finding a headache specialist to treat you at this point you also have the advantage of getting options even to using the triptans for your headaches. What if you are perhaps having headaches that are responsive to some of the newer modalities of treatments such as MAGNESIUM infusions, high dose MELATONIN REGIMENS.....or have you ever tried something like DHE 45 injectable (sounds like something Clint Eastwood might be carrying in his flak jacket!). Then, there's the question which I know you were not asking about but may be related to your situation which is just exactly how frequent is "occasional".....The reason that is an important question to answer is because if a person needs to take medication more than ONCE WEEKLY for migraine headaches then, the consensus and recommendations by specialists in the field is that they be given PROPHYLACTIC (preventative) treatment in addition to rescue medication.
And so, that may be something else that could be missing from the equation which would mitigate the use of abortive medications.
BTW, our family lived in Montreal and I still have friends that live (from primary school) in the DeCarrie Blvd area. I've also promised to go back one day to organize a CLASS REUNION! We'd all ride the SUBWAY starting at the ATWATER station as part of the reunion because we were all kids when the subway first opened in Montreal. I lived there during Expo 67....got lost in La Ronde but still remember many things about Montreal, the city, the school, the friends....good times. My wife also spent an exchange year in Montreal when she was 18 years old...but I was long gone by then....she also thought it was a great year and remembers a lot!......LOL.....Now, we're just across the border.. XXXXXXX OH....though that's a bit of a hike otherwise, I'd invite you to this side of the frontier.....In fact, I'm pretty sure I've still got some samples of Maxalt in the office that are NOT EXPIRED! HAHA!
In the end kind sir....it'll be your decision how you wish to proceed is yours and I fully appreciate and understand your rationale for using the medication you have and yes, according to published reports..... the medication is UNLIKELY to be harmful but nobody can guarantee point and it would be less than professional for me to do so.
I do think you have good options as stated above in obtaining very efficacious medicine notwithstanding that rizatriptan is no longer available to you. Just find yourself a good neurologist or headache specialist and they'll get you set up in no time flat....and MAYBE EVEN better than before now that you're armed with even a few more things to think about regarding your headaches and and can ask the doctor to consider a few more angles or treatment options since the science has progressed a bit more than you're probably aware.
Think about the frequency of these headaches, are there any other types of headaches aside from the MIGRAINES you may have...usually people have a mixed bag of headaches (migraines PLUS tension types, etc.) and if so, should you really be on a prophylactic agent in addition to your rescue agent? What other options are there not only to rizatriptan within the triptan class of drugs but perhaps outside of that realm to include things such as the ERGOTAMINES, HIGH DOSE NSAID's, mixtures of NSAID's with TRIPTANS (i.e. TREXIMET WHICH IS Naproxen in a mix with sumtriptan)?
Cheers to you and to Montreal ("Le Salut par La Concorde!")
Once again, if I've provided information of value to your query could you do me the favor of CLOSING THE QUERY and including some words of POSITIVE feedback and/or a 5 STAR rating if I've made the mark?
I'm definitely interested in knowing how things progress or turn out so please drop me a line in the near future at: www.bit.ly/drdariushsaghafi
This query has utilized a total of 88 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Many alternatives to rizatriptan if not available locally
Detailed Answer:
Thank you for the clarification on the problem of availability.
So, there are exactly 7 TRIPTAN medications on the market (in the U.S.) and rizatriptan goes by the brand name MAXALT. I don't know the brand name in Canada to be truthful. However, the ultimate differences between the triptans (one to another) resides in their speed to action, their side effects per individual, and finally how each one reacts metabolically in one's system to either take the headache away or not (i.e. does it work?).
