Paracetamol with isometheptene

How it works

Paracetamol provides central analgesia and antipyresis, while isometheptene is an indirectly acting sympathomimetic thought to relieve migraine through cranial vasoconstriction.

Prescribing in practice

• Because isometheptene is a sympathomimetic vasoconstrictor, it should be avoided in uncontrolled hypertension, significant cardiovascular or cerebrovascular disease and with monoamine oxidase inhibitors.
• Account for paracetamol from all sources to prevent inadvertent overdose and liver injury.
• Restrict the frequency of use to avoid medication-overuse headache and excessive sympathomimetic exposure.

Monitoring

Monitor blood pressure in those with cardiovascular risk and review headache frequency to detect medication-overuse headache.

Counselling the patient

• Do not take other paracetamol-containing products alongside this medicine.
• Limit how often you use it for migraine attacks, and seek advice if headaches become more frequent or your blood pressure is a concern.

Evidence & guidelines

Paracetamol with a sympathomimetic for migraine is used according to its SPC, with cardiovascular cautions reflecting the vasoconstrictor component.