Intranasal Zolmitriptan for the Treatment of Acute Migraine
Intranasal Zolmitriptan for the Treatment of Acute Migraine
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DOI：
10.1111/head.12181
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发表时间：
2013-09-01
期刊：
影响因子：
5
通讯作者：
Rapoport, Alan M.
中科院分区：
文献类型：
--
作者：
Tepper, Stewart J.;Chen, Susy;Rapoport, Alan M.
目的评价佐米曲坦鼻腔喷雾剂的药代动力学、疗效、耐受性和患者接受性。背景胃瘫可能延迟或减少口服曲普坦的吸收，恶心或呕吐可能会导致同样的效果和/或使服用片剂变得困难。一些偏头痛患者需要或更喜欢比口服药物提供更快的缓解。可注射曲普坦提供了进入血液的最快药物输送，但许多患者不愿使用它们。鼻腔喷雾剂可能会解决片剂和注射剂的一些问题，同时仍能提供药物的快速吸收。方法非系统综述。结果佐米曲坦NS在2-5分钟内即可在血浆中检测到显著浓度，其快速吸收是由于鼻黏膜的早期吸收所致。在两个随机试验中，服用佐米曲坦NS的患者比服用安慰剂的患者在服药后15分钟(第一个时间点)明显更有可能无痛，大约一半的患者在24小时内有持续的反应。在患者可以治疗任何严重程度的偏头痛的研究中，有证据表明佐米曲坦在10分钟内对头痛有显著的反应或缓解。在一项试验中，从服药后30分钟开始，生理盐水的总症状缓解率明显好于安慰剂。佐米曲坦NS最常见的副作用是不寻常的味道。患者满意度研究表明，佐米曲坦NS因其起效速度快、使用方便、可靠性和总体疗效而受到赞赏。结论佐米曲坦NS能在10分钟内缓解部分患者的头痛症状，并能迅速消除部分主要偏头痛症状。好的候选对象是那些发作迅速升级为中到重度疼痛的偏头痛患者，以及那些早上偏头痛、呕吐时间短或口服三联疗法失败的人。
ObjectiveTo review the pharmacokinetics, efficacy, tolerability, and patient acceptance of zolmitriptan nasal spray (NS). BackgroundGastroparesis may delay or diminish the absorption of oral triptans, and nausea or vomiting may do the same and/or make it difficult to take a tablet. Some migraineurs require or prefer faster relief than oral medications provide. Injectable triptans provide the fastest drug delivery into the bloodstream, but many patients are reluctant to use them. Nasal sprays may address some of the problems with tablets and injectables while still providing rapid absorption of drug. MethodsNon-systematic review. ResultsSignificant levels of zolmitriptan NS are detectable in plasma within 2-5 minutes, and the rapid absorption is due to early uptake through the nasal mucosa. In 2 randomized trials, users of zolmitriptan NS were significantly more likely than placebo recipients to be pain-free at 15 minutes post-dose, the first time point measured, and about half of patients had sustained response at 24 hours. Studies in which patients could treat a migraine of any severity have documented significant headache response or relief with zolmitriptan NS at 10 minutes. In one trial, the rate of total symptom relief was significantly better with the NS than with placebo from 30 minutes post-dose. The most common side effect of zolmitriptan NS is unusual taste. Patient satisfaction studies indicate that zolmitriptan NS is appreciated for its speed of onset, ease of use, reliability, and overall efficacy. ConclusionsZolmitriptan NS provides onset of headache relief within 10 minutes for some patients and quickly abolishes some of the major migraine symptoms. Good candidates are migraineurs whose episodes rapidly escalate to moderate-to-severe pain and those who have morning migraine, have a quick time to vomiting, or have failed oral triptans.