migraine days per month) (initiated by a specialist)
▶ Adult: 70 mg every 4 weeks; increased if necessary to
140 mg every 4 weeks, consider discontinuing if no
response after 3 months of treatment
▶ Common or very common Constipation . muscle spasms . skin reactions
▶ Frequency not known Oedema . swelling
l PREGNANCY Manufacturer advises avoid—limited
l BREAST FEEDING Manufacturer advises avoid during first
few days after birth—possible risk from transfer of
antibodies to infant. After this time, use during breastfeeding only if clinically needed.
l DIRECTIONS FOR ADMINISTRATION Manufacturer advises
injection into the abdomen, thigh, or upper arm (if not
self-administered). Patients may self-administer Aimovig
® after appropriate training in subcutaneous injection
l HANDLING AND STORAGE Manufacturer advises store in a
refrigerator (2-8°C) and protect from light—consult
product literature for further information regarding
Self-administration Manufacturer advises that patients and
their carers should be given training in subcutaneous
injection technique if appropriate.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (April 2019)
that erenumab (Aimovig ®) is accepted for restricted use
within NHS Scotland for the prophylaxis of migraine in
adults who have at least four migraine days per month and
in whom at least three prior prophylactic treatments have
failed. This advice is contingent upon the continuing
availability of the patient access scheme in NHS Scotland
or a list price that is equivalent or lower.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Aimovig (Novartis Pharmaceuticals UK Ltd) A
Erenumab 70 mg per 1 ml Aimovig 70mg/1ml solution for injection
pre-filled pen | 1 pre-filled disposable injection P £386.50
Management of cluster headache
▶ Adult: 1 mg once daily for 6 nights in 7; occasionally
given for 1–2 weeks, dose to be taken at night
l UNLICENSED USE Not licensed for the management of
l CONTRA-INDICATIONS Acute porphyrias p. 1058 . coronary
heart disease . hyperthyroidism . inadequately controlled
hypertension . obliterative vascular disease . peripheral
vascular disease . Raynaud’s syndrome . sepsis . severe
hypertension .temporal arteritis
l CAUTIONS Anaemia . cardiac disease . dependence . elderly .risk of peripheral vasospasm
l INTERACTIONS → Appendix 1: ergotamine
▶ Common or very common Abdominal pain . dizziness . nausea . vomiting
▶ Uncommon Cyanosis . diarrhoea . muscle weakness . pain
in extremity . sensation abnormal . vasoconstriction
l PREGNANCY Avoid; oxytocic effect on the uterus.
l BREAST FEEDING Avoid; ergotism may occur in infant;
repeated doses may inhibit lactation.
l HEPATIC IMPAIRMENT Avoid in severe impairment—risk of
l RENAL IMPAIRMENT Avoid; risk of renal vasoconstriction.
Peripheral vasospasm Warn patient to stop treatment
immediately if numbness or tingling of extremities
develops and to contact doctor.
l LESS SUITABLE FOR PRESCRIBING Ergotamine tartrate is
less suitable for prescribing.
l MEDICINAL FORMS No licensed medicines listed.
Ergotamine tartrate with caffeine
hydrate and cyclizine hydrochloride
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, ergotamine tartrate above, cyclizine p. 430.
Treatment of acute migraine and migraine variants
▶ Adult: 1 tablet, to be taken at onset, followed by
0.5–1 tablet after 30 minutes, then 0.5–1 tablet every
30 minutes if required, max. 3 tablets in 24 hours, max.
4 tablets per attack, max. 6 tablets in one week
l INTERACTIONS → Appendix 1: antihistamines, sedating . ergotamine
l PATIENT AND CARER ADVICE Patient counselling is advised
for cyclizine hydrochloride with caffeine hydrate and
ergotamine tartrate tablets (dosage).
l LESS SUITABLE FOR PRESCRIBING Cyclizine hydrochloride
with caffeine hydrate and ergotamine tartrate (Migril ®) is
less suitable for prescribing.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 2, 18
Ergotamine tartrate 2 mg, Cyclizine hydrochloride 50 mg,
Caffeine hydrate 100 mg Migril tablets | 100 tablet P £51.00
▶ Adult: 12.5 mg, dose to be taken as soon as possible
after onset, followed by 12.5 mg after 2 hours if
required, dose to be taken only if migraine recurs
(patient not responding to initial dose should not take
second dose for same attack); maximum 25 mg per day
l UNLICENSED USE Not licensed for use in elderly.
