Migramax sachets contain two active ingredients, lysine acetylsalicylate and metoclopramide. Lysine acetylsalicylate is a soluble form of acetylsalicyclic acid, otherwise known as aspirin. Metoclopramide is an antisickness medicine (antiemetic).
Aspirin is a painkiller that belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by blocking the action of a substance in the body called cyclo-oxygenase.
Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury or certain diseases and can cause pain, swelling and inflammation. By blocking the production of prostaglandins, aspirin relieves pain and inflammation, and is effective at relieving the pain of headaches and migraines.
During a migraine attack sufferers can often feel sick or vomit. Metoclopramide is used to treat this symptom of the migraine.
Metoclopramide works primarily by blocking dopamine receptors that are found in an area of the brain known as the chemoreceptor trigger zone (CTZ). The CTZ sends messages to another area of the brain, known as the vomiting centre, which in turn sends nerve messages to the gut that cause vomiting. By blocking dopamine receptors in the CTZ, metoclopramide prevents messages from being sent to the vomiting centre. This reduces the sensation of nausea and prevents vomiting.
Metoclopramide also acts in the upper gut, where it enhances the action of a chemical called acetylcholine. Increasing the action of acetylcholine results in the tightening of the muscles at the entry to the stomach, as well as relaxing the muscles at the exit of the stomach. It also increases the contraction of the muscles in the stomach itself, which speeds the passage of food through the stomach into the intestine. This physically helps to prevent vomiting, but is also useful in migraine attacks because it speeds the passage of the aspirin into the intestine, allowing it to be absorbed and relieve the headache more quickly.
This combination of aspirin and metoclopramide is most effective at relieving migraine when it is taken as soon as possible after the onset of an attack.
This medicine should not be used if you are allergic to one of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
Medicines and their possible side effects can affect individuals in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you take this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
People taking anticoagulant medicines used to prevent the blood clotting, eg warfarin, should not take aspirin to relieve pain or inflammation. This is because aspirin can irritate the stomach lining, as well as increasing the effects of warfarin, both of which increase the likelihood of bleeding.
There may also be an increased risk of bleeding if aspirin is taken with the following medicines:
Aspirin reduces the rate at which the body can remove the medicine methotrexate. The two should not usually be used together.
There is an increased risk of side effects if aspirin is taken with other non-steroidal anti-inflammatory drugs (NSAIDs), eg ibuprofen, diclofenac, indometacin. For this reason, aspirin should not be taken with any other NSAID.
There may be an increased risk of bleeding or ulceration of the stomach or intestines if aspirin is taken with corticosteroids, eg prednisolone, dexamethasone.
There may be an increased risk of side effects if aspirin is taken with acetazolamide.
Due to its action on the gut, metoclopramide may affect the absorption of various other medicines that are taken by mouth.
Metoclopramide may increase the blood level of the immunosuppressant medicine ciclosporin.
The following medicines may oppose the effect of metoclopramide on the gut and so could make it less effective at treating vomiting:
Metoclopramide may increase the drowsiness and sedation which are side effects of strong opioid painkillers such as morphine.
There may be an increased risk of side effects known as extrapyramidal effects if metoclopramide is taken with tetrabenazine or with antipsychotic medicines, eg chlorpromazine. Extrapyramidal side effects involve abnormal movements of the hands, legs, face and tongue, for example tremor or twitching.
Metoclopramide may oppose the effect of medicines for Parkinson's disease which work by stimulating dopamine receptors in the brain, for example apomorphine, ropinirole, pergolide, bromocriptine, levodopa. It should not be taken by people taking these kinds of medicine.
There may be an increased risk of a side effect called the serotonin syndrome if metoclopramide is taken in combination with the following medicines:
There are currently no other medicines available in the UK that contain both aspirin and metoclopramide. However these medicines are available separately.