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Why are doctors still prescribing old drugs for migraine?

Q: My 23 years old wife has been diagnosed with migraine and the doctor prescribed Vasograin (ergotamine tartrate based) on SOS basis. I did some internet search and I found that a combination of Sumatriptan 85 mg and Naproxen 100 mg is a preferred treatment for migraine attacks in the US. I checked the Central Drugs Standard Control Organisation (CDSCO) website for the list of approved drugs in India and found that both Sumatriptan and ergotamine tartrate are approved for marketing in India. Why are doctors still prescribing Vasograin?

A:New drugs (with much less experience) do not and should not necessarily replace old ones (in use for decades). In US, due to patents manufacturers often aggressively promote newly discovered molecules since old medicines (whose patents have expired) are not that profitable. If the patient is getting relief with Vasograin, then there is no clinical need to change the medication. If the side effects of sumatriptan and naproxen are added, then the overall adverse effects will be quite large and hence need to be kept in mind.

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