Dopamine Blockade With Domperidone: Bridge Between Prophylactic and Abortive Treatment of Migraine? A Dose-Finding Study

The feasibility of a “last moment” prevention of migraine with the selective dopamine receptor blocker domperidone (Motilium(r)) was evaluated in patients who experience typical, but minor prodromes several hours before the attack. Following a previous placebo-controlled trial, a dose-response study was done. In a randomized, double-blind cross-over setting, oral doses of 20 mg, 30 mg or 40 mg of domperidone were each given twice to 19 patients who were able to predict their attack several hours in advance. Taken at the very first appearance of the early warning symptoms, 20 mg, 30 mg and 40 mg prevented respectively 30%, 58% and 63% of the (imminent) attacks. Part of the attacks still occurring after domperidone, particularly after 20 mg, were reduced in severity. Irrespective of the dose given, the best response was observed when domperidone was taken 6 h, and even better, 12 h before the attack. Migraine-associated hypersensitivity of dopamine receptors might explain why dopamine blockade with domperidone is of benefit to the patient.

Download Full-text

The effect of several doses of oral tocainide HC1 on tinnitus: a dose-finding study

The Journal of Laryngology & Otology ◽

10.1017/s1755146300090570 ◽

1984 ◽

Vol 98 (S9) ◽

pp. 257-258

Author(s):

Jan H. Hulshof ◽

Pieter Vermey

Keyword(s):

Oral Administration ◽

Controlled Trial ◽

Dose Finding ◽

Double Blind ◽

Considerable Research ◽

Finding Study ◽

Dose Finding Study ◽

Single Blind ◽

Different Doses

From all methods of the treatment of tinnitus, medical, masking, surgery, electrical stimulation and psychological, we believe a reliable medical treatment would be preferable because it is easy to apply. An immense variety of drugs have been used for the treatment of tinnitus (Vernon, 1977). The most reliable drugs so far on tinnitus are intravenous procaine and lidocaine (Bárány, 1935; Lewy, 1937; Melding et al., 1978; Martin and Colman, 1980; Israel et al., 1982). The fact that these drugs cannot be given orally because of the poor biological availability after oral administration, is a great disadvantage. In view of the important pharmaco-therapeutic role of lidocaine as an anti-arrhythmic drug, considerable research has been devoted to drugs with comparable anti-arrhythmic properties but permitting oral administration. This work produced tocainide (Smith, 1981), which showed a certain degree of effect on tinnitus as well (Emmett and Shea, 1980; Cathcart, 1982). Before starting a randomized double-blind controlled trial to assess the effect on tinnitus of tocainide, we studied the effect of several doses of tocainide HCl on tinnitus in order to select an appropriate dosage. Nineteen patients with obstructive tinnitus of various aetiologies were admitted to the study. There were 10 women and nine men. Their mean age was 54 years (range 22–67 years). Tocainide was administered in five different doses in a single-blind controlled trial. To be able to judge the effect under steady conditions, each dose was given for four days, as shown in Table I. On the fourth day of each period the patients had to record the degree of impediment caused by the tinitus on a six-point scale (Table II). They were also asked to report all sideeffects.

Download Full-text