When a patient responds well to one of the triptans the chances are very good that they will respond to at least 1 if not more than 1 of the others. The original triptan that started it all is SUMATRIPTAN (Imitrex) but this one seems to also be the one that causes the most side effects in the greatest number of people. But in the injectable form (comes as nasal spray and tablets as well) it is the FASTEST ACTING of the whole bunch with some patients reporting near complete relief from their migraines and associated symptoms in 15 minutes....the average is about 30 min. It also is known to confer somewhat of a prophylactic element (preventative) to migraine headaches when used compared to the others. Eletriptan on the other hand is very similar to sumatriptan in chemical composition but not available as injection and has the convenient property of working a bit longer than 24 hrs. that sumatriptan and most of the other triptans function.
I guess the point is there should definitely be options to the triptans where you live and it would simply be a matter of finding a neurologist or headache specialist who is familiar with the various drugs in that family to recommend something to substitute. Preferable to my opinion and find something that will serve you in the longer term than using your remaining doses of a medication that is significantly outdated because at that the end of that road....you're going to be back where you started looking for an agent because you may very well be the last person in the province to have any of the Riza left! LOL!
And also, in finding a headache specialist to treat you at this point you also have the advantage of getting options even to using the triptans for your headaches. What if you are perhaps having headaches that are responsive to some of the newer modalities of treatments such as MAGNESIUM infusions, high dose MELATONIN REGIMENS.....or have you ever tried something like DHE 45 injectable (sounds like something Clint Eastwood might be carrying in his flak jacket!). Then, there's the question which I know you were not asking about but may be related to your situation which is just exactly how frequent is "occasional".....The reason that is an important question to answer is because if a person needs to take medication more than ONCE WEEKLY for migraine headaches then, the consensus and recommendations by specialists in the field is that they be given PROPHYLACTIC (preventative) treatment in addition to rescue medication.
And so, that may be something else that could be missing from the equation which would mitigate the use of abortive medications.
BTW, our family lived in Montreal and I still have friends that live (from primary school) in the DeCarrie Blvd area. I've also promised to go back one day to organize a CLASS REUNION! We'd all ride the SUBWAY starting at the ATWATER station as part of the reunion because we were all kids when the subway first opened in Montreal. I lived there during Expo 67....got lost in La Ronde but still remember many things about Montreal, the city, the school, the friends....good times. My wife also spent an exchange year in Montreal when she was 18 years old...but I was long gone by then....she also thought it was a great year and remembers a lot!......LOL.....Now, we're just across the border.. XXXXXXX OH....though that's a bit of a hike otherwise, I'd invite you to this side of the frontier.....In fact, I'm pretty sure I've still got some samples of Maxalt in the office that are NOT EXPIRED! HAHA!
In the end kind sir....it'll be your decision how you wish to proceed is yours and I fully appreciate and understand your rationale for using the medication you have and yes, according to published reports..... the medication is UNLIKELY to be harmful but nobody can guarantee point and it would be less than professional for me to do so.
I do think you have good options as stated above in obtaining very efficacious medicine notwithstanding that rizatriptan is no longer available to you. Just find yourself a good neurologist or headache specialist and they'll get you set up in no time flat....and MAYBE EVEN better than before now that you're armed with even a few more things to think about regarding your headaches and and can ask the doctor to consider a few more angles or treatment options since the science has progressed a bit more than you're probably aware.
Think about the frequency of these headaches, are there any other types of headaches aside from the MIGRAINES you may have...usually people have a mixed bag of headaches (migraines PLUS tension types, etc.) and if so, should you really be on a prophylactic agent in addition to your rescue agent? What other options are there not only to rizatriptan within the triptan class of drugs but perhaps outside of that realm to include things such as the ERGOTAMINES, HIGH DOSE NSAID's, mixtures of NSAID's with TRIPTANS (i.e. TREXIMET WHICH IS Naproxen in a mix with sumtriptan)?
Cheers to you and to Montreal ("Le Salut par La Concorde!")
Once again, if I've provided information of value to your query could you do me the favor of CLOSING THE QUERY and including some words of POSITIVE feedback and/or a 5 STAR rating if I've made the mark?
