ANTIHISTAMINES›SEDATING
Paracetamol with buclizine
hydrochloride and codeine phosphate
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, paracetamol p. 271 , codeine phosphate
p. 276.
lINDICATIONS AND DOSE
MIGRALEVE®
Acute migraine
▶BY MOUTH
▶Child 12–14 years:Initially 1 tablet, (pink tablet) to be
taken at onset of attack, or if it is imminent, followed
by 1 tablet every 4 hours if required, (yellow tablet) to
be taken following initial dose; maximum 1 pink and
3 yellow tablets in 24 hours
▶Child 15–17 years:Initially 2 tablets, (pink tablets) to be
taken at onset of attack or if it is imminent, followed by
2 tablets every 4 hours if required, (yellow tablets) to be
taken following initial dose; maximum 2 pink and
6 yellow tablets in 24 hourslINTERACTIONS→Appendix 1 : antihistamines, sedating.
opioids.paracetamol
lSIDE-EFFECTSAddiction.agranulocytosis.blood disorder
.bronchial secretion viscosity increased.constipation.
dizziness.drowsiness.dry mouth.dyspepsia.dysuria.
gastrointestinal disorder.headache.hyperhidrosis.
nausea.pancreatitis acute.pruritus.psychomotor skills
impaired.thrombocytopenia.vision blurred.vomiting
lLESS SUITABLE FOR PRESCRIBING
MIGRALEVE®Migraleve®is less suitable for prescribing.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS2, 17, 30
▶Migraleve Pink(McNeil Products Ltd)
Buclizine hydrochloride 6.25 mg, Codeine phosphate 8 mg,
Paracetamol 500 mgMigraleve Pink tablets| 12 tabletp
£ 3. 79 m| 24 tabletp£ 6. 08 m| 48 tabletP£ 3. 97 m
▶Migraleve Yellow(McNeil Products Ltd)
Codeine phosphate 8 mg, Paracetamol 500 mgMigraleve Yellow
tablets| 16 tabletPsm
Pizotifen
lINDICATIONS AND DOSE
Prophylaxis of migraine
▶BY MOUTH
▶Child 5–17 years:Initially 500 micrograms once daily,
dose to be taken at night, then increased to up to
1. 5 mg daily in divided doses, dose to be increased
gradually, max. single dose (at night) 1 mglUNLICENSED USE 1. 5 mg tablets not licensed for use in
children.
lCONTRA-INDICATIONSAcute porphyrias p. 603
lCAUTIONSAvoid abrupt withdrawal.history of epilepsy.
susceptibility to angle-closure glaucoma.urinary
retention
lINTERACTIONS→Appendix 1 : antihistamines, sedating
lSIDE-EFFECTS
▶Common or very commonAppetite increased.dizziness.
drowsiness.dry mouth.fatigue.nausea.weight increased
▶UncommonConstipation
▶Rare or very rareAggression.anxiety.arthralgia.central
nervous system stimulation.depression.hallucination.
muscle complaints.paraesthesia.seizure.skin reactions.
sleep disorders
▶Frequency not knownHepatic disorders
lPREGNANCYAvoid unless potential benefit outweighs risk.
lBREAST FEEDINGAmount probably too small to be
harmful, but manufacturer advises avoid.
lHEPATIC IMPAIRMENTUse with caution.
lRENAL IMPAIRMENTUse with caution.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Pizotifen to prevent migraine
headacheswww.medicinesforchildren.org.uk/pizotifen-to-
prevent-migraine-headaches
Driving and skilled tasksDrowsiness may affect
performance of skilled tasks (e.g. driving); effects of
alcohol enhanced.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution
Tablet
CAUTIONARY AND ADVISORY LABELS 2
▶Pizotifen (Non-proprietary)
Pizotifen (as Pizotifen hydrogen malate)
500 microgramPizotifen 500 microgram tablets| 28 tabletP
£ 8. 50 DT = £ 1. 10 | 60 tabletP£ 27. 00
Pizotifen (as Pizotifen hydrogen malate) 1.5 mgPizotifen 1. 5 mg
tablets| 28 tabletP£ 8. 50 DT = £ 1. 20TRIPTANS
Sumatriptan
lINDICATIONS AND DOSE
Treatment of acute migraine
▶BY MOUTH
▶Child 6–9 years:Initially 25 mg for 1 dose, followed by
25 mg after at least 2 hours if required, to be taken only
if migraine recurs (patient not responding to initial
dose should not take second dose for same attack)
▶Child 10–11 years:Initially 50 mg for 1 dose, followed by
50 mg after at least 2 hours, to be taken only if
migraine recurs (patient not responding to initial dose
should not take second dose for same attack)
▶Child 12–17 years:Initially 50 – 100 mg for 1 dose,
followed by 50 – 100 mg after at least 2 hours if
required, to be taken only if migraine recurs (patient
not responding to initial dose should not take second
dose for same attack)
▶BY SUBCUTANEOUS INJECTION
▶Child 10–17 years:Initially 6 mg for 1 dose, followed by
6 mg after at least 1 hour if required, to be taken only if
migraine recurs (patient not responding to initial dose
should not take second dose for same attack), dose to
be administered using an auto-injector; maximum
12 mg per day
▶BY INTRANASAL ADMINISTRATION
▶Child 12–17 years:Initially 10 – 20 mg for 1 dose, followed
by 10 – 20 mg after at least 2 hours if required, to be
taken only if migraine recurs (patient not responding
to initial dose should not take second dose for same
attack); maximum 40 mg per day
Treatment of acute cluster headache
▶BY SUBCUTANEOUS INJECTION
▶Child 10–17 years (under expert supervision):Initially
6 mg for 1 dose, followed by 6 mg after at least 1 hour if
required, to be taken only if headache recurs (patient
not responding to initial dose should not take
second dose for same attack), dose to be continued→BNFC 2018 – 2019 Migraine 291
Nervous system4