Am Fam Physician. 1998 Aug 1;58(2):530.
Sumatriptan accounted for the second highest outpatient drug expenditure in Denmark in 1995. Gaist and colleagues conducted a population-based interview study to investigate the appropriateness of sumatriptan use.
All patients who presented prescriptions for sumatriptan to pharmacists in a county in Denmark (population: 465,000) during a two-week period were included in the study. The patients were classified as high, intermediate or low users, based on the number of units of sumatriptan used in a 30-day period. Sumatriptan consumption was described as the defined daily dose unit (100 mg for oral sumatriptan and 6 mg for subcutaneous sumatriptan). High users were defined as those who took 60 U or more over a 30-day period; intermediate users were defined as those who took 30 to 59 U per 30-day period; and low users were defined as those who took less than 30 U over a 30-day period. Response rates varied greatly by level of usage. Only seven patients (33 percent) in the high-use group and 30 patients (47 percent) in the intermediate-use group agreed to be interviewed. Even within the groups, the highest users were least likely to agree to participate in the study.
Previous dependence on medications and chronic daily use of analgesics were commonly reported by patients in the high-use group.
The authors conclude that sumatriptan was widely used for inappropriate indications, particularly for tension and drug-induced headaches. They warn that a significant subgroup of patients are overusing sumatriptan, usually in substantial quantities.
Gaist D, et al. Inappropriate use of sumatriptan: population based register and interview study. BMJ. May 1998;316:1352–3.
editor's note: This study verifies a common observation in clinical practice that a few patients take sumatriptan in doses substantially in excess of recommendations. The drug was designed for use in migraine headaches—a condition that is characterized by episodic attacks—and was not intended for daily use or for use in dosages over 200 mg per day. Because only one third of the heaviest users participated in this study, the extent of overuse could be substantially higher than indicated in this study's results. Interestingly, the diagnosis of migraine or cluster headache was uncertain in many of the patients who overused the drug. Headache is a complex pain syndrome, and often drug dependency, and psychologic and social pathologies are intertwined with pathophysiology. Use of powerful medications must be monitored in all headache patients.—a.d.w.
Copyright © 1998 by the American Academy of Family Physicians.
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