I'm definitely interested in knowing how things progress or turn out so please drop me a line in the near future at: www.bit.ly/drdariushsaghafi
This query has utilized a total of 88 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I an overwhelmed by the information - actually too much, I am afraid. I don't live in Canada otherwise there would be no problem finding the alternatives you suggest. Thank you for your interest.
I an overwhelmed by the information - actually too much, I am afraid. I don't live in Canada otherwise there would be no problem finding the alternatives you suggest. Thank you for your interest.
Brief Answer:
Please allow me to share what I would do if no rizatriptan available
Detailed Answer:
Thank you for your return message on your situation and thoughts. I do sometimes seem to provide people with more information than the typical patient needs to overcome their problem. I always like to give people enough options to work with since most of the time they have physicians to discuss things with...and they are not specialists so it is good to also include the educational aspects and rationale for WHY I say WHAT I say in case the physician with whom the patient may be speaking may appreciate such data so that they can work with the patient to make a better choice.
I reread your initial introductory comments about your headaches. You describe them as MIGRAINES which are becoming MORE FREQUENT and INCAPACITATING, however, what you have on hand to combat those headaches is a stock of rizatriptan that is expired by 3 years. I won't rehash why using that medication is not advisable. I'm sure I've made my opinion clear and therefore, you are at your XXXXXXX to make your own decisions.
But if I were treating you as my patient in an medical office located across the way from where you lived and rizatriptan were not available to give you as a rescue medication I would MOST INTERESTED in getting your headaches under control by TRYING TO PREVENT them from even starting. It's worth a POUND OF CURE, so they say!
And therefore, I would recommend that you start a medication called NORTRIPTYLINE at the lowest dose possible (10mg.) taken at bedtime and then, on a weekly basis you could escalate that dose by 10mg. and continue this pattern until reaching a maximum of 50mg. per night. I would explain the possible side effects of the drug such as dry eyes, dry mouth, stomach upset, constipation but also tell you that by SLOWLY escalating the dose weekly these side effects can be MITIGATED in many cases. You'd also be instructed to start tracking your headaches so that you could really tell once they started DECREASING in their frequency because of course, that's the main objective....LESS HEADACHES as time passes until hopefully we can get to ZERO. See that? And therefore, no need to worry about trying to deal with the incapacitating migraine symptoms at all if nortriptyline works as billed.
Of course, I would also recommend AN ABORTIVE medication or rescue drug SUCH AS RIZATRIPTAN in the interim while the nortriptyline ramps up and does its job. But rizatriptan is not available I would prescribe SUMATRIPTAN which I found is available in Indonesia. I highly recommend the INJECTABLE 6mg. formulation since it is the quickest to give you relief of all the triptans as I explained earlier in my other answer. It also comes in tablets and nasal spray. If you get the tablets then, I always start with the 50mg. presentation (comes in 25's and 100's). 50's seem to work very well for the majority of folks. But remember, your headaches are INCREASING in their frequency. It is not recommended you use ANY TRIPTAN or other abortive medication more than TWICE WEEKLY otherwise, the headaches could get worse. That is why anyone with FREQUENT headaches should be on prophylactic therapy....OR figure out why the headaches suddenly bumped up and address THAT issue if possible.
I did a little research on the availability of SUMATRIPTAN where you live (appears to be YOGYAKARTA, INDONESIA) and guess what...I found another person suffering from migraines who was on a trip to Jakarta having the same problems of availability (their post is from May 2018). I'm not sure how close you are to Jakarta for the SPECIFICS of this person's post to be of value to you but the BRAND NAME of sumatriptan is TRIPTAGIC. If you cannot find this medication easily because the pharmacists tell you it's not available the alternative that may quell your headaches immediately could be a drug called ERICAF (much less expensive than sumatriptan).
Here is the link that takes you to the thread where this person explains EXACTLY where they found sumatriptan in JAKARTA:
https://www.tripadvisor.com/ShowTopic-g294225-i7219-k0000-URGENT_Where_can_i_find_Sumatriptan_migraine_med-Indonesia.html
I hope this more targetted set of recommendations helps you find relief quickly and please let me know if you do find the sumatriptan (or any other triptan for that matter) as well as the nortriptyline and I'd be happy to give you more information on the best ways of battling these headaches to get them to hopefully ZERO out both from a preventative as well as abortive point of view.
