Medications
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Medications

Medications may stop a cluster headache after it starts and prevent additional headaches from occurring. Finding the right medication can take some time. You may need a combination of medications to effectively treat your cluster headaches. The problem is, what may work quite well for one cluster may not work at all the next time you get a cluster.
For example, the very first time I got them, back in 1994, Deseril worked perfectly. I took a Deseril tablet in the morning when I woke, and I wouldn't get a CH that day. If I missed a Deseril I would get a CH. The next time I got the Cluster headaches, a few months laster, Deseril did absolutely nothing.

Imigran (Sumatriptan) seems to be the miracle drug, with 95% of sufferers finding it effective.

Some tips for your visit to the GP:

Go to your GP well prepared - and also make sure that they are well prepared. Print off as much information as you can from the sources on this site and send it to them a couple of days before your appointment if you can. Make sure that you have also read the information and have a general idea as to what your options are.

GP's don't know everything so try not to blame them. Be polite but be forceful, many GP's will not prescribe the correct medication on the grounds of cost. If they suffered the same pain that you do they would prescribe what you needed in a heartbeat!

Ensure your prescriptions give you enough medication to avoid going short. If this is a problem ensure you ask for more when you need it - most doctors will give in if you simply keep going back.

Medication Choices

Treatments used to stop cluster headaches are called abortive headache treatments and most often include:

    High-flow oxygen inhalation therapy, which is inhaled through a face mask to quickly relieve headache pain.
    Intranasal lidocaine, which is taken by nose drops to stop severe headache pain.
    Sumatriptan     (Imigran), which is injected to narrow blood vessels and reduce pressure and pain. This medication can also be taken as a nasal spray, although it may be less effective than the injection.
Medicines that prevent cluster headaches are called prophylactic headache medications. You must take these medicines every day, even on days when you do not have headaches. They include:

    Ergotamine preparations, such as Deseril and Cafergot, which narrow blood vessels to relieve pressure and reduce headache pain. These are sometimes classified as abortives, but have a long lasting effect so can be used as a preventative if you know when your CH will arrive.

    Calcium channel blockers, such as verapamil hydrochloride (Calan, Isoptin, Verelan), which relax narrowed blood vessels and reduce pain. Verapamil hydrochloride is the first choice drug for preventing both occasional and chronic cluster headaches.

    Corticosteroids    , such as prednisone (Panafcort), which can break a headache cycle, although it is not clear how these medications work.

    Lithium. Lithium carbonate (Lithobid, Lithonate, Lithotabs, Eskalith) is thought to affect the brain's biological clock (hypothalamus), which some experts think is linked to cluster headaches, although the specific problem or abnormality that triggers cluster headaches is unclear. Lithium is often prescribed to prevent chronic cluster headaches.

    Antiseizure medications     such as divalproex sodium (Depakote), valproate (valproic acid), or topiramate (Topamax), which may be tried if other treatments are not effective.

    The most effective treatments in the majority of sufferers. Try these first.

    Deseril
    Cafergot
    Oxygen
    Imigran (Sumatriptan)
    Verapamil
    Panafcort (prednisone)
    Relpax
    Tegretol

 

 

Deseril

How does it work?

Deseril tablets contain the active ingredient methysergide, which is a type of medicine called an ergot alkaloid.

Although the cause of attacks is not fully understood, it is thought that the widening of blood vessels in the brain causes the pain associated with attacks.

It is also believed that a chemical called serotonin (also known as 5HT) is released in the brain at the beginning of an attack. Serotonin triggers the release of other chemicals which cause blood vessels in the brain to widen. Serotonin itself causes blood vessels in the brain to narrow.

Methysergide in Deseril blocks serotonin (or 5HT) receptors in the brain. Blocking these receptors stops blood vessels in the brain from dilating and contracting. By stopping these changes, it helps prevent headaches from occuring. It reduces the frequency and severity of attacks of cluster headaches and other types of vascular headache such as migraine. However, the medicine won't stop an attack once it has started.

Methysergide can cause severe side effects and is only used if other treatment options have failed, or the headaches are so severe or regular that normal daily activities are severely affected and this level of treatment is warranted.

Warning!