l CONTRA-INDICATIONS Coronary vasospasm . ischaemic
heart disease . peripheral vascular disease . previous
l CAUTIONS Conditions which predispose to coronary artery
l INTERACTIONS → Appendix 1: almotriptan
▶ Common or very common Asthenia . dizziness . drowsiness . nausea . vomiting
▶ Rare or very rare Coronary vasospasm . myocardial
▶ Frequency not known Intestinal ischaemia . seizure . vision
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l ALLERGY AND CROSS-SENSITIVITY Caution in patients with
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Present in milk in animal studies—
withhold breast-feeding for 24 hours.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment; avoid in severe
impairment—no information available.
Dose adjustments Max. 12.5 mg in 24 hours if eGFR less
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 3
▶ Almotriptan (Non-proprietary)
Almotriptan (as Almotriptan hydrogen malate)
Almotriptan (as Almotriptan hydrogen malate) 12.5 mg Almogran
12.5mg tablets | 3 tablet P £9.07 | 6 tablet P £18.14 DT =
▶ Adult: 40 mg, followed by 40 mg after 2 hours if
required, dose to be taken only if migraine recurs
(patient not responding to initial dose should not take
second dose for same attack); increased if necessary to
80 mg, dose to be taken for subsequent attacks if 40 mg
dose inadequate; maximum 80 mg per day
l UNLICENSED USE Not licensed for use in elderly.
disease . previous cerebrovascular accident. previous
l CAUTIONS Conditions which predispose to coronary artery
l INTERACTIONS → Appendix 1: eletriptan
▶ Common or very common Arrhythmias . asthenia . chest
weakness . nausea . pain . palpitations . sensation
abnormal .throat tightness . vertigo
disorders . oedema . oral disorders . peripheral vascular
disease .respiratory disorder. skin reactions . speech
syndrome . stroke . syncope . vomiting
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Present in milk—avoid breast-feeding
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
l RENAL IMPAIRMENT Avoid if eGFR less than
Dose adjustments Reduce initial dose to 20 mg; maximum
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 3
Eletriptan (as Eletriptan hydrobromide) 20 mg Relpax 20mg
tablets | 6 tablet P £22.50 DT = £22.50
Eletriptan (as Eletriptan hydrobromide) 40 mg Relpax 40mg
tablets | 6 tablet P £22.50 DT = £22.50
▶ Adult: 2.5 mg, dose to be taken as soon as possible after
onset, followed by 2.5 mg after 2 hours if required, dose
to be taken only if migraine recurs (patient not
responding to initial dose should not take second dose
for same attack); maximum 5 mg per day
l UNLICENSED USE Not licensed for use in elderly.
l CONTRA-INDICATIONS Coronary vasospasm . ischaemic
heart disease . peripheral vascular disease . previous
l CAUTIONS Conditions which predispose to coronary artery
l INTERACTIONS → Appendix 1: frovatriptan
nausea . sensation abnormal .throat complaints . vision
altered .thirst.tinnitus .tremor. urinary disorders . vertigo
decreased .renal pain .respiratory disorders . self
▶ Frequency not known Angioedema . coronary vasospasm . hypersensitivity . myocardial infarction
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Present in milk in animal studies—
withhold breast-feeding for 24 hours.
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
severe impairment—no information available.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 3
▶ Frovatriptan (Non-proprietary)
Frovatriptan (as Frovatriptan succinate monohydrate)
2.5 mg Frovatriptan 2.5mg tablets | 6 tablet P £4.40–£16.67 DT
▶ Migard (A. Menarini Farmaceutica Internazionale SRL)
Frovatriptan (as Frovatriptan succinate monohydrate)
2.5 mg Migard 2.5mg tablets | 6 tablet P £16.67 DT = £4.56
Frovatriptan (as Frovatriptan succinate monohydrate)
2.5 mg Mylatrip 2.5mg tablets | 6 tablet P £16.50 DT = £4.56
▶ Adult: 2.5 mg, followed by 2.5 mg after at least 4 hours
if required, to be taken only if migraine recurs (patient
not responding to initial dose should not take second
dose for same attack); maximum 5 mg per day
l UNLICENSED USE Not licensed for use in elderly.
l CONTRA-INDICATIONS Coronary vasospasm . ischaemic
accident. previous myocardial infarction . previous
transient ischaemic attack . Prinzmetal’s angina . uncontrolled hypertension
l CAUTIONS Conditions which predispose to coronary artery
l INTERACTIONS → Appendix 1: naratriptan
▶ Uncommon Arrhythmias . feeling abnormal . pain . palpitations . visual impairment
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l ALLERGY AND CROSS-SENSITIVITY Caution in patients with
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Withhold breast-feeding for 24 hours.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment (risk of decreased
clearance); avoid in severe impairment.
