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Pharmaco-epidemiology of sumatriptan Cardiovascular adverse reactions to a new antimigrainous drug Jan Paul Oltervanger Acknowledgements Financial support by the Netllerlands Heart Foundation and the Rotterdam Medical Research Foundation (ROMERES) for tlle publication of this tllesis is gratefully acknowledged. The studies described in this tllesis could not have been performed without the assistance of tlle Dutch drug-dispensing general practitioners. ISBN 90-9009261-7 '" J. P. Ottervanger No part of this thesis may be reproduced, stored in a retrieval system or transmitted in any otller form or by any means, without written permission of the author. or, when appropriate. of the publishers of the publications. PHARMACO-EPIDEMIOLOGY OF SUMATRIPTA N CARDIOVASCULAR ADVERSE REACTIONS TO A NEW ANTI MIGRAINOUS DRUG Farmaco-epidemiologie van sumatriptan Cardiovasculaire bijwerkingen van een nieuw anti-migrainemiddel Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Prof. dr P.W.C. Akkermans M.A. en vol gens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op woensdag 13 maart 1996 om 15.45 uur door Jan Paul Ottervanger geboren te Rotterdam. Promotie conllnissie Promotor: Prof. dr D .E. Orobbee Co-promotor: Dr B.H.Ch. Stricker Overige leden: Prof. J.H.P. Wilson Prof. dr P.R. Saxena Dr H.O.M. Leufkens Ter nagedachtenis van mijn Quders, D.G. Ottervanger (maart 1937 - febmari 1971) D.W. Ottervanger-Gerritsen (januari 1937 - febmari 1971) Vaa/' Annette en Wendy CONTENTS PART J, BACKGROUND 1. Introduction and outline of the project 13 2. Post Marketing Surveillance 17 PART lJ, REPORTS TO A NATIONAL VOLUNTARY REPORTING SCHEME 3. The Netherlands Centre for Monitoring of Adverse Reactions to Dmgs 39 4. Dmg-induced chest pain and myocardial infarction: A review of reports to a national centre 47 S. Adverse reactions to sumatriptan: Reports to the Netherlands Centre for Monitoring of Adverse Reactions to Dmgs 5.1 Chest pain attributed to sumatriptan 61 5.2 Acute myocardial infarction to sumatriptan 67 6. Cardiovascular adverse reactions to sumatriptan: Cause for concern? 75 PART JJJ, EXPLORATION OF THE PROBLEM 7. Frequency and character of adverse reactions to sumatriptan 7.1 Adverse reactions as reported by dmg dispensing general practitioners 97 7.2 Adverse reactions as reported by patients 103 7.3 Differences between perceived and presented adverse reactions to dmgs 113 8. Determinants of ovelUse of sumatriptan 123 9. Characteristics and determinants of sumatriptan associated chest pain 131 10. Cardiac exercise testing in patients with chest pain due to sumatriptan 145 General discussion 153 Sununary 159 Nederlandse Samenvatting 163 Epiloog 167 Curriculum vitae 171 List of publications 173 Manuscripts based on the resnlts presented in tllis thesis Chapter 3 Stricker BHCh, Ottervanger JP. Meldingen van vermoedelijke bijwerkingen bij het Bureau Bijwerldngen Geneesmiddelen en onderzoeksactiviteiten in 1992. Ned Tijdschr Geneeskd 1993;137:1784-7. Stricker BHCh, Ottervanger JP, van del' Klauw M. Meldingen van vermoedelijke bijwerkingen bij het Bureau Bijwerkingen Geneesmiddelen in onderzoeksactiviteiten in 1993. Ned Tijdschr Geneeskd 1994;138:2110-13. Chapter 4 Ottervanger JP, Wilson JHP, Stricker BHCh. Drug-induced chest pain and myocardial infarction: A review of reports to a national centre. (submitted). Chapter 5 Stricker BHCh, Ottervanger JP. Pijn op de borst door sumatriptan. Ned Tijdschr Geneeskd 1992; 136: 1774-6. Stricker BHCh, Ottervanger JP. Hartinfarct door sumatriptan. Ned Tijdschr Geneeskd 1993; 137:141. Ottervanger JP, Paalman HJA, Boxma GL, Stricker BHCh. Transmural myocardial infarction with sumatriptan. Lancet 1993;341:861-62. Chapter 6 Ottervanger JP, Stricker BHCh. Cardiovascular adverse reactions to sumatriptan: Cause for concern? CNS Drugs 1995;3:90-98. Chapter 7 Stricker BHCh, Ottervanger JP, Witsen van TB, Hoeven van del' ACJ, Valkenburg HA. De betekenis van apotheekhoudende huisartsen voor de postmarketing surveillance. Med Contact 1993;48:169-71. Ottervanger JP, Witsen van TB, Valkenburg HA, Stricker BHCh. Postmarketing study of cardiovascular adverse reactions associated with sumatriptan. BMJ 1993;307: 1185. 9 Ollervanger JP, Valkenburg HA, Grobbee DE, Stricker BHCh. Adverse reaclions attributed to sumatriptan: A poslmarketing study in general practice. Eur J Clin Pharmacol 1994;47:305-9. Ottervanger JP, Valkenburg HA, Grobbee DE, Stricker BHCh. Differences in perceived and presented adverse reactions to drugs in general practice. (submitted). Chapter 8 Ottervanger JP, Valkenburg HA, Grobbee DE, Stricker BHCh. Pattern of sumatriptan use and overuse in general practice. Eur J Clin Pharmacol (in press). Chapter 9 Ottervanger JP, Valkenburg HA, Grobbee DE, Stricker BHCh. Characteristics and determinants of sumatriptan associated chest pain. (submitted). Chapter 10 Ottervanger JP, Hoorntje JAC, Valkenburg HA, Grobbee DE, Stricker BHCh. Cardiac exercise testing in patients with chest pain due to sumatriptan. (submitted). 10

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Regulations of the European Union and the definitions of the WHO In 1906, the Pure Food and Drngs Act was passed in the USA Federal Food, Drug and Cosmetic Act was passed by the U.S. Congress and signed. 23 . In the international randomized trial on the effect of surgery for carotid.
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