Cheers and all the best!
Please allow me to share what I would do if no rizatriptan available
Detailed Answer:
Thank you for your return message on your situation and thoughts. I do sometimes seem to provide people with more information than the typical patient needs to overcome their problem. I always like to give people enough options to work with since most of the time they have physicians to discuss things with...and they are not specialists so it is good to also include the educational aspects and rationale for WHY I say WHAT I say in case the physician with whom the patient may be speaking may appreciate such data so that they can work with the patient to make a better choice.
I reread your initial introductory comments about your headaches. You describe them as MIGRAINES which are becoming MORE FREQUENT and INCAPACITATING, however, what you have on hand to combat those headaches is a stock of rizatriptan that is expired by 3 years. I won't rehash why using that medication is not advisable. I'm sure I've made my opinion clear and therefore, you are at your XXXXXXX to make your own decisions.
But if I were treating you as my patient in an medical office located across the way from where you lived and rizatriptan were not available to give you as a rescue medication I would MOST INTERESTED in getting your headaches under control by TRYING TO PREVENT them from even starting. It's worth a POUND OF CURE, so they say!
And therefore, I would recommend that you start a medication called NORTRIPTYLINE at the lowest dose possible (10mg.) taken at bedtime and then, on a weekly basis you could escalate that dose by 10mg. and continue this pattern until reaching a maximum of 50mg. per night. I would explain the possible side effects of the drug such as dry eyes, dry mouth, stomach upset, constipation but also tell you that by SLOWLY escalating the dose weekly these side effects can be MITIGATED in many cases. You'd also be instructed to start tracking your headaches so that you could really tell once they started DECREASING in their frequency because of course, that's the main objective....LESS HEADACHES as time passes until hopefully we can get to ZERO. See that? And therefore, no need to worry about trying to deal with the incapacitating migraine symptoms at all if nortriptyline works as billed.
Of course, I would also recommend AN ABORTIVE medication or rescue drug SUCH AS RIZATRIPTAN in the interim while the nortriptyline ramps up and does its job. But rizatriptan is not available I would prescribe SUMATRIPTAN which I found is available in Indonesia. I highly recommend the INJECTABLE 6mg. formulation since it is the quickest to give you relief of all the triptans as I explained earlier in my other answer. It also comes in tablets and nasal spray. If you get the tablets then, I always start with the 50mg. presentation (comes in 25's and 100's). 50's seem to work very well for the majority of folks. But remember, your headaches are INCREASING in their frequency. It is not recommended you use ANY TRIPTAN or other abortive medication more than TWICE WEEKLY otherwise, the headaches could get worse. That is why anyone with FREQUENT headaches should be on prophylactic therapy....OR figure out why the headaches suddenly bumped up and address THAT issue if possible.
I did a little research on the availability of SUMATRIPTAN where you live (appears to be YOGYAKARTA, INDONESIA) and guess what...I found another person suffering from migraines who was on a trip to Jakarta having the same problems of availability (their post is from May 2018). I'm not sure how close you are to Jakarta for the SPECIFICS of this person's post to be of value to you but the BRAND NAME of sumatriptan is TRIPTAGIC. If you cannot find this medication easily because the pharmacists tell you it's not available the alternative that may quell your headaches immediately could be a drug called ERICAF (much less expensive than sumatriptan).
Here is the link that takes you to the thread where this person explains EXACTLY where they found sumatriptan in JAKARTA:
https://www.tripadvisor.com/ShowTopic-g294225-i7219-k0000-URGENT_Where_can_i_find_Sumatriptan_migraine_med-Indonesia.html
I hope this more targetted set of recommendations helps you find relief quickly and please let me know if you do find the sumatriptan (or any other triptan for that matter) as well as the nortriptyline and I'd be happy to give you more information on the best ways of battling these headaches to get them to hopefully ZERO out both from a preventative as well as abortive point of view.