Dose adjustments Manufacturer advises maximum 2.5 mg
in 24 hours in mild to moderate impairment.
l RENAL IMPAIRMENT Avoid if eGFR less than
Dose adjustments Max. 2.5 mg in 24 hours.
Driving and skilled tasks Drowsiness may affect
performance of skilled tasks (e.g. driving).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 3
▶ Naratriptan (Non-proprietary)
Naratriptan (as Naratriptan hydrochloride) 2.5 mg Naratriptan
2.5mg tablets | 6 tablet P £24.55 DT = £6.67 | 12 tablet P £30.00–£46.00
▶ Naramig (GlaxoSmithKline UK Ltd)
Naratriptan (as Naratriptan hydrochloride) 2.5 mg Naramig
2.5mg tablets | 6 tablet P £24.55 DT = £6.67
▶ Adult: 10 mg, dose to be taken as soon as possible after
onset, followed by 10 mg after 2 hours if required, dose
to be taken only if migraine recurs (patient not
responding to initial dose should not take second dose
for same attack); maximum 20 mg per day
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶ Manufacturer advises reduce dose to 5 mg with
concurrent use of propranolol.
l UNLICENSED USE Not licensed for use in elderly.
l CONTRA-INDICATIONS Coronary vasospasm . ischaemic
heart disease . peripheral vascular disease . previous
l CAUTIONS Conditions which predispose to coronary artery
l INTERACTIONS → Appendix 1: rizatriptan
swelling .tremor. vertigo . vision blurred
▶ Rare or very rare Hypersensitivity . stroke . wheezing
▶ Frequency not known Colitis ischaemic . myocardial
infarction . myocardial ischaemia . peripheral vascular
disease . seizure . serotonin syndrome .toxic epidermal
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Present in milk in animal studies—
withhold breast-feeding for 24 hours.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment; avoid in severe impairment
Dose adjustments Manufacturer advises dose reduction to
5 mg in mild to moderate impairment.
l RENAL IMPAIRMENT Avoid in severe impairment.
Dose adjustments Reduce dose to 5 mg in mild to moderate
l DIRECTIONS FOR ADMINISTRATION Rizatriptan
orodispersible tablets should be placed on the tongue,
allowed to disperse and swallowed. Rizatriptan oral
lyophilisates should be placed on the tongue and allowed
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer rizatriptan
orodispersible tablets and oral lyophilisates.
Driving and skilled tasks Drowsiness may affect
performance of skilled tasks (e.g. driving).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 3
EXCIPIENTS: May contain Aspartame
▶ Rizatriptan (Non-proprietary)
Rizatriptan (as Rizatriptan benzoate) 5 mg Rizatriptan 5mg
orodispersible tablets sugar free sugar-free | 3 tablet P s
Rizatriptan (as Rizatriptan benzoate) 10 mg Rizatriptan 10mg
orodispersible tablets sugar free sugar-free | 3 tablet P £14.00 DT
= £5.08 sugar-free | 6 tablet P £19.75–£28.00
CAUTIONARY AND ADVISORY LABELS 3
▶ Rizatriptan (Non-proprietary)
Rizatriptan (as Rizatriptan benzoate) 5 mg Rizatriptan 5mg tablets
| 3 tablet P £13.37 | 6 tablet P £26.74 DT = £26.74
Rizatriptan (as Rizatriptan benzoate) 10 mg Rizatriptan 10mg
tablets | 3 tablet P £13.37 DT = £4.17 | 6 tablet P £8.34–
▶ Maxalt (Merck Sharp & Dohme Ltd)
Rizatriptan (as Rizatriptan benzoate) 5 mg Maxalt 5mg tablets | 6 tablet P £26.74 DT = £26.74