  • Deseril tablets should be taken with food.
  • This medication may cause drowsiness, dizziness, or disturbances in vision. If affected do not drive or operate machinery. Avoid alcoholic drink.
  • Regular clinical supervision and periodic breaks from treatment are essential so that any adverse effects of this medicine can be recognised and minimised. This medicine should not be taken for longer than six months at a time without a break of at least one month.
  • You should tell your GP immediately if you experience any of the following symptoms during treatment: problems passing urine; an unexpected decrease in the amount of urine passed; pain in your lower back or chest; shortness of breath; pain, coldness or numbness in your legs or arms; severe abdominal pain; or loss of vision.
  • Your GP will ask you to have regular check-ups during treatment so that your heart, lungs, blood vessels and other organs can be monitored.
  • When stopping treatment this should be done gradually over two to three weeks to avoid rebound headaches. Follow the instructions given by your GP.
  • This medicine should not be used to treat an attack once it has started.

Use with caution in

  • History of peptic ulcer

Not to be used in

  • Children
  • Decreased kidney function
  • Decreased liver function
  • Pregnancy
  • Breastfeeding
  • Coronary heart disease
  • Valvular heart disease
  • Progressive hardening of the arteries (arteriosclerosis)
  • Hardening of the arteries in the legs (peripheral vascular disease)
  • Very high blood pressure (severe hypertension)
  • Inflammation of the veins in the legs (phlebitis)
  • Inflammation of connective tissue (commonly the skin) of the legs (cellulitis)
  • Lung disease
  • Diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus, rheumatoid arthritis (collagen vascular diseases)
  • Diseases of the urinary tract
  • Septic conditions, eg severe infections
  • General weight loss, malnutrition and wasting occurring in the course of a chronic disease or emotional disturbance (cachectic conditions)
  • History of disorders involving scarring and stiffening of body tissues (fibrosis, for example retroperitoneal fibrosis) caused by a medicine

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your GP or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your GP or pharmacist immediately.

Pregnancy and Breastfeeding

  • This medicine should not be used during pregnancy or breastfeeding. Seek medical advice from your GP.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Disturbances of the gut such as heartburn, diarrhoea, constipation, nausea, vomiting or abdominal pain
  • Dizziness
  • Drowsiness
  • Excessive fluid retention in the body tissues, resulting in swelling (oedema)
  • Difficulty in sleeping (insomnia)
  • Leg cramps
  • Weight gain
  • Rash
  • Hair loss
  • Spasm of the arteries in a limb, this may cause symptoms such as coldness, loss of feeling or pain in an arm or leg
  • Spasm of the arteries in the heart, causing angina-like chest pain
  • Spasm of the arteries to the eye, causing reversible loss of vision
  • Spasm of the arteries to the kidneys, causing a temporary rise in blood pressure
  • Spasm of the arteries to the intestines, causing abdominal pain
  • Mental or behavioural disturbances
  • Scarring or stiffening (fibrosis) of tissues in the heart valves, lungs, urinary tract or major blood vessels
  • The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your GP or pharmacist.

How can this medicine affect other medicines?

It is important to tell your GP or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your GP or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

You should not take this medicine if you have taken any kind of triptan medicine, eg almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan or zolmitriptan, in the previous six hours.

You should not take any of these triptan medicines until at least 24 hours after taking the last dose of this medicine.

The following medicines should be avoided in people taking this medicine, because they can increase the blood level of methysergide and increase the risk of its side effects:

  • macrolide antibiotics (eg telithromycin, erythromycin, clarithromycin)
  • protease or reverse transcriptase inhibitors for treating HIV infection (eg ritonavir, indinavir, nelfinavir, amprenavir, saquinavir)
  • azole antifungals (eg ketoconazole, itraconazole)
  • cimetidine.

If ergotamine or other ergot alkaloids are taken in combination with methysergide there may be an increased risk of persistant spasm in the major arteries. These medicines should be avoided or used with caution in people taking methysergide.

There may be an increased risk of narrowing or the blood vessels in the arms and legs if methysergide is used in combination with beta-blockers. If you are taking this medicine in combination with a beta-blocker such as propranolol it is important to let your GP know if you get cold, numb or painful hands or feet.

 

Cafergot

ergotamine - caffeine

How does this medication work? What will it do for me?

Ergotamine and caffeine are used together for the treatment of migraine headache. Ergotamine works by constricting blood vessel walls in the head, relieving dilation that causes the pain of migraine headaches. Caffeine helps the ergotamine to be absorbed into the bloodstream more effectively.

The tablets are most effective if taken at the first sign of a migraine headache. They are not effective for other types of headache. Relief is often obtained within one-half hour of taking the medication. Extra medication may be required if relief is not obtained within one-half hour (see maximum doses).

Your doctor may choose to use this medication for other conditions. If you're unsure why you are taking this medication, contact your doctor.

How should I use this medication?

