Acute Migraine Treatment with Timolol 0.5% Nasal Spray - Compounding Pharmacists Have an Important Role.

For the foreseeable future, timolol 0.5% nasal spray prepared by compounding pharmacists will be the only source for a potentially dramatic new paradigm in the treatment of acute migraine.1 It is also likely other medical conditions can be treated with the compounded timolol nasal spray that need extremely rapid therapeutic beta blocker blood levels when IV infusion is not possible or practical. This manuscript will review the research and development of compounded timolol medication over the past dozen years and reference previous articles in IJPC detailing how the pharmaceutical compounded product is prepared.2 A final goal is to engage physicians in a beneficial working relationship with compounding pharmacies to make immediately available to patients a nasal spray formulation of the beta blocker timolol 0.5% in solution. It has recently been demonstrated for the first time to benefit acute migraine treatment.

Nasally Delivered 0.5% Timolol Beta Blocker Successfully Treats Acute Migraines in a Referral Headache Clinic: A Case Series.

This is the first reported case series of nasally delivered beta blocker (timolol 0.5%) for the treatment of acute migraine. In a retrospective chart review, 16 patients were found who had received intranasal timolol for sub-optimally treated acute migraines. Of these, 10 (62.5%) reported to their provider that the medication was helpful. Encouragingly, the treatment was beneficial even for patients previously refractory to other medications. Intranasal timolol was well tolerated, with only one patient reporting mild nasal congestion and no other side effects reported. These findings suggest the need for a prospective pilot study followed by a larger double-blind randomized placebo-controlled trial to determine the overall efficacy and safety of nasally delivered beta blockers for acute migraine treatment.

Compounded Beta-blocker Nasal Spray for Treatment of Acute Migraine: A New Therapeutic Modality.

Beta blockers (timolol 0.5% ophthalmic solution) delivered topically to the eyes or sublingually have recently been reported in case series and small placebo controlled studies to be effective in some cases of acute migraine. Rapid systemic absorption to achieve therapeutic levels of beta blockers is extremely important in the treatment of acute migraine. Nasal delivered beta blockers have been shown to be absorbed as fast as intravenous administration and seem ideal for acute migraine treatment. A nasal delivered beta-blocker spray has not been available. In 2019, O'Brien Pharmacy prepared a compounded timolol nasal spray that is now available to authorized prescribers. The theoretical basis for using nasal beta blocker spray is presented and research on fast-acting beta-blocker solutions for acute migraine is reviewed.