Cheers and all the best!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Please allow me to share what I would do if no rizatriptan available
Detailed Answer:
Thank you for your return message on your situation and thoughts. I do sometimes seem to provide people with more information than the typical patient needs to overcome their problem. I always like to give people enough options to work with since most of the time they have physicians to discuss things with...and they are not specialists so it is good to also include the educational aspects and rationale for WHY I say WHAT I say in case the physician with whom the patient may be speaking may appreciate such data so that they can work with the patient to make a better choice.
I reread your initial introductory comments about your headaches. You describe them as MIGRAINES which are becoming MORE FREQUENT and INCAPACITATING, however, what you have on hand to combat those headaches is a stock of rizatriptan that is expired by 3 years. I won't rehash why using that medication is not advisable. I'm sure I've made my opinion clear and therefore, you are at your XXXXXXX to make your own decisions.
But if I were treating you as my patient in an medical office located across the way from where you lived and rizatriptan were not available to give you as a rescue medication I would MOST INTERESTED in getting your headaches under control by TRYING TO PREVENT them from even starting. It's worth a POUND OF CURE, so they say!
And therefore, I would recommend that you start a medication called NORTRIPTYLINE at the lowest dose possible (10mg.) taken at bedtime and then, on a weekly basis you could escalate that dose by 10mg. and continue this pattern until reaching a maximum of 50mg. per night. I would explain the possible side effects of the drug such as dry eyes, dry mouth, stomach upset, constipation but also tell you that by SLOWLY escalating the dose weekly these side effects can be MITIGATED in many cases. You'd also be instructed to start tracking your headaches so that you could really tell once they started DECREASING in their frequency because of course, that's the main objective....LESS HEADACHES as time passes until hopefully we can get to ZERO. See that? And therefore, no need to worry about trying to deal with the incapacitating migraine symptoms at all if nortriptyline works as billed.
Of course, I would also recommend AN ABORTIVE medication or rescue drug SUCH AS RIZATRIPTAN in the interim while the nortriptyline ramps up and does its job. But rizatriptan is not available I would prescribe SUMATRIPTAN which I found is available in Indonesia. I highly recommend the INJECTABLE 6mg. formulation since it is the quickest to give you relief of all the triptans as I explained earlier in my other answer. It also comes in tablets and nasal spray. If you get the tablets then, I always start with the 50mg. presentation (comes in 25's and 100's). 50's seem to work very well for the majority of folks. But remember, your headaches are INCREASING in their frequency. It is not recommended you use ANY TRIPTAN or other abortive medication more than TWICE WEEKLY otherwise, the headaches could get worse. That is why anyone with FREQUENT headaches should be on prophylactic therapy....OR figure out why the headaches suddenly bumped up and address THAT issue if possible.
I did a little research on the availability of SUMATRIPTAN where you live (appears to be YOGYAKARTA, INDONESIA) and guess what...I found another person suffering from migraines who was on a trip to Jakarta having the same problems of availability (their post is from May 2018). I'm not sure how close you are to Jakarta for the SPECIFICS of this person's post to be of value to you but the BRAND NAME of sumatriptan is TRIPTAGIC. If you cannot find this medication easily because the pharmacists tell you it's not available the alternative that may quell your headaches immediately could be a drug called ERICAF (much less expensive than sumatriptan).
Here is the link that takes you to the thread where this person explains EXACTLY where they found sumatriptan in JAKARTA:
https://www.tripadvisor.com/ShowTopic-g294225-i7219-k0000-URGENT_Where_can_i_find_Sumatriptan_migraine_med-Indonesia.html
I hope this more targetted set of recommendations helps you find relief quickly and please let me know if you do find the sumatriptan (or any other triptan for that matter) as well as the nortriptyline and I'd be happy to give you more information on the best ways of battling these headaches to get them to hopefully ZERO out both from a preventative as well as abortive point of view.