Tablets - adults and adolescents 12 years and over: The recommended initial adult dose is 2 tablets at the first sign of a headache followed by 1 tablet after each one-half hour that the headache is not relieved. If it is found that more that 2 tablets are needed to relieve the headache, 3 tablets can be used as an initial dose for the next headache. Do not take more than 6 tablets within 24 hours or 10 tablets within 7 days.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Who should NOT take this medication?

Cafergot should not be taken by anyone who:

  • is less than 6 years old
  • has a known sensitivity or allergy to ergotamine or any other ingredient of the medication
  • has blood circulation disorders
  • has a history of coronary artery disease
  • has severe high blood pressure
  • has reduced liver or kidney function
  • has a septic (internal infection) condition
  • is or may become pregnant
  • is a breast-feeding mother
  • is taking the following medications:
    • protease inhibitors (e.g., ritonavir, nelfinavir, indinavir)
    • macrolide antibiotics (e.g., erythromycin, clarithromycin, troleandomycin)
    • antifungal agents (e.g., ketoconazole, itraconazole)

What side effects are possible with this medication?

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor. Your health professional may be able to help you deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if they continue or become bothersome.

More common:

diarrhea, nausea, or vomiting (occurring without other signs of overdose or problems with blood circulation)
dizziness or drowsiness (occurring without other signs of overdose or problems with blood circulation)
nervousness or restlessness
dryness of mouth


Check with your doctor as soon as possible if any of the following side effects occur:

  • swelling of face, fingers, feet, or lower legs


Check with your doctor immediately if any of the following side effects occur:

  • itching of skin
  • coldness, numbness, or tingling in fingers, toes, or face
  • weakness in legs


Less common or rare:

Side effects that may mean you are developing blood circulation problems:

  • anxiety or confusion (severe)
  • change in vision
  • chest pain
  • increase in blood pressure
  • pain in arms, legs, or lower back, especially if pain occurs in your calves or heels while you walk
  • pale, bluish-coloured, or cold hands or feet (not caused by cold temperatures and occurring together with other side effects listed)
  • red or violet-coloured blisters on the skin of the hands or feet

Signs of overdose:

  • convulsions (seizures)
  • diarrhea, nausea, vomiting, or stomach pain or bloating (severe) occurring together with other signs of overdose or blood circulation problems
  • difficulty moving bowels, occurring along with pain or discomfort in the rectum
  • dizziness, drowsiness, or weakness (severe), occurring together with other signs of overdose or blood circulation problems
  • dry mouth (excessive)
  • fast or slow heartbeat
  • headaches, more often or more severe than before
  • shortness of breath
  • unusual excitement
  • vision changes

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Dependence: People who take ergotamine - caffeine for extended periods of time may become dependent upon it and require progressively increasing doses for relief of vascular headaches or to prevent the increasing unpleasant effects which may follow withdrawal of the medication.

Occupational hazards: Do not undertake activities requiring mental alertness, such as driving or operating hazardous equipment, until you determine your response and sensitivity to ergotamine - caffeine.

Overdose: It is important to stay within the limits of the recommended dosage and avoid excessive or prolonged use.

Excessive dryness of the mouth and visual disturbances are signs of overdosage or of sensitivity to belladonna alkaloids. In such cases, your doctor may recommend reducing the dose.

If an overdose is suspected, seek medical help immediately.

Pregnancy: Ergotamine - caffeine may cause harm when taken by a pregnant woman. It should not be taken by women who are or may become pregnant.

Breast-feeding: This medication passes into breast milk and may cause symptoms of vomiting, diarrhea, weak pulse, and unstable blood pressure in nursing infants. Breast-feeding mothers should not use this medication.

What other drugs could interact with this medication?

The following medications can affect how ergotamine - caffeine works, be affected by it, or increase the occurrence of side effects:

  • sumatriptan
  • naratriptan
  • rizatriptan
  • other ergot medicines (e.g., methysergide, dihydroergotamine, ergonovine, ergoloid mesylates)
  • nicotine
  • beta-blockers (e.g., propranolol, sotalol, timolol)
  • nitrates (e.g., nitroglycerin, isosorbide)
  • protease inhibitors (e.g., ritonavir, nelfinavir, indinavir)
  • macrolide antibiotics (e.g., erythromycin, clarithromycin, troleandomycin)
  • antifungal agents (e.g., ketoconazole, itraconazole)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.


Oxygen: It’s use, why it works, and why it can hurt

One of the features of cluster headaches, is that it is often very responsive to oxygen. The response can be only temporary, and not work at all in some people, but for many, it is a quick and painless way to treat acute attacks.

