OBJECTIVETo describe a patient who developed reversible segmental cerebral arterial vasospasm and cerebral infarction while taking excessive amounts of sumatriptan succinate and a combination drug (Midrin) consisting of isometheptene mucate, 65 mg, dichloralphenazone, 100 mg, and acetaminophen, 325 mg.DESIGNCase report.SETTINGTertiary care center.PATIENTA 43-year-old man who developed a left occipital infarct after taking a total of 23 sumatriptan succinate tablets (25 mg per tablet) and 32 Midrin tablets during a 7-day period and who on digital subtraction angiography was shown to have segmental cerebral arterial narrowing in multiple vessels. An extensive evaluation for other possible risk factors for cerebral infarction was unrevealing.MAIN OUTCOME AND RESULTSDiscontinuation of sumatriptan and Midrin regimens and administration of nicardipine hydrochloride led to nearly total resolution of the angiographic findings, and the patient had no recurrent strokes.CONCLUSIONSOne should consider the diagnosis of drug-induced vasospasm in patients with cerebral infarction and a history of excessive use of sumatriptan and Midrin. The initial angiographic abnormalities may resemble those found in patients with primary angiitis of the central nervous system.

10 Apr 1996·JAMA: The Journal of the American Medical Association

Computerized drug interaction programs: how reliable?

Letter

Author: Kraft, K E ; Dore, F H

ABSTRACT To the Editor. —How often do we prescribe two or more adversely interacting drugs to the same patient? Maybe more often than we think. One benefit to busy pharmacists designed to minimize this problem is the computerized drug-interaction database, which can alert them to potential interactions between drugs entered into a patient's profile. However, this is only as useful as the information entered into the database is accurate.We recently observed an adverse drug interaction when a 40-year-old woman taking Nardil (phenelzine sulfate) for chronic depression was also prescribed Midrin (isometheptene mucate plus dichloralphenazone and acetaminophen) for headaches. Forty minutes after the first dose of Midrin, the patient experienced neck pain, palpitation, worsening headache, diaphoresis, nonsustained ventricular tachycardia, and premature ventricular contractions. The patient was taken to the hospital emergency department and treated for a hypertensive crisis. The patient was treated with intravenous phentolamine and had rapid resolution of her

01 Sep 1985·Archives of physical medicine and rehabilitationQ1 · MEDICINE

Autonomic dysreflexia due to medication: misadventure in the use of an isometheptene combination to treat migraine.

Q1 · MEDICINE

Article

Author: Basford, J R ; Wineinger, M A

Autonomic dysreflexia, a syndrome sometimes occurring in spinal cord injured (SCI) individuals, may be life-threatening. It involves, in varying degrees, hypertension, diaphoresis, headache, bradycardia, anxiety, and flushing and is believed due to unrestricted sympathetic activity below the level of the lesion in individuals with injuries above T4-6. The most frequent causes of the syndrome are urinary infections, rectal impaction, bladder distention, and decubitus ulcers. To our knowledge, medication has seldom been described as causal agent. We report here on an autonomic dysreflexic syndrome following use of an isometheptene combination (Midrin), to treat migraine. The individual involved is a C4-quadriplegic man with a long history of migraines. He was given a standard initial adult dose of the medication. Over a one-hour period, he was initially relieved of the headache, but then noted a new more severe headache, diaphoresis, and flushing. His vital signs showed progressive BP elevation to 210/130 and a relative bradycardia. Treatment over the next three hours was limited to elevation of the head of the bed and observation, during which his vital signs returned to baseline and he became asymptomatic. This experience reinforces the belief that sympathomimetic drugs in general, and isometheptene in particular, should be used in caution in patients with high-level SCI.

100 Deals associated with Acetaminophen/Isometheptene/Dichloralphenazone

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Indication	Highest Phase	Country/Location	Organization	Date
Migraine Disorders	Preclinical	US	GALT Pharmaceuticals LLCStartup	29 Apr 2024

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