PMID- 34214182 OWN - NLM STAT- MEDLINE DCOM- 20211214 LR - 20211214 IS - 1526-4610 (Electronic) IS - 0017-8748 (Print) IS - 0017-8748 (Linking) VI - 61 IP - 6 DP - 2021 Jun TI - A narrative review of the importance of pharmacokinetics and drug-drug interactions of preventive therapies in migraine management. PG - 838-853 LID - 10.1111/head.14135 [doi] AB - OBJECTIVE: To review the pharmacokinetics of major classes of migraine preventives and the clinical implications of drug-drug interactions (DDIs) with the use of these therapies in migraine management. BACKGROUND: Preventive treatments for migraine are recommended for a large proportion of patients with frequent migraine attacks. These patients often exhibit a number of comorbidities, which may lead to the introduction of multiple concomitant therapies. Potential DDIs must be considered when using polytherapy to avoid increased risk of adverse events (AEs) or inadequate treatment of comorbid conditions. METHODS: A literature search was performed to identify pharmacokinetic properties and potential DDIs of beta-blockers, antiepileptic drugs, antidepressants, calcium channel blockers, gepants, and monoclonal antibody therapies targeting the calcitonin gene-related peptide pathway with medications that may be used for comorbid conditions. RESULTS: Most DDIs occur through alterations in cytochrome P450 isoenzyme activity and may be complicated by genetic polymorphism for metabolic enzymes. Additionally, drug metabolism may be altered by grapefruit juice ingestion and smoking. The use of migraine preventive therapies may exacerbate symptoms of comorbid conditions or increase the risk of AEs associated with comorbid conditions as a result of DDIs. CONCLUSIONS: DDIs are important to consider in patients with migraine who use multiple medications. The development of migraine-specific evidence-based preventive treatments allows for tailored clinical management that reduces the risk of DDIs and associated AEs in patients with comorbidities. CI - (c) 2021 Amgen Inc. Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society. FAU - Joshi, Shivang AU - Joshi S AD - Neurology/Headache Medicine, DENT Neurologic Institute, Amherst, NY, USA. FAU - Tepper, Stewart J AU - Tepper SJ AD - Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA. FAU - Lucas, Sylvia AU - Lucas S AD - Department of Neurology, University of Washington Medical Centers, Seattle, WA, USA. FAU - Rasmussen, Soeren AU - Rasmussen S AD - Global Medical, Amgen Inc., Thousand Oaks, CA, USA. FAU - Nelson, Rob AU - Nelson R AD - Global Medical, Amgen Inc., Thousand Oaks, CA, USA. AD - US Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - Headache JT - Headache JID - 2985091R RN - 0 (Adrenergic beta-Antagonists) RN - 0 (Antibodies, Monoclonal) RN - 0 (Anticonvulsants) RN - 0 (Antidepressive Agents) RN - 0 (Calcitonin Gene-Related Peptide Receptor Antagonists) RN - 0 (Calcium Channel Blockers) RN - JHB2QIZ69Z (Calcitonin Gene-Related Peptide) SB - IM MH - Adrenergic beta-Antagonists/pharmacokinetics MH - Antibodies, Monoclonal/pharmacokinetics MH - Anticonvulsants/pharmacokinetics MH - Antidepressive Agents/pharmacokinetics MH - Calcitonin Gene-Related Peptide MH - Calcitonin Gene-Related Peptide Receptor Antagonists/pharmacokinetics MH - Calcium Channel Blockers/pharmacokinetics MH - Comorbidity MH - Drug Interactions MH - Humans MH - Migraine Disorders/*drug therapy/epidemiology PMC - PMC8361687 OTO - NOTNLM OT - drug-drug interactions OT - migraine OT - pharmacodynamics OT - pharmacokinetics OT - polytherapy COIS- Shivang Joshi reports consulting for Allergan, Amgen, Biohaven, Lilly, Teva, and Currax and speaking for Allergan, Amgen, Biohaven, Lilly, and Teva. Stewart Tepper reports consulting for Aeon, Alexsa, Allergan/AbbVie, Alphasights, Amgen, Aperture Venture Partners, Aralez Pharmaceuticals Canada, Axsome Therapeutics, Becker Pharmaceutical Consulting, BioDelivery Sciences International, Biohaven, ClearView Healthcare Partners, CRG, Currax, Decision Resources, DeepBench, Eli Lilly and Company, Equinox, ExpertConnect, GLG, GSK, Guidepoint Global, Impel, M3 Global Research, Medicxi, Navigant Consulting, Neurolief, Nordic BioTech, Novartis, Pulmatrix, Reckner Healthcare, Relevale, Revance, Satsuma, Slingshot Insights, Spherix Global Insights, Teva, Theranica, Thought Leader Select, Trinity Partners, XOC, and Zosano; speaking and teaching for American Academy of Neurology, American Headache Society, Cleveland Clinic Foundation, Diamond Headache Clinic, Elsevier, Forefront Collaborative, Hamilton General Hospital (Ontario, Canada), Headache Cooperative of New England, Henry Ford Hospital (Detroit), Inova, Medical Learning Institute Peerview, Medical Education Speakers Network, Miller Medical Communications, North American Center for CME, Physicians' Education Resource, Rockpointe, ScientaCME, and WebMD/Medscape; employment with American Headache Society and Dartmouth-Hitchcock Medical Center; and other activities with Headache, Headache Currents, and Wiley Blackwell. Sylvia Lucas reports consulting or advising and/or serving on advisory committees for Allergan, Amgen, Biohaven, Impel, Lilly, Lundbeck, and Teva and consulting for Premera Blue Cross. Soeren Rasmussen and Rob Nelson are employees and stockholders of Amgen. EDAT- 2021/07/03 06:00 MHDA- 2021/12/15 06:00 PMCR- 2021/08/13 CRDT- 2021/07/02 17:21 PHST- 2021/04/09 00:00 [revised] PHST- 2021/02/18 00:00 [received] PHST- 2021/04/12 00:00 [accepted] PHST- 2021/07/02 17:21 [entrez] PHST- 2021/07/03 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/08/13 00:00 [pmc-release] AID - HEAD14135 [pii] AID - 10.1111/head.14135 [doi] PST - ppublish SO - Headache. 2021 Jun;61(6):838-853. doi: 10.1111/head.14135.