The purpose of this discussion is to select appropriate medications depending on a certain case. Thus, the case of Mia, a 35-year-old female with severe headaches, is selected. The clinical problem is the following one: the woman experiences occasional severe headaches (migraines) which make her take drugs that were not prescribed for her case. Furthermore, the patient breastfeeds her 2-month-old infant. Clinical goals for this case include minimizing pain, increasing the quality of life, and avoiding adverse effects on a child.
Non-pharmacological interventions include keeping a diary to determine migraine triggers, keeping a diet to avoid consuming alcohol and caffeine, following regular sleep patterns, and avoiding loud noise or bright light if they are noticed to be triggers of migraines (Serrano, Buse, Manack Adams, Reed, & Lipton, 2015). The clinical practice guideline which can be used to determine treatment decisions for the case of migraine was developed and reviewed by the American Headache Society (AHS) and the American Academy of Neurology (AAN) in 2012 to update the information regarding the most advanced approaches to overcoming the problem (American Academy of Neurology, 2012). The provided guidelines are “the result of a systematic search, expert review, and synthesis of relevant evidence for preventive treatments of episodic migraine” (Loder, Burch, & Rizzoli, 2012, p. 931). Still, there is a lack of evidence to prove strong effects of some medications. The identified population includes adults suffering from migraine symptoms.
The class of medications appropriate for the patient’s case is triptans. It is possible to choose sumatriptan (Imitrex) because studies indicate its safety for those women who breastfeed infants (Davanzo, Bua, Paloni, & Facchina, 2014; Hutchinson et al., 2013). The decision is also based on analyzing the patient’s age, gender, and symptoms of the disease. A safe dosage for this woman is 5 mg that equals one spray into one nostril. During a day, it is possible to repeat the procedure in two hours if there is no relief. The dosage is appropriate to minimize the concentration of sumatriptan in the breast milk (Davanzo et al., 2014). This medication should be selected instead of non-steroidal anti-inflammatory drugs which can be ineffective to cope with migraines and instead of antiemetics, neuroleptics, and opioids which can be characterized by high toxicity (Woo & Wynne, 2012). Thus, many of these drugs are not compatible with breastfeeding and provoke side effects. The use of triptans during pregnancy is questionable, but studies indicate that the use of sumatriptan while breastfeeding is safe (Hutchinson et al., 2013). The price of Imitrex nasal spray (5 mg) is about $50-$55. It cannot be purchased in Walmart or Target stores.
Sumatriptan is expected to block pain within 30 minutes after using a spray. Imitrex is most effective when it is used when the first signs of a migraine are observed. If one dose is needed to relieve pain, this medication is effective. If two doses (10 mg/day) are required, it is necessary to monitor the patient’s state during a month. It is also important to monitor whether a migraine is observed more than four times a month. When some side effects, including dizziness, unpleasant taste, or numbness, are observed, it is important to stop using Imitrex, and a new treatment will be prescribed. The major drug-drug interactions are identified for Imitrex and ergotamines, other triptans, Monoamine Oxidase-A inhibitors, and serotonin-specific reuptake inhibitors (Hutchinson et al., 2013). There are no drug-food interactions. Before taking the medication, the patient should be educated regarding the following aspects: it is ineffective to use a spray when there are no signs of a migraine; it is reasonable to breastfeed an infant before using a spray; it is inappropriate to use more than 20 mg of Imitrex for this patient during 24 hours.
American Academy of Neurology. (2012). Update: Pharmacologic treatment for episodic migraine prevention in adults. Web.
Davanzo, R., Bua, J., Paloni, G., & Facchina, G. (2014). Breastfeeding and migraine drugs. European Journal of Clinical Pharmacology, 70(11), 1313-1324.
Hutchinson, S., Marmura, M. J., Calhoun, A., Lucas, S., Silberstein, S., & Peterlin, B. L. (2013). Use of common migraine treatments in breast‐feeding women: A summary of recommendations. Headache: The Journal of Head and Face Pain, 53(4), 614-627.
Loder, E., Burch, R., & Rizzoli, P. (2012). The 2012 AHS/AAN guidelines for prevention of episodic migraine: A summary and comparison with other recent clinical practice guidelines. Headache: The Journal of Head and Face Pain, 52(6), 930-945.
Serrano, D., Buse, D. C., Manack Adams, A., Reed, M. L., & Lipton, R. B. (2015). Acute treatment optimization in episodic and chronic migraine: Results of the American Migraine Prevalence and Prevention (AMPP) study. Headache: The Journal of Head and Face Pain, 55(4), 502-518.
Woo, T. M., & Wynne, A. L. (2012). Pharmacotherapeutics for nurse practitioner prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company.