Stern Jennifer I, Datta Shae, Chiang Chia-Chun, Garza Ivan, Vieira Dorice L, Robertson Carrie E
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurology, NYU Langone Health, New York, New York, USA.
Headache. 2023 Jan;63(1):9-24. doi: 10.1111/head.14437.
OBJECTIVES/BACKGROUND: Treatment of migraine in the setting of either renal or hepatic disease can be daunting for clinicians. Not only does the method of metabolism have to be considered, but also the method of elimination/excretion of the parent drug and any active or toxic metabolites. Furthermore, it is difficult to think about liver or kidney disease in isolation, as liver disease can sometimes contribute to impaired renal function and renal disease can sometimes impair hepatic metabolism, through the cytochrome P450 system.
A detailed search for terms related to liver disease, renal disease, and migraine management was performed in PubMed, Ovid Medline, Embase, and the Cochrane Library.For each medication, product labels were retrieved and reviewed using the US FDA website, with additional review of IBM Micromedex, LiverTox, and the Renal Drug Handbook.
This manuscript provides an overview of migraine drug metabolism and how it can be affected by liver and renal impairment. It reviews the standard terminology recommended by the US Food and Drug Administration for the different stages of hepatic and renal failure. The available evidence regarding the use of abortive and preventative medicines in the setting of organ failure is discussed in detail, including more recent therapies such as lasmiditan, gepants, and calcitonin gene-related peptide antibodies.
For acute therapy, the use of NSAIDS should be limited, as these carry risk for both severe hepatic and renal disease. Triptans can be selectively used, often with dose guideline adjustments. Ubrogepant may be used in severe hepatic disease with dose adjustment and lasmiditan can be used in end stage renal disease. Though non-medicine strategies may be the most reasonable initial approach, many preventative medications can be used in the setting of hepatic and renal disease, often with dose adjustment. This review provides tables of guidelines, including reduced dosing recommendations, for the use of abortive and preventative migraine medications in hepatic and renal failure.
目的/背景：对于临床医生而言，在肾病或肝病背景下治疗偏头痛可能颇具挑战。不仅要考虑药物的代谢方式，还要考虑母体药物及其任何活性或有毒代谢产物的消除/排泄方式。此外，单独考虑肝脏或肾脏疾病很困难，因为肝脏疾病有时会导致肾功能受损，而肾脏疾病有时会通过细胞色素P450系统损害肝脏代谢。
在PubMed、Ovid Medline、Embase和Cochrane图书馆中对与肝脏疾病、肾脏疾病和偏头痛管理相关的术语进行了详细检索。对于每种药物，使用美国食品药品监督管理局（US FDA）网站检索并审查产品标签，并额外参考IBM Micromedex、LiverTox和《肾脏药物手册》。
本手稿概述了偏头痛药物代谢及其如何受到肝脏和肾脏损害的影响。它回顾了美国食品药品监督管理局为肝衰竭和肾衰竭不同阶段推荐的标准术语。详细讨论了在器官衰竭情况下使用终止发作药物和预防性药物的现有证据，包括最近的疗法，如拉米地坦、 gepants和降钙素基因相关肽抗体。
对于急性治疗，应限制使用非甾体抗炎药（NSAIDS），因为这些药物对严重肝脏和肾脏疾病均有风险。曲坦类药物可选择性使用，通常需调整剂量指南。乌布罗吉泮可在严重肝病中使用并调整剂量，拉米地坦可在终末期肾病中使用。尽管非药物策略可能是最合理的初始方法，但许多预防性药物可在肝脏和肾脏疾病情况下使用，通常需调整剂量。本综述提供了指南表格，包括在肝衰竭和肾衰竭中使用终止发作和预防性偏头痛药物的减少剂量建议。
