Indomethacin, in combination with prochlorperazine and caffeine (IPC), is often overused by migraine patients who develop medication-overuse headache. Indomethacin clearance is lower in chronic migraine patients overusing IPC combination than in migraine patients only occasionally taking it. Objective: to verify if indomethacin reduced clearance reverts to normal after withdrawal of the overused IPC combination. Methods: We repeated the study of indomethacin pharmacokinetics in 9 female chronic migraine patients after 3 months from inpatient withdrawal treatment from IPC combination overuse. The IPC combination (indomethacin 50 mg, prochlorperazine 8 mg, caffeine 150 mg) habitually taken was administered by rectal route to each patient. Blood samples were drawn before dosing and at the following post-dose times: 0.5, 1, 2, 3, 4, and 6 h. Indomethacin concentrations were measured by HPLC method. Results: Pharmacokinetic parameters of indomethacin in 4 patients who relapsed into IPC overuse were similar to those observed before withdrawal treatment; on the other hand, indomethacin clearance reverted to values consistent with published data in 5 patients who discontinued IPC combination overuse. Conclusions: Indomethacin normal clearance was related to a reduced frequency of migraine; conversely, indomethacin delayed clearance sustained medication-overuse headache.

Kinetics of indomethacin in headache patients who abitually take an association of indomethacin, caffeine and prochlorperazine / Ferrari, Anna; Bertolini, A; Savino, G; Pasciullo, G; Gallesi, D; Sances, G; Sternieri, E.. - ELETTRONICO. - (2003), pp. 56-56.

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