Migraines affect about 1 out of 10 adults in the U.S. and can be extremely debilitating. Medications exist for both preventative and acute treatment and can target multiple aspects of this complex condition. Midrin is a combination migraine medication that has been marketed under many brand names like Amidrine, Nodolor, Duradrin, Migrin-A, and Epidrine. The formulation contains three ingredients: acetaminophen, dichloralphenazone and isometheptene.
An Effective Combination for Migraine Relief
According to the American Migraine Foundation, “while ‘headache’ often acts as a catch-all term for head pain, headache is just one aspect of a migraine attack. During the timeline of a migraine attack, different symptoms can appear outside of head pain such as problems concentrating, temporary loss of sight, insomnia, nausea/vomiting, light or sound sensitivity, dizziness and more.” Migraines are not “just headaches” but in fact complex neurological events that patients are susceptible to based on their genetics.
Patients often require multiple treatments to manage their migraines. These include changes to diet, exercise, and sleep patterns along with preventative medications. An acute treatment for migraines is also required for helping reduce the severity of an attack if it does occur. Even with an excellent preventative program, migraines can still happen. One medication for acute treatment of migraines and tension headaches is called Midrin.
Midrin for migraines is referred to as an acute or “abortive” medication because it is used to stop a migraine after it starts. It is not recommended for daily use as a preventative treatment. This is mostly due to its sedative effects and the use of acetaminophen, which can cause liver issues when taken too frequently. When used as-needed, however, Midrin is relatively safe and has few adverse effects that are worse than the migraines itself. It is a reliably effective medication that is found in the medicine cabinets of many migraine sufferers.
For most patients, a combination of ingredients is needed to best treat migraines. Even over-the-counter medications for migraines like Excedrin use combinations of ingredients (Excedrin contains acetaminophen, caffeine, and aspirin). The ingredients in Midrin work together and target different aspects of migraine and headache pain. Isometheptene is a vasoconstrictor that reduces the dilation of cranial and cerebral arterioles that lead to vascular headaches. Acetaminophen is an analgesic that reduces pain from multiple types of headaches. Dichloralphenazone is a mild sedative that helps with the emotional reaction to a migraine by calming the nerves.
Midrin for Migraines Dosage
The most common dosages that are used in Midrin capsules include Isometheptene 65mg, Acetaminophen 325mg, and Dichloralphenazone 100mg. When the capsules are made by a compounding pharmacy, the dosages of each ingredient can be adjusted as needed.
For migraines, 2 capsules are taken by mouth at the onset of a headache. One additional capsule can be taken every hour until the headache is relieved, with a maximum dosage of 5 capsules in a 12 hour period.
For a tension headache, the dosage should be decreased. One to two capsules by mouth every four hours is recommended, with no more than 8 capsules taken in a 12 hour period.
The above dosage guidelines are for adults. While Midrin is sometimes prescribed for children, in general it is not recommended since there are no established pediatric dosage guidelines.
Acute treatment of migraines is best suited for individuals who have no more than 2 migraines each month, or who will take the medication no more than 8 days in a month. If you are using a migraine medication for acute attacks more frequently, you should be working with your doctor to develop a better prevention plan. Using acute migraine medication too frequently can result in headaches from overuse.
Midrin is contraindicated in glaucoma, severe cases of renal disease, hypertension, organic heart disease, hepatic disease and in those patients who are on monoamine-oxidase (MAO) inhibitor therapy. Caution should be taken when prescribing for patients with hypertension, peripheral vascular disease and who recently experienced cardio-vascular attacks. Patients with liver problems should consult their doctor or pharmacist for a safe dosage of this medication as it contains acetaminophen. Healthy patients who take more than 4,000mg of acetaminophen per day can experience severe liver disease. Other contraindications include allergies to acetaminophen, isometheptene, or dichloralphenazone and also to chloral hydrate (dichloralphenazone is a mixture of antipyrine and chloral hydrate).
Midrin Adverse Reactions
Transient dizziness and skin rash may appear in hypersensitive patients. This can usually be eliminated by reducing the dose. Midrin may also make you drowsy or dizzy, so avoid driving or other activities that may be dangerous. Taking other drugs that cause drowsiness can enhance these effects. It is better to take Midrin and rest if possible while you wait for the migraine to pass. Overuse of Midrin can lead to more headaches.
Drugs used for treating migraines include serotonin receptor antagonists, ergot derivatives, opiates, antiemetic agents, and more. Some of these drugs can have undesirable side effects or even be addictive. Midrin has few side effects and is well-tolerated by most patients when used as prescribed.
Midrin for Migraines and the FDA
In January of 2018, all companies that were making Midrin commercially ceased manufacturing and distribution. The FDA had earlier announced that the ingredient isometheptene could no longer be used as it did not go through the FDA approval process. The drug had actually been in use since before the newer approval process was implemented in 1962, and had only been tested for safety. The newer FDA rules required that drugs be tested for efficacy as well. For decades, Midrin continued to be used by thousands of patients until the FDA’s recent decision to withdraw its approval. There is little incentive for any company to go through the rigorous approval process now when the drug can easily be made into a generic.
Compounding pharmacies have come in to help supply patients with this combination medication. Each ingredient in Midrin already has a USP monograph and is able to be combined into capsules. Compounding pharmacies specialize in providing treatments that are not commercially available, including those that have been discontinued for reasons other than safety. A doctor can write the prescription for Midrin by writing out the ingredients and their dosages. The prescription is then sent to the compounding pharmacy where it is custom-made for the patient. At Woodland Hills Pharmacy, we make Midrin as well as Prodrin and can ship directly to the patient’s home.