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Nortriptyline is an active metabolite of amitriptyline by demethylation in the liver. Chemically, it is a secondary amine dibenzocycloheptene and pharmacologically it is classed as a first-generation antidepressant. [36] Nortriptyline may also have a sleep-improving effect due to antagonism of the H 1 and 5-HT 2A receptors. [37]
Amitriptyline is probably effective for the prevention of periodic migraine in adults. Amitriptyline is similar in efficacy to venlafaxine and topiramate but carries a higher burden of adverse effects than topiramate. [16] For many patients, even very small doses of amitriptyline are helpful, which may allow for minimization of side effects. [38]
The triptan drug class includes 1st generation sumatriptan (which has poor bioavailability), and second generation zolmitriptan. [2] Due to their safety, efficacy and selectivity, triptans are considered first line agents for abortion of migraines. [2]
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Rescue treatment involves acute symptomatic control with medication. [4] Recommendations for rescue therapy of migraine include: (1) migraine-specific agents such as triptans, CGRP antagonists, or ditans for patients with severe headaches or for headaches that respond poorly to analgesics, (2) non-oral (typically nasal or injection) route of administration for patients with vomiting, (3) avoid ...
Amitriptyline, sold under the name Elavil, is a tricyclic antidepressant used to treat depression, especially when other medications aren’t effective. It’s also used to treat certain forms of ...
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