Pizotifen (
INN) or pizotyline (
USAN), trade name Sandomigran, is a
benzocycloheptene-based drug used as a medicine, primarily as a preventive to reduce the frequency of recurrent
migraine headaches.[1]
Uses
The main medical use for pizotifen is for the prevention of
migraine and
cluster headache. Pizotifen is one of a range of medications used for this purpose, other options include
propranolol,
topiramate,
valproic acid,
cyproheptadine and
amitriptyline. While pizotifen is effective in adults,[2] evidence of efficacy in children is limited,[3] and its use is limited by side effects, principally drowsiness and weight gain, and it is usually not the first choice medicine for preventing migraines, instead being used as an alternative when other drugs have failed to be effective.[4] It is not effective in relieving migraine attacks once in progress. Pizotifen has also been reported as highly effective in a severe case of erythromelalgia, a rare neurovascular disease that is sometimes refractory to the other drugs named above.[5]
Other applications for which pizotifen may be used include as an
antidepressant, or for the treatment of
anxiety or
social phobia.[6][7] Animal studies also suggest that pizotyline could be used in the treatment of
serotonin syndrome or
MDMAoverdose[8] in a similar manner to the closely related antihistamine/antiserotonin medication
cyproheptadine.
Adverse effects
Side effects include
sedation,
dry mouth, drowsiness, increased appetite and weight gain.[9] Occasionally it may cause nausea, headaches, or dizziness. In rare cases, anxiety, aggression and depression may also occur.
Contraindications
Caution is required in patients having closed angle
glaucoma and in patients with a predisposition to
urinary retention as the medication exhibits a relatively small anticholinergic effect. Dose adjustment is required in people who have
chronic kidney disease. Liver injury has also been reported. Pizotifen treatment should be discontinued if there is any clinical evidence of liver dysfunction during treatment. Caution is advised in patients having a history of
epilepsy.
Withdrawal symptoms like depression, tremor, nausea, anxiety, malaise, dizziness, sleep disorder and weight decrease have been reported following abrupt cessation of pizotifen.[10]
Pizotifen is contraindicated in patients who suffer from hypersensitivity to any of its components, also Pizotifen is contraindicated in
gastric outlet obstruction,
pregnancy, angle-closure glaucoma and difficulty urinating.[11]
^Banki CM (March 1978). "Clinical observations with pizotifene (Sandomigran) in the treatment of nonmigrainous depressed women". Archiv für Psychiatrie und Nervenkrankheiten. 225 (1): 67–72.
doi:
10.1007/bf00367352.
PMID348154.
S2CID13510725.
^Young R, Khorana N, Bondareva T, Glennon RA (October 2005). "Pizotyline effectively attenuates the stimulus effects of N-methyl-3,4-methylenedioxyamphetamine (MDMA)". Pharmacology, Biochemistry, and Behavior. 82 (2): 404–410.
doi:
10.1016/j.pbb.2005.09.010.
PMID16253319.
S2CID20885754.
^Crowder D, Maclay WP. Pizotifen once daily in the prophylaxis of migraine: results of a multi-centre general practice study. Current Medical Research and Opinion. 1984;9(4):280-5.
Pizotifen (
INN) or pizotyline (
USAN), trade name Sandomigran, is a
benzocycloheptene-based drug used as a medicine, primarily as a preventive to reduce the frequency of recurrent
migraine headaches.[1]
Uses
The main medical use for pizotifen is for the prevention of
migraine and
cluster headache. Pizotifen is one of a range of medications used for this purpose, other options include
propranolol,
topiramate,
valproic acid,
cyproheptadine and
amitriptyline. While pizotifen is effective in adults,[2] evidence of efficacy in children is limited,[3] and its use is limited by side effects, principally drowsiness and weight gain, and it is usually not the first choice medicine for preventing migraines, instead being used as an alternative when other drugs have failed to be effective.[4] It is not effective in relieving migraine attacks once in progress. Pizotifen has also been reported as highly effective in a severe case of erythromelalgia, a rare neurovascular disease that is sometimes refractory to the other drugs named above.[5]
Other applications for which pizotifen may be used include as an
antidepressant, or for the treatment of
anxiety or
social phobia.[6][7] Animal studies also suggest that pizotyline could be used in the treatment of
serotonin syndrome or
MDMAoverdose[8] in a similar manner to the closely related antihistamine/antiserotonin medication
cyproheptadine.
Adverse effects
Side effects include
sedation,
dry mouth, drowsiness, increased appetite and weight gain.[9] Occasionally it may cause nausea, headaches, or dizziness. In rare cases, anxiety, aggression and depression may also occur.
Contraindications
Caution is required in patients having closed angle
glaucoma and in patients with a predisposition to
urinary retention as the medication exhibits a relatively small anticholinergic effect. Dose adjustment is required in people who have
chronic kidney disease. Liver injury has also been reported. Pizotifen treatment should be discontinued if there is any clinical evidence of liver dysfunction during treatment. Caution is advised in patients having a history of
epilepsy.
Withdrawal symptoms like depression, tremor, nausea, anxiety, malaise, dizziness, sleep disorder and weight decrease have been reported following abrupt cessation of pizotifen.[10]
Pizotifen is contraindicated in patients who suffer from hypersensitivity to any of its components, also Pizotifen is contraindicated in
gastric outlet obstruction,
pregnancy, angle-closure glaucoma and difficulty urinating.[11]
^Banki CM (March 1978). "Clinical observations with pizotifene (Sandomigran) in the treatment of nonmigrainous depressed women". Archiv für Psychiatrie und Nervenkrankheiten. 225 (1): 67–72.
doi:
10.1007/bf00367352.
PMID348154.
S2CID13510725.
^Young R, Khorana N, Bondareva T, Glennon RA (October 2005). "Pizotyline effectively attenuates the stimulus effects of N-methyl-3,4-methylenedioxyamphetamine (MDMA)". Pharmacology, Biochemistry, and Behavior. 82 (2): 404–410.
doi:
10.1016/j.pbb.2005.09.010.
PMID16253319.
S2CID20885754.
^Crowder D, Maclay WP. Pizotifen once daily in the prophylaxis of migraine: results of a multi-centre general practice study. Current Medical Research and Opinion. 1984;9(4):280-5.