Second drug boosts triptan efficacy for migraine

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Adding trimebutine to rizatriptan therapy appears to hasten the resolution of migraine attacks, according to a study.

Trimebutine is “well-tolerated” and “may represent an additional resource in the available arsenal to treat migraine attacks,” investigators say.

“In an era of potential new agents for the acute treatment of migraine, raising the efficacy of already safe and available drugs through the combination of traditional medications may represent an attractive option,” they write in a report in the journal Cephalagia. 

Delayed gastric emptying, or “gastric paralysis,” is common during migraine attacks and can delay the onset of action for drugs taken by mouth, Dr. Abouch V. Krymchantowski, from Hospital Pasteur in Rio de Janeiro, Brazil, and colleagues explain.

This is particularly relevant for triptans, which seem to work best during the early stages of an attack.

Therefore, use of a “gastrokinetic” agent, such as trimebutine that helps regulate movement of contents in the gastrointestinal tract, could potentially improve the efficacy of triptan therapy. Trimebutine is often used to treat irritable bowel syndrome (spastic colon).

In a crossover study, the investigators assessed the outcomes of 40 patients who were randomized to treat two consecutive migraine attacks with rizatriptan (10 mg) plus either trimebutine (200 mg) or placebo.

A total of 64 attacks were treated with each of the regimens.

Within 1 hour of dosing, 30 (46.8 percent) of the attacks treated with the two-drug combination had resolved compared with just 8 (12.5 percent) of the attacks treated with rizatriptan alone, a significant difference. At 2 hours, the difference persisted with corresponding resolution rates of 73.4 percent and 31.2 percent.

Rizatriptan plus trimebutine was also significantly better than rizatriptan alone at resolving the nausea and photophobia accompanying the migraines.

Cephalalgia July 2006.

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