Drug dependence associated with triptans and ergot derivatives: a case/non-case study.
BACKGROUND
The aim of this case/non-case study was to assess and compare the risk of drug dependence associated with different migraine-specific drugs, i.e., ergot derivatives and triptans, using the French pharmacovigilance database.


METHODS
Reports on drug side effects recorded in this database between January 1985 and June 2007 were analyzed, and triptans (almotriptan, eletriptan, naratriptan, sumatriptan, and zolmitriptan) as well as ergot derivatives used in acute migraine were examined. For all reports, cases were defined as those reports corresponding to "drug abuse," "physical or mental drug dependence," and "pharmacodependence," whereas "non-cases" were defined as all the remaining SED reports. The method's reliability was assessed by calculating the risk associated with a negative (amoxicillin) and a positive (benzodiazepines) control. The risk of dependence associated with each drug and control was evaluated by calculating the odds ratio (OR) with a confidence interval of 95%.


RESULTS
Among the 309,178 reports recorded in the database, drug dependence accounted for 0.8% (2,489) of the reports, with 10.9% (449) involving a triptan, and 9.33% (332) an ergot derivative. The risk of dependence was similar for triptans and ergot derivatives and did not differ from that of benzodiazepines. In the triptan group, the risk (odds ratio [95% CI]) ranged from 10.3 [4.8-22.3] for sumatriptan to 21.5 for eletriptan [10.1-45.6], while in the ergot derivative group, it ranged from 12 [8-17.9] for ergotamine to 20.6 [8-53] for dihydroergotamine.


CONCLUSIONS
These findings confirm the hypothesis that triptans and ergot derivatives are associated with an increased risk of drug dependence.
Beau-Salinas
Frédérique
F
Department of Pharmacology, CHRU of Tours, Bretonneau Hospital, Regional Centre of Pharmacovigilance, France. f.beau-salinas@chu-tours.fr
Jonville-Béra
Annie Pierre
AP
Cissoko
Haware
H
Bensouda-Grimaldi
Lamiae
L
Autret-Leca
Elisabeth
E
D002967:Claviceps / Q000737:chemistry*; D004087:Dihydroergotamine / Q000627:therapeutic use; D004878:Ergotamine / Q000627:therapeutic use; D006801:Humans; D008881:Migraine Disorders / Q000139:chemically induced / Q000188:drug therapy*; D023303:Oxazolidinones / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use; D012306:Risk; D019966:Substance-Related Disorders / Q000188:drug therapy*; D018170:Sumatriptan / Q000627:therapeutic use; D014363:Tryptamines / Q000627:therapeutic use*
D023303:Oxazolidinones; D010880:Piperidines; D011759:Pyrrolidines; D014363:Tryptamines; C409045:almotriptan; C115647:eletriptan; C089750:zolmitriptan; D004087:Dihydroergotamine; D018170:Sumatriptan; D004878:Ergotamine; C106783:naratriptan