To get it, you need a prescription. There are people who work around this by getting oxygen intended for non-human consumption (i.e. welding, etc), but the users run the risk of it not being pure. The same restrictions are not present when making industry grade oxygen when compared to medical grade. Toxins, oil, etc, are not as closely monitored, and may be present. Beware.

Most people require high concentrations of oxygen to benefit them significantly. This is obtained at 8+ liters per minute flow through a mask. Relief is usually seen within a few minutes, but may only be partial. Removing the oxygen will often cause the headache to return.

Why does it work? Well, remember that cluster headaches are considered a vascular headache (actually much more involved than just vascular, but there is a definite vascular component to it). Many of the medications that relieve CHs cause constriction of the vessels in the brains (Ergotomines, Imigran, etc), and oxygen is no different. The brain closely regulates how much oxygen it receives…and if the levels get too high, it clamps down the vessels to decrease the amount of blood flow. So, when you inhale high concentrations of oxygen, the brain says "Wow, too much," and starts to clamp down. This reaction happens to benefit those with cluster headaches.

So, can use of oxygen cause harm? Yes it can. Oxygen is actually very toxic to the lungs (as strange as that sounds). Concentrations above 21% (room air), cause damage. Small amounts of damage can be repaired. At large levels, though, the damage can cause permanent scarring.

Defining how much the human lung can tolerate without damage is still debated. In fact, some suggest that previous exposure to high dose oxygen can be protective (increases the production of the bodies defense mechanisms against free radicals such as oxygen). There has been good documentation, however, of lung damage done on patients exposed to high dose oxygen for extended periods of time, some as short as 24hours on 100% oxygen.

So, what does this mean? It means that the long term effects of using oxygen for treating CHs are not well known. It is advisable, however, to limit each exposure as much as possible, and not taking in oxygen unnecessarily, such as sleeping with it on.

It is strongly advised that you discuss all of this with your GP, get a good plan together about how best to treat your headaches, and if possible, avoiding anything but medical grade oxygen.

 

Imigran

Serotonin is a chemical neurotransmitter in the brain. What that means is that the brain uses it to send signals across short distances. . Imigran is a serotonin analogue, meaning it looks to the brain a lot like serotonin, except that it is recognized only by a small portion of the brain.

Imagine, for a moment, all the doors in a building. You could make a master key, one that would open all of the doors, or a key specific to just a few. Serotonin is the master key...Imigran opens only just a few.
Increasing the amount of serotonin everywhere in the brain does not help in the treatment of headaches. It seems that stimulating some parts helps, others hurt. What was needed was something that stimulated only those sections that help.

Imigran, and the other triptans, do just that. They work at the doors labeled 5HT1, doors that cause constriction of the arteries in the brain... also believed to interact with the ends of nerves that secrete pain chemicals, decreasing their activity. By doing so, the medication works quickly, and often effectively, in reducing pain involved with vascular headaches (clusters and migraines).

The major concern with these medications, however, is that they are not specific enough. They also stimulate the vessels in the heart to constrict. If already diseased and narrowed, the constriction can cause chest pain, or worse, a heart attack.

These medications can be tried safely in young adults with no cardiac risk factors. In older people, or those with risk factors (family history, smoking, cholesterol, obesity, etc), discussions of the risks and benefits should be undertaken with your doctor, and possibly the first dose given in the office while undergoing an EKG.

Side effects from long term use are not yet well known, as these medications are relatively new. Doses of up to two times per week have been well studied, and are currently the maximum recommended dosing. But that is just because that is all that has been studied. More frequent dosing is possible, but again, the risks and benefits need to be discussed with your doctor. Many people, especially those with cluster headaches, know that daily dosing is required, because the cluster headaches occur daily, and at LEAST once per day, and is worth the risk of not knowing the long term effects...a decision that is made between doctor and patient.

New triptans are being developed as we speak...and many about to be released. One may work for some, while not for others. Injections (Imigran only) work within 3-7 minutes, the nasal spray (Imigran) within 5-15, and the pills (others) 20-30 minutes.

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Verapamil (Calcium Channel Blockers)

Verapamil is in a class of medications called calcium channel blockers.

Calcium is used in the body in many ways. Membranes in the body separate cells, line muscles, and help regulate what goes in and out of spaces in the body. They are the walls around castles. And like castle walls, they have doors. Doors that will open and close selectively and let things through. One of these doors allows calcium to flow across the membrane. In the arteries of the brain, the muscles that cause the arteries to constrict use calcium to help regulate how hard they squeeze. By blocking the flow of calcium, the muscles don’t react as quickly.