Rizatriptan (as Rizatriptan benzoate) 10 mg Maxalt 10mg tablets
| 3 tablet P £13.37 DT = £4.17 | 6 tablet P £26.74
CAUTIONARY AND ADVISORY LABELS 3
EXCIPIENTS: May contain Aspartame
▶ Maxalt Melt (Merck Sharp & Dohme Ltd)
Rizatriptan (as Rizatriptan benzoate) 10 mg Maxalt Melt 10mg
oral lyophilisates sugar-free | 3 tablet P £13.37 DT = £13.37
sugar-free | 6 tablet P £26.74 DT = £26.74 sugar-free | 12 tablet P £53.48
▶ Adult: Initially 50–100 mg for 1 dose, followed by
50–100 mg after at least 2 hours if required, to be taken
only if migraine recurs (patient not responding to
initial dose should not take second dose for same
attack); maximum 300 mg per day
▶ Adult: Initially 6 mg for 1 dose, followed by 6 mg after
at least 1 hour if required, to be taken only if migraine
recurs (patient not responding to initial dose should
not take second dose for same attack), dose to be
administered using an auto-injector; not for
intravenous injection which may cause coronary
vasospasm and angina; maximum 12 mg per day
▶ BY INTRANASAL ADMINISTRATION
▶ Adult 18–65 years: Initially 10–20 mg, to be
administered into one nostril, followed by 10–20 mg
after at least 2 hours if required, to be taken only if
migraine recurs (patient not responding to initial dose
should not take second dose for same attack);
Treatment of acute cluster headache
▶ Adult: Initially 6 mg for 1 dose, followed by 6 mg after
at least 1 hour if required, to be taken only if headache
recurs (patient not responding to initial dose should
not take second dose for same attack), dose to be
administered using an auto-injector; not for
intravenous injection which may cause coronary
vasospasm and angina; maximum 12 mg per day
▶ BY INTRANASAL ADMINISTRATION
▶ Adult 18–65 years: Initially 10–20 mg, dose to be
administered into one nostril, followed by 10–20 mg
after at least 2 hours if required, to be taken only if
headache recurs (patient not responding to initial dose
should not take second dose for same attack);
l UNLICENSED USE Not licensed for use in elderly.
l CONTRA-INDICATIONS Coronary vasospasm . ischaemic
heart disease . mild uncontrolled hypertension . moderate
infarction . previous transient ischaemic attack . Prinzmetal’s angina
l CAUTIONS Conditions which predispose to coronary artery
disease . elderly . history of seizures . mild, controlled
hypertension . pre-existing cardiac disease .risk factors for
l INTERACTIONS → Appendix 1: sumatriptan
▶ Rare or very rare Hypersensitivity
▶ With intranasal use Epistaxis . nasal irritation .taste altered . throat irritation
▶ With subcutaneous use Haemorrhage . swelling
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l ALLERGY AND CROSS-SENSITIVITY Caution in patients with
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Present in milk but amount probably too
small to be harmful; withhold breast-feeding for 12 hours
l HEPATIC IMPAIRMENT Manufacturer advises caution
(reduced pre-systemic clearance increases exposure);
avoid in severe impairment (no information available).
Dose adjustments ▶ With oral use Manufacturer advises
consider dose reduction to 25–50 mg in mild to moderate
l RENAL IMPAIRMENT Use with caution.
Driving and skilled tasks Drowsiness may affect
performance of skilled tasks (e.g. driving).