Cheers and all the best!
Please allow me to share what I would do if no rizatriptan available
Detailed Answer:
Thank you for your return message on your situation and thoughts. I do sometimes seem to provide people with more information than the typical patient needs to overcome their problem. I always like to give people enough options to work with since most of the time they have physicians to discuss things with...and they are not specialists so it is good to also include the educational aspects and rationale for WHY I say WHAT I say in case the physician with whom the patient may be speaking may appreciate such data so that they can work with the patient to make a better choice.
I reread your initial introductory comments about your headaches. You describe them as MIGRAINES which are becoming MORE FREQUENT and INCAPACITATING, however, what you have on hand to combat those headaches is a stock of rizatriptan that is expired by 3 years. I won't rehash why using that medication is not advisable. I'm sure I've made my opinion clear and therefore, you are at your XXXXXXX to make your own decisions.
But if I were treating you as my patient in an medical office located across the way from where you lived and rizatriptan were not available to give you as a rescue medication I would MOST INTERESTED in getting your headaches under control by TRYING TO PREVENT them from even starting. It's worth a POUND OF CURE, so they say!
And therefore, I would recommend that you start a medication called NORTRIPTYLINE at the lowest dose possible (10mg.) taken at bedtime and then, on a weekly basis you could escalate that dose by 10mg. and continue this pattern until reaching a maximum of 50mg. per night. I would explain the possible side effects of the drug such as dry eyes, dry mouth, stomach upset, constipation but also tell you that by SLOWLY escalating the dose weekly these side effects can be MITIGATED in many cases. You'd also be instructed to start tracking your headaches so that you could really tell once they started DECREASING in their frequency because of course, that's the main objective....LESS HEADACHES as time passes until hopefully we can get to ZERO. See that? And therefore, no need to worry about trying to deal with the incapacitating migraine symptoms at all if nortriptyline works as billed.
Of course, I would also recommend AN ABORTIVE medication or rescue drug SUCH AS RIZATRIPTAN in the interim while the nortriptyline ramps up and does its job. But rizatriptan is not available I would prescribe SUMATRIPTAN which I found is available in Indonesia. I highly recommend the INJECTABLE 6mg. formulation since it is the quickest to give you relief of all the triptans as I explained earlier in my other answer. It also comes in tablets and nasal spray. If you get the tablets then, I always start with the 50mg. presentation (comes in 25's and 100's). 50's seem to work very well for the majority of folks. But remember, your headaches are INCREASING in their frequency. It is not recommended you use ANY TRIPTAN or other abortive medication more than TWICE WEEKLY otherwise, the headaches could get worse. That is why anyone with FREQUENT headaches should be on prophylactic therapy....OR figure out why the headaches suddenly bumped up and address THAT issue if possible.
I did a little research on the availability of SUMATRIPTAN where you live (appears to be YOGYAKARTA, INDONESIA) and guess what...I found another person suffering from migraines who was on a trip to Jakarta having the same problems of availability (their post is from May 2018). I'm not sure how close you are to Jakarta for the SPECIFICS of this person's post to be of value to you but the BRAND NAME of sumatriptan is TRIPTAGIC. If you cannot find this medication easily because the pharmacists tell you it's not available the alternative that may quell your headaches immediately could be a drug called ERICAF (much less expensive than sumatriptan).
Here is the link that takes you to the thread where this person explains EXACTLY where they found sumatriptan in JAKARTA:
https://www.tripadvisor.com/ShowTopic-g294225-i7219-k0000-URGENT_Where_can_i_find_Sumatriptan_migraine_med-Indonesia.html
I hope this more targetted set of recommendations helps you find relief quickly and please let me know if you do find the sumatriptan (or any other triptan for that matter) as well as the nortriptyline and I'd be happy to give you more information on the best ways of battling these headaches to get them to hopefully ZERO out both from a preventative as well as abortive point of view.
Cheers and all the best!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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