Cluster headaches seem to involve dilatation of the arteries in the brain. Whether that causes the pain, or is just a step in the process, we don’t know. However, many of the medications that relieve cluster headache pain cause constriction of the vessels...so they definitely play a part. By blocking the calcium channels, the medication, in theory, decreases the irritability, or responsiveness, of these vessels.

It doesn’t work 100%, as the blockade is not complete (can’t be, you need some of the calcium channels to beat your heart, etc). But, by decreasing the responsiveness, a reduction in headache frequency is often seen.

The major side effects of verapamil include constipation (also slows down the muscles surrounding your intestines), decrease in blood pressure (the vessels in the rest of your body also relax), as well as a slight decrease in heart rate (the most important muscle of all). The body does tend to adjust to the blockade slowly, so a gradual increase in doses is often better than starting high. Because of the above effects, other side effects might include dizziness upon standing (from lower blood pressure), decrease exercise tolerance (from decrease heart rate), and fatigue...although these side effects are less common.

Other calcium channel blockers can be effective, but verapamil is the best studied. Because constipation is usually the only major side effect, it is a safe medication to try for most people, and as it tends to be very effective, it is one of the first line treatments against clusters.

 

Panafcort (prednisone)

CONSUMER MEDICINE INFORMATION
(direct from the leaflet that comes with the drug)

What Panafcort is used for

Panafcort is used to prevent or reduce the symptoms of inflammation (such as swelling, redness, pain, tenderness or itching) in any part of the body. These symptoms can occur in response to injury or can be caused by many different conditions.

Panafcort also suppresses the body's defences which are responsible for the inflammation in auto-immune diseases, where the defence cells attack the body's own tissues.

Panafcort works by entering inflammatory cells and blocking the inflammatory reaction. It is only able to prevent or reduce symptoms of your condition, it does not cure it.

Panafcort belongs to a group of medicines called corticosteroids. It is a synthetic version of a naturally occurring body hormone called cortisol. This hormone is made by the adrenal glands which lie just above your kidneys.

Panafcort is used in the treatment of many different conditions. Some of these conditions include: severe allergies, severe or chronic asthma, skin problems, arthritis, inflammatory diseases of the bowel, cancer and auto-immune diseases.

Your GP, however, may have prescribed Panafcort for another reason. Ask your GP if you have any questions about why Panafcort has been prescribed for you.

Before you take Panafcort

When you must not take it

Do not take Panafcort if you have ever had an allergic reaction to:

• prednisone or prednisolone
• any of the tablet ingredients listed at the end of this leaflet.

If you have an allergic reaction you may get a skin rash, have difficulty in breathing, get symptoms of hay fever or feel faint.

Do not take Panafcort after the expiry date (EXP) printed on the bottle.
It may have no effect at all, or an entirely unexpected effect if you take it after the expiry date.
Do not take Panafcort if the bottle shows signs of having been tampered with.
Do not take Panafcort to treat any other complaints unless your GP has instructed you to do so.

Before you start to take it

Your GP must know about all the following before you start to take Panafcort.

You must tell your GP if:

1. you are allergic to any other medicines or any foods, dyes or preservatives.
2. you have any medical conditions, including:

  • a current serious or uncontrolled infection
  • recent surgery or serious injury
  • diabetes mellitus (sugar diabetes)
  • osteoporosis (softening of the bone)
  • a stomach ulcer or other stomach or intestinal problems
  • liver, kidney or heart disease
  • tuberculosis
  • epilepsy
  • muscle weakness
  • glaucoma (high pressure in the eye)
  • thyroid disease
  • high blood pressure.

It may not be safe for you to take Panafcort if you have any of these medical conditions.

3. you are taking any other medicines, including medicines that you buy without a prescription from a pharmacy, supermarket or health food shop.

Some of the medicines in common use that may interfere with Panafcort include:

  • antacids (in large amounts)
  • medicines for diabetes
  • some medicines for heart disease
  • medicines for removal of fluid (diuretics)
  • some medicines for epilepsy
  • some types of antibiotics
  • potassium or salt supplements
  • immunisations or vaccines.

These medicines may be affected by Panafcort or may affect how well it works. You may need to take different amounts of your medicine or you may need to take different medicines. Your GP or pharmacist has a more complete list of medicines to avoid while taking Panafcort.

Your GP or pharmacist can tell you what to do if you are taking any of these or other medicines.

4. you are pregnant or plan to become pregnant.

Do not take Panafcort if you are pregnant unless you and your GP have discussed the risks and benefits involved.

It is recommended that you do not breastfeed while taking Panafcort as it is found in breastmilk. If you have not told your GP about any of these things, tell them before you take Panafcort.

