Update: Migraine Abortive Midrin and Equivalents, 3/31/11
You can read the latest update on Midrin here: Midrin-October 2011 Update
People are still asking about the Migraine abortive Midrin and other equivalent and similar drugs and their removal from the market. So, we thought it was time to post a bit of a summary of the situation.
Midrin was the first of this group of Migraine abortive medications containing isometheptene mucate USP, 65 mg; dichloralphenazone USP, 100 mg; and acetaminophen USP, 325 mg. It changed hands several times, but in the end was owned and made by Caraco. There were other medications with the same ingredients including Epidrin, Duradin, and others, as well as a so-called generic. Technically, since none of these medications ever went through the current FDA approval process, there were no generics, just medications with the same ingredients that were made by different companies and sold under different names.
Prodrin, manufactured by Gentex Pharma, is still being made and shipped. It is similar to the Midrin medications, containing isometheptene mucate, acetaminophen, and caffeine. It does not contain the dichloralphenazone (sedative) that was in Midrin.
Another option for people who still want to use Midrin is to ask their doctors for a prescription to take to a compounding pharmacy. Compounding pharmacies can “compound” the three ingredients that we in Midrin to make medication. At this time, however, some compounding pharmacies are reporting that there is a shortage of dichloralphenazone, and they cannot get it.
One reason Midrin was so popular is that some people – doctors and patients alike – thought it was safer for patients with a history of or risk factors for stroke or heart issues. The prescribing / labeling information never carried a warning like those of the triptan and ergotamine medications. There is, however, some debate on that point. It’s thought that the triptans and ergotamines carry a warning because they have vasoconstrictive (shrinking blood vessels) properties. Since the isometheptene mucate in the Midrin medications also has vasoconstrictive properties, some doctors feel that it has never been safer than triptans or ergotamines.
Several people have told me that their doctors have prescribed Fioricet (butalbital, acetaminophen, and caffeine) as a replacement for Midrin. I want to explain that the two medications are very different. Midrin was a Migraine abortive. It could actually work to stop (abort) a Migraine in progress, thus also stopping the symptoms. Fioricet is a bartiturate pain reliever. The butalbital (the barbiturate) is similar to the dichloralphenazone in Midrin in that it has a sedative effect. However, Fioricet cannot abort a Migraine attack. It can help you relax and mask the pain for a few hours. That’s all. If the Migraine doesn’t end on it’s own before the Fioricet wears off, it will still be there. If you have a history of or risk factors for stroke or heart issues that keep you from being able to use the triptan and ergotamine Migraine abortive medications, Fioricet may be a good choice for you. I just want you to understand that it cannot abort a Migraine, so it’s not exactly a substitute for Midrin.
If you’re looking for a Migraine abortive to replace the Midrin products, the Migraine abortive medications currently available include:
- sumatriptan: Imitrex (tablets, nasal spray, StatDose injections), Treximet, generic (tablets, nasal spray, StatDose injections), Sumavel DosePro needle-free injection, and Alsuma (an injection similar to an ipi-pen)
- naratriptan: Amerge, Naramig, and generic tablets
- zolmitriptan: Zomig tablets and nasal spray, Zomig-ZMT orally disintegrating tablets
- rizatriptan: Maxalt tablets, Maxalt-MLT orally disintegrating tablets
- eletriptan: Relpax
- almotriptan: Axert
- frovatriptan: Frova
- dihydroergotamine: D.H.E. 45, which can be used at home via subcutaneous injections, and Migranal Nasal Spray
- ergotamine tartrate and caffeine tablets: Cafergot, brand name discontinued, but generic still being made
- ergotamine tartrate sublingual tablets: Ergomar
- ergotamine tartrate and caffeine suppositories: Migergot
- For the background on why Midrin and equivalent medications have been removed from the market, see Looking for Midrin Equivalents for Your Migraines?
- For more information about Migraine abortive treatments, see Migraine Management Essential 5: Abortive Treatment.
- To join the ongoing Midrin discussion visit the Midrin Forum .