The Bounce

This is a boringly concrete answer: the patent was awarded in 1992, so cheap generic triptans should be available in the US by the end of next year. I can find a 1989 paper which seems to describe a triptan migraine medicine, and given the normal drug-design timescale I assume that the work started in the mid-seventies.

Hopeless idealist…

..to imagine that what we allow the drug companies to charge for any medication has anything to do with mechanism of action, production costs, proven efficacy or the severity of the condition that can be efficaciously treated. The price of medications is governed strictly by the Golden Rule, that he who has the gold makes the rules. Tom Womack above expresses the hope that the patents should start running out by the end of 1999, and that should, again merely hopefully, result in cheap generics soon thereafter. These hopes could be derailed if the patent-holders, using their gold, cadge an extension out of Congress, or if the oligopoly that is Big Pharma is gentlemanly (to each other, they don’t waste humanity or civility on the patient or taxpayer) enough to not compete with each other to bid down the price even after a triptan is out from under patent protection. I found out today, though these things no longer shock me, that the bromocriptine one of my patients needs, though it has been out from under patent since long before I was out from under med school, costs $300 a month.

Maybe a single payer in the US could rein this in. But until something does some reining in, it’s mob rule and club law that determines what meds cost.

I knew the patent on Imitrex must be running out, because I just saw television ads here in the US for a new version – which is nothing more than the old Imitrex plus over-the-counter Aleve (naproxene sodium, something you can buy for $5 for 100 pills at any gas station). I pity anyone whose doctor is unethical enough to let them pay the jacked up price for this “new” drug, instead of the forthcoming generic plus a separate over-the-counter.

Me, I’m the pharmacutical companies’ dream customer. I burn through these drugs faster than the patents expire. Imitrex worked for a few years, then Maltax, now Relpax. I dread the day when the Relpax loses its efficacy and I have to find something else.

Why is this not the post entitled “The Name of This Band is Exploding Heads”?

For all those on triptans, remember to tell your doctor if you are also taking an anti-depressant. Triptans and SSRIs don’t play well together.

mollymooly wins the thread!

I burn through these drugs faster than the patents expire. Imitrex worked for a few years, then Maltax, now Relpax. I dread the day when the Relpax loses its efficacy and I have to find something else.

Maybe you can record the adverts and keep the packaging for the old name-brand drug and then put the generic version in the fancy packaging, play back the adverts and so get the full effect without shelling out for the new drug?

Wheels within wheels

Jay,
All of the neuro-transmitters, including serotonin, act in many different neural circuits. It’s not as if serotonin were even remotely exclusive to the circuits that make migraines or depression happen, even if we had any very precise idea what those circuits might be. All we know, and we only know it empirically, and not because the effects of serotonin enhancement or blockade were in any way predictable from any sort of detailed knowledge of the neural circuitry involved, is that these agents, at the right dose range, block the wrong circuits just enough, or encourage the right circuits just enough, to help most people with migraine or depression.

Yes, it is absolutely possible, to be expected, even, for the brain to adapt to pharmacologic intervention that floods the zone with pro- or anti-serotonin effect, by increasing its own effect in the opposite direction. Living systems auto-regulate to keep themselves in equilibrium, so, yes, auto-regulation to counter a medication is not unexpected, and actually observed with many classes of medication. If serotonin had only one action in the brain, you would be right, you would expect the body’s attempts to auto-regulate towards a healthy equlibrium would act with the medication to get back to the healthy state. But because serotinin has many actions, does many things besides the migraine or depression that we’re interested in, the body has evolved to maintain overall equlibrium of serotinin, so will tend to react to pharmacologic flooding of the zone with an equally non-specific counter-flooding in the opposite direction. This, unfortunately, will sometines make a medication lose efficacy over time.

Yes, Glen, thank you for defending my honor against charges of being a dupe.

On a tangent, isn’t that counter-flooding response to the serotonin flood essentially the same reason MDMA (ecstacy) isn’t a very good regular hobby?

Laura, I apologize for not expressing myself clearly enough, leaving room for misunderstandings. Of course I never doubted in any way that people develop a resistance to triptans. It’s only that I didn’t have a clue as to why that would be so, and I sincerely wanted to know.

I think itwas gdr @ #18 suggesting that Laura was a dupe, not you Jay.

Thanks Katherine, now I see. I was kind of wondering, but I didn’t want to rule it out… My writing and reading skills often need a day or two to fully recover from a migraine attack, and during that period I can muddle things up quite beautifully.

I get the fun “ocular” migraines; Don’t particularly hurt, I just go blind, and spend a half hour or so watching the kaleidoscope. If I understand right, it’s the exact same mechanism, just a slightly different part of the brain effected. On the bright side, I can see it coming with a few minutes warning, (My vision starts getting pixilated.) so I’ve got time to pull over to the side of the road. On the down side, I have to be careful how closely I look at brightly lit, sparkly objects, prolonged exposure will trigger an attack. (I’d never make it as a jeweler!)

Might be worth getting some triptans once the price drops, if the effect is fast enough that I could pop a pill, and stop the attack before I’m totally blind. Does it work that fast if you’ve got one right at hand when the attack starts?

Also, the injections work w/in seconds- really great stuff. But, the case for carrying them around is bit big to fit in your pocket so you’d need a bag or purse or jacket or something, and, as noted, at least w/ my insurance company they make you pay the same amount for 2 injections (they come in sets of two) as for 9 pills, so I almost always use a pill, even if it will mean suffering for a half hour to an hour. (Unless you are _really_ afraid of needles there’ s no need to be afraid of the injections- it’s a little mechanism, just pops right in, you can’t hardly feel it, and you don’t see the needle until it’s all done. It’s easy to use but there is sometimes a bit of bleeding- small enough to stop, but enough to stain your clothes if you don’t watch for it.)

I am a headache physician and frequently come across patients who report that a drug that once worked now no longer does (tachyphylaxis). Sometimes I suspect that the patient’s headaches have actually worsened overall making the drug no longer effective. In cases where this doesn’t hold, often returning to an old drug that used to work is effective. The tolerance (or whatever change has produced the lack of effect) has now worn off and the old drug works again!

Also, we commonly use medications with different mechanisms of action (such as triptans + NSAIDS + anti-nauseants) together for better efficacy if one alone is not sufficient.