Use in children

Take special care when giving Panafcort to children. It should only be given under your GP's supervision.

If possible, children should not be exposed to common childhood illnesses such as chickenpox or measles while they are taking Panafcort. They may suffer from more serious attacks of these illnesses if such exposure occurs.

Children should not be vaccinated with live vaccines against common childhood illnesses while they are taking Panafcort, as this may result in severe attacks of these illnesses.

Potentially serious side effects can occur in children and growing teenagers who are taking corticosteroids. Some of these include obesity, slowed growth, osteoporosis (softening of the bone), and changes to the adrenal glands.

Use in elderly

Elderly patients may be more sensitive to the effects or side effects of Panafcort.

How to take Panafcort

How much to take

Your GP will tell you how much Panafcort to take. Take the amount your GP tells you to.

The dose of Panafcort prescribed by your GP will depend on the condition being treated and your response to the treatment. Your initial dose will be maintained or adjusted until a satisfactory response is noted.

How to take it

Panafcort is best taken with or immediately after food.

When to take it

How often Panafcort can be taken may vary depending on what condition is being treated. It can be taken once daily, several times a day or on alternate days (every other day).

If you are taking Panafcort

  • once a day, it is best taken at the same time each day as instructed by your GP.
  • several times a day, it is best if you can have the doses evenly spaced throughout the day.
  • on alternate days, it is best to take it in the morning (after breakfast).

Do not miss any doses and do not stop taking the medicine even if you do feel better as this may make your symptoms worse.

How long to take it

This will depend on your condition and on your response to treatment. Some people will need Panafcort for only short periods of time, whilst others may require long term therapy.

What to expect

Individuals will vary greatly in their response to Panafcort. Your GP will check your progress at regular intervals.

If you forget to take it

If you miss a dose of Panafcort whether you should take it or not will depend on how many times a day you take Panafcort.

If you take one dose a day:

If you miss a dose and remember in less than 12 hours, take it straight away, then continue as normal the next day. Otherwise, skip that day's dose but be sure to take the next day's dose when it is due.

If you take several doses a day:

If you miss a dose and it is more than 2 hours before your next dose is due, take it straight away, then continue as you normally would.
If it is less than 2 hours to your next dose, skip the dose you have missed but be sure to take the next dose when you are meant to.

If you take a dose on alternate days:

If you miss a dose and remember it the same morning, take it straight away, then continue as you normally would. If you do not remember the missed dose until later, wait and take it the following morning. Then skip a day before continuing your regular dosage schedule.

Do not try to make up for missed doses by taking more than one dose at a time.

If you have trouble remembering when to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

Immediately telephone your GP or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at your nearest hospital if you think that you or anyone else may have taken too much Panafcort. Do this even if there are no signs of discomfort or poisoning.

While you are taking Panafcort

Things you must do

Take Panafcort exactly as your GP has prescribed.

If you do not follow your GP's instructions, you may not get improvement in the symptoms of your condition. Try not to miss any doses and take the medicine even if you feel well.

Tell your GP if your condition returns or becomes worse after your dose of Panafcort has been reduced or treatment has been stopped.
Tell your GP immediately if you become pregnant while taking Panafcort.
Tell all GPs, dentists and pharmacists who are treating you that you are taking Panafcort, especially if you are being started on any new medicines.
Tell your GP, surgeon or dentist that you are taking Panafcort if you are about to undergo surgery or an operation.
The trauma of the operation or surgery may mean that your dose of Panafcort may need to be increased to cover the stressful period.
Tell your GP straight away if you are a diabetic, and you notice a change in the results of your blood or urine sugar tests.

Panafcort may affect your blood sugar levels as it can affect the body's ability to handle glucose.
For diabetics, this means that your diabetes may become more severe.
For others, diabetes may develop for the first time while taking corticosteroids such as Panafcort.

Ask your GP, when and how you should stop taking Panafcort.

If you have been taking Panafcort for a long time, your GP may gradually reduce the amount you are taking over a period of several days, weeks or months before stopping completely.

If you have been taking Panafcort for a short period of time, this may not apply.

Things you must not do

Do not give this medicine to anyone else even if their symptoms seem similar to yours.
Do not stop taking Panafcort suddenly unless advised by your GP.

If you stop taking Panafcort suddenly, the symptoms of your condition may return, or you may develop symptoms of cortisol deficiency such as fainting, weakness, restlessness, nausea, vomiting, headache, dizziness, muscle weakness or joint pain.

If you want to stop taking Panafcort, your GP will tell you how to do it gradually.

