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Abstract
Frovatriptan is a triptan characterized by a high affinity for 5-HT1B/1D receptors and a long half-life contributing to a more sustained and prolonged action than other triptans. Dexketoprofen is a nonsteroidal anti-inflammatory drug with a relatively short half-life and rapid onset of action, blocking the action of cyclo-oxygenase, which is involved in prostaglandins’ production, thus reducing inflammation and pain. Both drugs have been successfully employed as monotherapies for the treatment of acute migraine attacks. The combination of these two drugs (frovatriptan 2.5 mg plus dexketoprofen 25 or 37.5 mg) has been tested in migraine sufferers, showing a rapid and good initial efficacy, with 2-h pain free rates of 51%, and a high persistence in the 48-h following the onset of pain: recurrence occurred in only 29% of attacks and sustained pain free rates were 43% at 24- and 33% at 48-h.
Financial & competing interests disclosure
G Allais has occasionally served as scientific consultant for manufacturers of frovatriptan, rizatriptan, zolmitriptan and almotriptan. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Key issues
Frovatriptan is a triptan characterized by a high affinity for 5-HT1B/1D receptors and a long half-life (roughly 25 h) contributing to its more sustained and prolonged action than other triptans.
Dexketoprofen is an nonsteroidal anti-inflammatory drug (NSAID) that blocks the action of cyclo-oxygenase, which is involved in prostaglandins’ production, thus reducing inflammation and pain.
Both drugs have been successfully employed as monotherapies for the treatment of acute migraine attack: as for other triptans and NSAIDs, however, in a variable portion of the migraine sufferers, they provide only incomplete relief.
The two drugs, when combined, allowed to achieve pain free at 2 h and sustained pain free over the 24 h in half of the treated patients, with recurrences at 48 h in only one-third of patients.
The combination was more effective than the frovatriptan monotherapy in the 2 h and 24 h pain-free response (51 vs 29% at 2 h and 43 vs 24% at 24 h).
Recurrence rates over the 48 h were similar: 29% combination versus 22% monotherapy.
The efficacy profile of the frovatriptan plus dexketoprofen combination was consistent or even better than that of other triptans plus NSAIDs combinations.
The clinical advantage of combining frovatriptan with dexketoprofen is likely to be a rapid and good initial efficacy and a high persistence in the 48 h following the onset of pain.