Tepper Stewart, Allen Christopher, Sanders David, Greene Alison, Boccuzzi Stephen
New England Center for Headache, Stamford, CT, USA.
Headache. 2003 Jan;43(1):44-8. doi: 10.1046/j.1526-4610.2003.03007.x.
Little information exists about the actual prescription of triptans within large, geographically diverse populations, in terms of demographic characteristics and co-prescriptions with other medications with potential interactions.
To investigate the demographic characteristics associated with triptan use, and examine the rate of co-prescription of triptans with specified pharmacologic agents with the potential for drug interactions.
This study examined the rate of co-prescription of triptans available in the US up to May 2001 (sumatriptan, naratriptan, rizatriptan, and zolmitriptan) with specified agents with potential for drug interactions. A cohort of 240,268 patients receiving pharmacy benefits from Merck-Medco (N = 65 + M) was followed over a one-year period. This analysis included patients who received at least two triptan prescriptions during the study (6/00-5/01). Ninety-one percent of the cohort remained on the same triptan during the study period. 'Co-prescription' was defined as any fill for a medication that was contraindicated or could potentially adversely interact with a triptan, obtained between and during the first and last triptan fills throughout the study period.
Mean patient age was 43 (SD +/- 11.6) and 82% were female. Twenty-one percent were co-prescribed selective serotonin reuptake inhibitors, reflecting the considerable co-morbidity of migraine and depression. Patients taking triptans were almost never co-prescribed monoamine oxidase inhibitors (0.02%), and co-prescription of ergots was also low (1.45%). Less than one percent (0.45%) received cimetidine while taking zolmitriptan, while 2.7% of patients taking rizatriptan 10 mg also took propranolol. While agents unavailable in the U.S. were not evaluated in this cohort, six percent of patients were treated with potent CYP 3A4 inhibitors, which would not be expected to cause any problems with the triptans in the survey. However, such agents are specifically contraindicated for use with one triptan (eletriptan), recently launched in the EU, suggesting that continued vigilance will be necessary to avoid coprescription of medicines with the potential for producing adverse side effects.
Triptan use mirrors migraine demographics. The frequency of co-prescription of triptans with SSRIs is about 20%. Continued vigilance will be necessary to avoid co-prescription of medicines with the potential for producing adverse drug events.
关于曲坦类药物在地域分布广泛的大规模人群中的实际处方情况，涉及人口统计学特征以及与其他可能存在相互作用的药物的联合处方信息较少。
调查与曲坦类药物使用相关的人口统计学特征，并研究曲坦类药物与具有药物相互作用可能性的特定药理剂的联合处方率。
本研究调查了截至2001年5月在美国可用的曲坦类药物（舒马曲坦、那拉曲坦、利扎曲坦和佐米曲坦）与具有药物相互作用可能性的特定药剂的联合处方率。在一年的时间里跟踪了一组从默克 - 美可公司获得药房福利的240,268名患者（N = 65 + M）。该分析包括在研究期间（2000年6月 - 2001年5月）接受至少两张曲坦类药物处方的患者。在研究期间，91%的队列患者持续使用同一种曲坦类药物。“联合处方”定义为在整个研究期间首次和最后一次曲坦类药物配药之间及期间获得的任何与曲坦类药物禁忌或可能产生不良相互作用的药物配药。
患者平均年龄为43岁（标准差±11.6），82%为女性。21%的患者同时被开具了选择性5-羟色胺再摄取抑制剂，这反映了偏头痛和抑郁症的相当高的共病率。服用曲坦类药物的患者几乎从未同时被开具单胺氧化酶抑制剂（0.02%），麦角类药物的联合处方率也较低（1.45%）。服用佐米曲坦时，不到1%（0.45%）的患者同时服用西咪替丁，而服用10毫克利扎曲坦的患者中有2.7%同时服用普萘洛尔。虽然在美国不可用的药剂未在该队列中评估，但6%的患者接受了强效CYP 3A4抑制剂治疗，预计在该调查中这些抑制剂与曲坦类药物不会产生任何问题。然而，此类药剂与最近在欧盟推出上市的一种曲坦类药物（依立曲坦）明确禁忌联用，这表明需要持续保持警惕以避免可能产生不良副作用的药物的联合处方。
曲坦类药物的使用情况反映了偏头痛的人口统计学特征。曲坦类药物与选择性5-羟色胺再摄取抑制剂的联合处方频率约为20%。需要持续保持警惕以避免可能产生不良药物事件的药物的联合处方。