Do not have any immunisations (particularly with live vaccines such as measles, oral polio or yellow fever) without your GP's approval while you are being treated with Panafcort.

Things to be careful of

Avoid close contact with anyone who has a contagious disease such as measles or chickenpox.

Exposure to such diseases while you are taking Panafcort, particularly if large doses are being taken, can put you at greater risk of developing these diseases if you have not had them before. Tell your GP straight away if you think you have been exposed to chickenpox or measles.

Things to be aware of

Panafcort is not known to cause drowsiness and does not appear to affect the ability to drive or operate machinery.
Check with your GP or pharmacist before drinking alcohol while you are taking Panafcort.
If you drink alcohol while taking Panafcort you may find that stomach problems occur.
As with any new medicine, you should take care when driving, operating machinery or drinking alcohol until you know how Panafcort affects you.

The signs and symptoms of infections such as fever or inflammation may be hidden by the anti-inflammatory action of Panafcort. You should see your GP for medical advice for any but the most minor infections.

Side effects

Tell your GP or pharmacist as soon as possible if you do not feel well while you are taking Panafcort.

Panafcort helps most people who take it, but it may have unwanted side effects in some people.
All medicines have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your GP or pharmacist to answer any questions you may have.

Short term use

When Panafcort is taken for short periods of time it is unlikely to cause any problems.

Tell your GP if you notice any of the following side effects and they worry you.

  • nausea (feeling sick)
  • vomiting
  • anorexia (which may result in weight loss)
  • increased appetite (which may result in weight gain)
  • stomach bloating or irritation
  • diarrhoea or constipation.

These common side effects may occur when Panafcort is taken for short periods of time. Most of these side effects will improve or resolve with time.

Long term use

When Panafcort is taken for long periods of time and in high doses the risk of side effects is greater.

Tell your GP if you notice any of the following and they worry you:

• general changes to the body:

- bloating and rounding of the face (moon face)
- headache
- dizziness
- weight gain
- redistribution of body fat
- water retention leading to swollen legs and feet, high blood pressure or an irregular heart beat.
- cramps or weakness in the muscles of the arms and legs.
- slowed growth in children
- irregular menstrual periods.

• changes to the skin:

- acne
- red or flushed face
- extra hair growth
- red or purple streaks
- easy bruising
- skin thinning
- increased sweating
- poor wound healing.

• changes to the immune system:

- an increased seriousness or frequency of infections.

• changes in behaviour:

- mood changes
- anxiety or nervousness
- restlessness
- trouble sleeping.

• changes in eyes:

- decreased or blurred vision
- cataracts.

Tell your GP immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following symptoms:

• severe stomach or intestinal pain
• epileptic fits
• sudden changes in your vision
• symptoms such as severe dizziness, fainting, weakness, chest pain or irregular heart beat (severe cortisol deficiency)
• psychiatric disturbances.

These are all serious side effects of Panafcort which may occur with high doses and long term use. You may need urgent medical attention or hospitalisation.

Some side effects can only be detected by your GP. So, when Panafcort is taken for long periods of time it is important to visit your GP regularly for check-ups. Such side effects can include:

• osteoporosis or other changes in bone which can result in an increased chance of fractures due to brittleness or softening of the bone.
• changes in other hormone levels in your body
• changes in the body's ability to handle glucose (steroid diabetes)
• effects on the parathyroid and thyroid glands (glands which control body calcium and body metabolism).
• increased amounts of cholesterol in the blood
• changes to your white blood cells
• changes to your nervous system which may affect the way your nerves work
• changed sperm count
• increased blood pressure
• increased pressure in the skull
• increased pressure in the eye (glaucoma)

Tell your GP if you notice anything else that is making you feel unwell.

Some people may get other side effects while using Panafcort.

There is no evidence that Panafcort is addictive.

Product description

What it looks like

Panafcort tablets are available in three strengths: 1mg, 5mg and 25mg.
The 1mg tablets are white, round and flat. The tablets are available in bottles of 100.
he 5mg tablets are white, scored, round and flat. They are marked with PN/5 on one side. The tablets are available in bottles of 60.
The 25mg tablets are white, scored, round and flat. They are marked with PN/25 on one side. The tablets are available in bottles of 30.

Ingredients

Active ingredient

Panafcort 1mg - 1mg prednisone per tablet.
Panafcort 5mg - 5mg prednisone per tablet.
Panafcort 25mg - 25mg prednisone per tablet.

Additives

Panafcort tablets also contain:

• maize starch
• lactose
• povidone
• crospovidone
• macrogol 6000
• magnesium stearate.