l EXCEPTIONS TO LEGAL CATEGORY
▶ With oral use Sumatriptan 50 mg tablets can be sold to the
public to treat previously diagnosed migraine; max. daily
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 3, 10
▶ Sumatriptan (Non-proprietary)
Sumatriptan (as Sumatriptan succinate) 12 mg per
1 ml Sumatriptan 6mg/0.5ml solution for injection pre-filled pen |
2 pre-filled disposable injection P £39.50 DT = £39.50
▶ Imigran Subject (GlaxoSmithKline UK Ltd)
Sumatriptan (as Sumatriptan succinate) 12 mg per 1 ml Imigran
Imigran Subject 6mg/0.5ml solution for injection pre-filled syringes
with device | 2 pre-filled disposable injection P £50.96 DT =
CAUTIONARY AND ADVISORY LABELS 3, 10
▶ Imigran (GlaxoSmithKline UK Ltd)
Sumatriptan 100 mg per 1 ml Imigran 10mg nasal spray | 2 unit
Sumatriptan 200 mg per 1 ml Imigran 20mg nasal spray | 2 unit
dose P £14.16 | 6 unit dose P £42.47 DT = £42.47
CAUTIONARY AND ADVISORY LABELS 3, 10
▶ Sumatriptan (Non-proprietary)
Sumatriptan (as Sumatriptan succinate) 50 mg Sumatriptan 50mg
tablets | 6 tablet P £31.00 DT = £2.90
Sumatriptan (as Sumatriptan succinate) 100 mg Sumatriptan
100mg tablets | 6 tablet P £40.18 DT = £2.99
▶ Imigran (GlaxoSmithKline UK Ltd)
Sumatriptan (as Sumatriptan succinate) 50 mg Imigran Radis
50mg tablets | 6 tablet P £23.90 DT = £2.90
Imigran 50mg tablets | 6 tablet P £31.85 DT = £2.90
Sumatriptan (as Sumatriptan succinate) 100 mg Imigran 100mg
tablets | 6 tablet P £51.48 DT = £2.99
Imigran Radis 100mg tablets | 6 tablet P £42.90 DT = £2.99
▶ Migraitan (Bristol Laboratories Ltd)
Sumatriptan (as Sumatriptan succinate) 50 mg Migraitan 50mg
▶ Adult: 2.5 mg, followed by 2.5 mg after at least 2 hours
if required, dose to be taken only if migraine recurs,
then increased if necessary to 5 mg, dose to be taken
only for subsequent attacks in patients not achieving
satisfactory relief with 2.5 mg dose; maximum 10 mg
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: 5 mg, dose to be administered as soon as
possible after onset into one nostril only, followed by
5 mg after at least 2 hours if required, dose to be
administered only if migraine recurs; maximum 10 mg
Treatment of acute cluster headache
▶ BY INTRANASAL ADMINISTRATION
▶ Adult: 5 mg, dose to be administered as soon as
possible after onset into one nostril only, followed by
5 mg after at least 2 hours if required, dose to be
administered only if migraine recurs; maximum 10 mg
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶ Manufacturer advises max. dose 5 mg in 24 hours with
concurrent use of moderate and potent inhibitors of
CYP1A2, cimetidine and moclobemide.
DOSE EQUIVALENCE AND CONVERSION
▶ 1 spray of Zomig ® nasal spray = 5 mg zolmitriptan.
l UNLICENSED USE Not licensed for use in elderly. Not
licensed for treatment of cluster headaches.
l CONTRA-INDICATIONS Arrhythmias associated with
accessory cardiac conduction pathways . coronary
vasospasm . ischaemic heart disease . moderate to severe
hypertension . peripheral vascular disease . previous
l CAUTIONS Conditions which predispose to coronary artery
disease . elderly . should not be taken within 24 hours of
any other 5HT1-receptor agonist
l INTERACTIONS → Appendix 1: zolmitriptan
▶ Common or very common Abdominal pain . asthenia . chest
weakness . nausea . pain . palpitations . sensation
▶ Uncommon Tachycardia . urinary disorders
▶ Rare or very rare Angina pectoris . angioedema . coronary
vasospasm . gastrointestinal disorders . gastrointestinal
infarction . hypersensitivity . myocardial infarction . splenic infarction . urticaria
▶ With oral use Muscle complaints . sensation of pressure . throat complaints
SIDE-EFFECTS, FURTHER INFORMATION Discontinue if
symptoms of heat, heaviness, pressure or tightness
(including throat and chest) occur.
l PREGNANCY There is limited experience of using 5HT1-
receptor agonists during pregnancy; manufacturers advise
that they should be avoided unless the potential benefit
l BREAST FEEDING Use with caution—present in milk in
l HEPATIC IMPAIRMENT Manufacturer advises caution in
moderate to severe impairment (risk of increased
Dose adjustments Manufacturer advises maximum 5 mg in
24 hours in moderate to severe impairment.
l DIRECTIONS FOR ADMINISTRATION Zolmitriptan
orodispersible tablets should be placed on the tongue,
allowed to disperse and swallowed.
