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Risk of ischemic complications related to the intensity of triptan and ergotamine use

From the Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands; and the Department of Neurology (C.C.T.), St. Elisabeth Hospital Tilburg, The Netherlands.

Address correspondence and reprint requests to Prof. DrG. Egberts, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508 TB Utrecht, The Netherlands; e-mail: A.C.G.Egberts{at}pharm.uu.nl

Objective: To investigate whether the intensity of triptan and ergotamine use, in specific overuse, is associated with the risk of ischemic complications.

Methods: We conducted a retrospective nested case-control study using data from the PHARMO Record Linkage System. All patients with more than one prescription for either a triptan or ergotamine were initially identified. Cases were all patients who were admitted to the hospital for an ischemic complication. Matched controls were assigned the same index date as the cases. The determinant was the intensity of use of triptans and ergotamine during 1 year preceding the index date. Overuse was defined as use of 90 defined daily doses during that year. Conditional logistic regression was used to estimate odds ratios (ORs), adjusting for confounders. Stratified analysis was used to estimate the risk for both patients using and those not using cardiovascular drugs.

Results: A total of 17,439 patients received more than one prescription. A total of 188 cases and 689 controls were identified. Triptan overuse was not associated with an increased risk of ischemic complications (OR 0.96; 95% CI: 0.49 to 1.90). Overuse of triptans in patients concomitantly using cardiovascular drugs did not increase this risk. Overuse of ergotamine turned out to be a risk factor for ischemic complications (OR 2.55; 95% CI: 1.22 to 5.36). Patients overusing ergotamine and concomitantly using cardiovascular drugs were at highest risk (OR 8.52; 95% CI 2.57 to 28.2).

Conclusions: In general practice, triptan overuse does not increase the risk of ischemic complications. Overuse of ergotamine may increase the risk of these complications, especially in those simultaneously using cardiovascular drugs.

Commentary, see page 1111

Disclosure: The authors report no conflicts of interest.

Received March 31, 2006. Accepted in final form July 17, 2006.

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October 10 Highlight and Commentary: Triptan and ergotamine overuse in patients with headache at risk for vasoconstrictive complications
Neurology 2006 67: 1111. [Full Text] [PDF]

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