 

 

Relpax

What is Relpax?

  • Relpax is a migraine headache medicine. It is in a class of drugs called serotonin receptor agonists. They are believed to work by causing vasoconstriction (narrowing) of arteries and veins that supply blood to the head.
  • Relpax is used to treat existing headaches. Relpax will not prevent them from occurring or decrease the number of attacks. It will only treat a headache that is already occurring.

How RELPAX works:

RELPAX is believed to block the release of substances from nerve endings in the brain:

These substances cause the swelling of blood vessels around the brain. This swelling is thought to cause headache pain.

Do not take a Relpax if you:

  • have taken an ergot-based medication within the last 24 hours--ergot-based medicines include methysergide (Sansert), ergotamine (Ergostat, Ergomar, others), dihydroergotamine (D.H.E. 45, Migranal Nasal Spray), and ergotamine combination products (Bellergal-S, Cafergot, Wigraine, Cafatine-PB, and others);
  • have taken another serotonin receptor agonist within the last 24 hours - these include almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt, Maxalt-MLT), sumatriptan (Imitrex), and zolmitriptan (Zomig, Zomig-ZMT);
  • have taken ketoconazole (Nizoral), itraconazole (Sporanox), nefazodone (Serzone), troleandomycin (TAO), clarithromycin (Biaxin), ritonavir (Norvir), or nelfinavir (Viracept) in the last 72 hours;
  • have basilar or hemiplegic migraine headaches (if you are not sure about this, ask your GP);
  • heart disease including angina (chest pain), history of heart attack, or unsymptomatic heart disease;
  • have a history of stroke or transient ischemic attacks (TIA's);
  • have uncontrolled high blood pressure (hypertension);
  • have circulation (blood flow) problems including ischemic bowel disease or Raynaud's syndrome;
  • are experiencing a headache that is not like other migraines that you have had.


Taking Relpax may be dangerous if you have any of the conditions, or have taken any of the medications, listed above.

  • Before taking this medication, tell your GP if you
  • have a history of chest pain, shortness of breath, or palpitations (irregular heartbeats);
  • have diabetes;
  • have high blood pressure;
  • have a family history of heart disease;
  • have high cholesterol (a type of fat in the blood);
  • are overweight;
  • have diabetes;
  • smoke cigarettes;
  • are postmenopausal; or
  • are a male over 40 years of age.


Take RELPAX at the very first sign of a migraine.
It is best to take one RELPAX tablet whenever you feel migraine pain coming on because the sooner you take RELPAX, the better it will work.

If you cannot take RELPAX right away, do not worry, just take it as soon as possible. You can still get relief.


What are the possible side effects of Relpax?

If you experience any of the following serious side effects, stop taking Relpax and seek emergency medical attention or contact your GP immediately:

  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
  • an irregular heartbeat or tightness, pain, pressure or heaviness in your chest, throat, neck, or jaw; or a rash or itching.

Other, less serious side effects may be more likely to occur. Continue to take the Relpax and talk to your GP if you experience

  • dizziness;
  • fatigue (tiredness);
  • headache (other than a migraine headache);
  • dry mouth;
  • upset stomach or nausea;
  • weakness;
  • flushing (hot flashes); or
  • paresthesia (a feeling of tingling).

Side effects other than those listed here may also occur. Talk to your GP about any side effect that seems unusual or that is especially bothersome.

Tegretol

Tegretol, carbamazepine , is an anticonvulsant and specific analgesic for trigeminal neuralgia

USES: Carbamazepine is used to prevent and control seizures (also called an anticonvulsant or antiepileptic drug). It is also used to relieve one type of nerve pain (trigeminal neuralgia). This medication works by reducing excessive nerve signals in the brain and restoring the normal balance of nerve activity.

OTHER USES: This drug may also be used to treat certain mental/mood conditions (e.g., bipolar disorder, schizophrenia) and other types of nerve pain.

What is Tegretol?

Tegretol is in a group of drugs called anticonvulsants. It works by decreasing nerve impulses that cause seizures and pain.

Tegretol is used to treat certain types of seizures associated with epilepsy, the treatment of the nerve pain associated with true trigeminal neuralgia and diabetic neuropathy. It is also used to treat bipolar disorder.

Tegretol may also be used for other purposes not listed in this guide.

Important information about Tegretol
You should not take this medicine if you have a history of bone marrow suppression, or if you are allergic to an antidepressant such as amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), or nortriptyline (Pamelor).

Do not take Tegretol if you have taken an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or selegiline (Eldepryl, Emsam) in the past 14 days.