l PATIENT AND CARER ADVICE Patients or carers should be
given advice on how to administer zolmitriptan
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Zolmitriptan 50 mg per 1 ml Zomig 5mg/0.1ml nasal spray 0.1ml
unit dose | 6 unit dose P £36.50 DT = £36.50
EXCIPIENTS: May contain Aspartame
▶ Zolmitriptan (Non-proprietary)
Zolmitriptan 2.5 mg Zolmitriptan 2.5mg orodispersible tablets sugar
free sugar-free | 6 tablet P £20.35 DT = £10.54
Zolmitriptan 5 mg Zolmitriptan 5mg orodispersible tablets sugar
free sugar-free | 6 tablet P £20.35 DT = £13.44
▶ Zomig Rapimelt (Grunenthal Ltd)
Zolmitriptan 2.5 mg Zomig Rapimelt 2.5mg orodispersible tablets
sugar-free | 6 tablet P £23.99 DT = £10.54
▶ Zolmitriptan (Non-proprietary)
Zolmitriptan 5 mg Zolmitriptan 5mg tablets | 6 tablet P £3.60
DT = £3.60 | 12 tablet P £7.20
Zolmitriptan 2.5 mg Zomig 2.5mg tablets | 6 tablet P £23.94 DT
Neuropathic pain, which occurs as a result of damage to
neural tissue, includes phantom limb pain, compression
neuropathies, peripheral neuropathies (e.g. due to Diabetic
complications p. 688, chronic excessive alcohol intake, HIV
infection p. 640, chemotherapy, idiopathic neuropathy),
trauma, central pain (e.g. pain following stroke, spinal cord
injury, and syringomyelia), and postherpetic neuralgia
(peripheral nerve damage following acute herpes zoster
infection (shingles)). The pain may occur in an area of
sensory deficit and is sometimes accompanied by pain that is
evoked by a non-noxious stimulus (allodynia).
Trigeminal neuralgia is also caused by dysfunction of
neural tissue, but its management is distinct from other
Neuropathic pain is generally managed with a tricyclic
antidepressant or with certain antiepileptic drugs.
Amitriptyline hydrochloride p. 372 [unlicensed indication]
and pregabalin p. 324 are effective treatments for
neuropathic pain. Amitriptyline hydrochloride and
pregabalin can be used in combination if the patient has an
inadequate response to either drug at the maximum
Nortriptyline p. 378 [unlicensed indication] may be better
tolerated than amitriptyline hydrochloride.
Gabapentin p. 315 is also effective for the treatment of
Neuropathic pain may respond to opioid analgesics.
There is evidence of efficacy for tramadol hydrochloride
p. 471, morphine p. 463, and oxycodone hydrochloride
p. 466; however, treatment with morphine or oxycodone
hydrochloride should be initiated only under specialist
supervision. Tramadol hydrochloride can be prescribed when
other treatments have been unsuccessful, while the patient
is waiting for assessment by a specialist.
Patients with localised pain who are unable to take oral
medicines may benefit from topical local anaesthetic
preparations, such as lidocaine hydrochloride medicated
plasters p. 1352, while awaiting specialist review.
Capsaicin below is licensed for neuropathic pain (but the
intense burning sensation during initial treatment may limit
use). Capsaicin 0.075% cream is licensed for the
symptomatic relief of postherpetic neuralgia. A self-adhesive
patch containing capsaicin 8% is licensed for the treatment
of peripheral neuropathic pain in non-diabetic patients. It
should be used under specialist supervision.
A corticosteroid may help to relieve pressure in
compression neuropathy and thereby reduce pain.
Neuromodulation by spinal cord stimulation may be of
benefit in some patients. Many patients with chronic
neuropathic pain require multidisciplinary management,
including physiotherapy and psychological support.
Surgery may be the treatment of choice in many patients; a
neurological assessment will identify those who stand to
benefit. Carbamazepine p. 311 taken during the acute stages
of trigeminal neuralgia, reduces the frequency and severity
of attacks. It is very effective for the severe pain associated
with trigeminal neuralgia and (less commonly)
glossopharyngeal neuralgia. Blood counts and electrolytes
should be monitored when high doses are given. Small doses
p. 323; the drug may be given by intravenous infusion
(possibly as fosphenytoin sodium p. 314) in a crisis
Chronic oral and facial pain including persistent idiopathic
facial pain (also termed ‘atypical facial pain’) and
temporomandibular dysfunction (previously termed
temporomandibular joint pain dysfunction syndrome) may
call for prolonged use of analgesics or for other drugs.
Tricyclic antidepressants may be useful for facial pain
[unlicensed indication], but are not on the Dental
Practitioners’ List. Disorders of this type require specialist
referral and psychological support to accompany drug
treatment. Patients on long-term therapy need to be
monitored both for progress and for side-effects.
Other drugs used for Neuropathic pain Amantadine
▶ Adult: Apply 3–4 times a day, dose to be applied
sparingly; important; after lesions have healed, not
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