Question: Compare side effects of Lyrica and Namenda in terms of safety?
Answer:
Full Question:
How would you compare the side effect profiles
of Lyrica and Namenda in terms of safety? Is one drug known more
than the other for causing potential long-term health risks? Also, has one been
studied more than the other in terms of migraine prevention? I've been given the
choice of starting one and would appreciate some further perspective. Thanks!
Hope.
Answer:
Dear Hope;
Both medications are new to the US and both have great safety margins. Each works by a different mechanism of action. Both have been studies to a small extent for migraine and headache treatment. We have a small publication on Namenda from last year. Ultimately it revolves around your comfort level
Memantine: Novel mechanism for migraine and headache prophylaxis
Diane Cammarata, APNP, Stephanie Hall, BS, and John Claude Krusz, PhD, MD
Anodyne Headache and PainCare
Dallas, Texas
ABSTRACT:
We studied the efficacy of a new moderate affinity NMDA-receptor antagonist
in the treatment of migraines and tension-type headaches (TTH). The primary
endpoint of this open label study was reduction of frequency and severity of
migraines. Secondary endpoints included reduction of TTH and pain related to
the head and neck in our study patients.
Memantine has recently been introduced in the US for dementing disorders,
although has been used in Europe for some time. It blocks NMDA glutamate
receptors, thought to be intrinsic to pain transmission, windup, long-term
potentiation and central sensitization. Excitatory amino acid systems, like
glutamate and its receptor subtypes, play a role in promoting pain
mechanisms. Therefore, blockade of NMDA might reduce central barrage of
afferent signals that might contribute to maintenance of migraine states.
Agents whose activity, in part, impinges on the glutamate system are in use
for migraine prophylaxis (topiramate).
20 patients with chronic migraines who had not responded to other
prophylaxis measures were studied. They had an average of 9.2 migraines per
month. 14/20 (60%) had TTH as well (average of 12.5 days per month). We
added memantine 5mg per day with weekly increases of 5 mg, up to a maximum
of 20 mg per day, as tolerated.
Patients kept headache diaries for migraines and TTH and pain scores as
well. Evaluation were made after 1 month of therapy on 20 mg (or maximally
tolerated dose) of memantine.
Migraine frequency fell to an average of 4.1 migraines per month, or almost 56% less than at baseline, in 14 of 20 patients. Remaining migraines were rated as less severe and easier to treat. Acute migraine and rescue medication use dropped by two-thirds. TTH frequency fell by 62%, to 6 headaches per month. 6 patients saw no response of their migraines to memantine. 4 patients reported dizziness and one nausea. 2 of these patients had betterment of their migraines.
We conclude from this preliminary open-label study that memantine has the ability to offer successful prophylaxis of migraines and TTH in situations where other regimens have not benefited the patient. It speaks to the potential role of NMDA glutamate receptors in the maintenance of migraine and headache states. Memantine should be studied in migraine therapy in a double-blind manner.
Good luck,
Teri Robert and John Claude Krusz
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Published May 1, 2006
