Imitrex (sumatriptan)

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Imitrex (sumatriptan)

Postby tootingbec » Thu Nov 16, 2006 7:27 pm

I am signed up for Wavefront LASIK on a VISX machine next week, and I am pretty excited about it. But I've noticed some ambiguous information on the Internet about whether the use of Imitrex contraindicates LASIK surgery.

I use Imitrex a few times a month for migraine headaches. Assuming I don't get any migraines between now and my surgery, two weeks will have elapsed since my last dose when I have the procedure.

The VISX patient information booklet lists, in its "discuss these conditions with your doctor" section: "Take medicines that might make it harder for wounds to heal, such as Sumatriptan (Imitrex@*) used for migraine headaches, because it is unknown whether LASIK is safe and effective for this condition."

My LASIK surgeon does indeed ask on his patient intake form whether patients use Imitrex, and I said that I did. When I spoke with him about the surgery after my evaluation exam, he gave me reassuring words to this effect, although I'm embarrassed to say I can't remember them right now. Needless to say, I have a call into his office to get reminded of this.

I notice that there seem to be no allegations of similar problems with the later members of the triptan family (zolmitriptan and the like).

I went through a consultation with a different LASIK specialist, one I later decided not to go with. They have a Bausch & Lomb laser, and its patient information booklet explicitly lists Imitrex use as a contraindication. On the other hand, I also disclosed to the team at this specialist's office that I used Imitrex too, and they didn't think it was a problem either.

Otherwise, I am a good candidate for LASIK: I have nice thick corneas and average-sized pupils.

Here's a link to a pretty small study of epithelial defects in LASIK patients who reported use of Imitrex:

http://cat.inist.fr/?aModele=afficheN&cpsidt=16586642

Is there any more up-to-date guidance on this subject?
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Postby LasikExpert » Fri Nov 17, 2006 4:52 pm

The problem with Imitrex is not so much the epithelial abrasions as the quality of the surface. Prior use of Imitrex is not an absolute contraindication, but is something that may affect the quality of the corneal surface and possibly the vision.

Imitrex has a long half-life. That is to say it takes a long time for Imitrex to purge from your system. Discuss this in more detail with your surgeon.
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Postby tootingbec » Sat Nov 18, 2006 1:38 am

LasikExpert wrote:Imitrex has a long half-life. That is to say it takes a long time for Imitrex to purge from your system.


At first, I reacted with surprise when I read your post. I thought, "If Imitrex has such a long half-life, why am I allowed to take 2 doses in 24 hours if the first one doesn't provide relief?" And a quick Google search revealed that the plasma half-life of Imitrex is 2 hours.

However, I kept looking. GlaxoSmithKline says, in its datasheet for nasal-spray Imitrex: "In rats treated with a single subcutaneous dose (0.5 mg/kg) or oral dose (2 mg/kg) of radiolabeled sumatriptan, the elimination half-life of radioactivity from the eye was 15 and 23 days, respectively, suggesting that sumatriptan and/or its metabolites bind to the melanin of the eye."

That wording suggests that the researchers jumped to the conclusion that Imitrex was binding preferentially to melanin. I wonder why they were so sure about that, and why they didn't consider the possibility that the Imitrex was binding to collagen, or the other components of the cornea. Maybe I am a nut, but I don't think my cornea has a lot of melanin in it. :)

Anyhow, I talked with the LASIK surgeon again. Based on his experience, he considers Imitrex use to be a risk for poor outcomes of PRK, not LASIK.

And anyway, I am very myopic; I would experience a quality-of-life improvement if I went from 20/400 to 20/100.

At this point, I think I am going to trust the practitioner and move ahead.
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Postby LasikExpert » Sat Nov 18, 2006 9:23 am

Trusting a qualified doctor who has actually examined your eyes is always better than trusting a non-doctor over the Internet!
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