My First Aimovig Injection

I’m going to tell you a little bit about my first injection of Aimovig.  I am allergic to or have terrible side effects to Tricyclic anti depressants, anti convulsants, beta-blockers, and calcium channel blockers. Hence, trying a new injectable makes me more than a tad nervous.  I’ll also try to keep you abreast of any reactions I have as well as any success with Aimovig.  However, before I tell you about my first injection experience the scientist in me is going to review a little of the science behind this new preventative medication.

The Science Behind Amovig

Aimovig is a monoclonal antibody acting on CGRP (a protein) activation. During a migraine a patient experiences Cortical Spreading Depression leading to brain hyper stimulation.  Which correlates with photophobia and activation of the Trigeminal Vascular system.  This system releases, among other things, CGRP, oxytocin, and serotonin.  As a medical professional, I always wantthe details behind these things.

Chemicals Released

Lets take a quick look at the chemicals released during activation of the Trigeminal Vascular System.

Oxytocin

Oxytocin,  the “cuddle hormone”,  releases during activities such as cuddling or nursing your baby.  This can affect how you bond with people either increasing the bond or making you suspicious.  The effects are partially dependent on your environment.  In nursing a baby, its primary effect is increasing baby bonding.  There’s lots of info out on Oxytocin if you want more facts please feel free to learn more.

Serotonin

Serotonin release is one of the reasons migraine patients often receive anti-depressants that have the “side-effect” of helping migraine. The class of medications often prescribed are Tricyclic Antidepressants. This class of medication regulates the serotonin by increasing the levels as well as norepinephrine.  Some other medications that affect these levels are SSRIs and some of the Triptans.  Triptans are a prescribed class of medications for acute migraine attack drugs.  I do not fully understood the full reasoning between increasing serotonin levels and alleviating migraine pain.  Primarily because increased serotonin symptoms include nausea. Triptans and certain anti-depressant use (often for migraine) can cause Serotonin Syndrome.

CGRP

CGRP, Calcitonin Gene-related Protein, increasingly studied over the last few years is raised during a migraine.  Post migraine the levels typically drop.  In fact, I was invited to a study a few years ago, but paranoia caused me to turn down my spot.  CGRP increases vasodilation, neurogenic inflammation and the development of Central Nervous System (CNS) sensation.  In fact, researchers have found that infusing migraine susceptible people with CGRP can artificially induce a migraine attack.  On the flip side CGRP helps relax arteries and performs some essential cardiac functions so its not just some THING floating around causing pain.  However speaking about migraines, they find Triptans decrease CGRP, which leads us to the latest in preventive medications CGRP blockers and Aimovig.

Preparations for Aimovig

Nursing is not recommended when you are on Aimovig, neither is attempting to conceive or being pregnant.  This is important to me because I have an 11 month old actively nursing.  Much to my chagrin at 12 months I came up with a plan to wean him.  Fortunately, this process was easy and the changeover is complete. I do feel sad, we are unable to continue with flu season upon us, but the prospects of being a more active functional wife and mom on this medication provide solace.

Aimovig

One of the first monoclonal medications approved by the FDA, it emerged in the market last spring from Amgen.  Studies of the long term effects are still up in the air so consider the last text on the science of CGRP on your cardiac function.  Will it, much like many other medications, make patients more prone to stroke or heart attack?  This remains to be seen.  It is something I am very aware of and in the event of an Emergency Room visit this medication will be the first thing I tell them.

Cost is another topic of concern.  Although I am presently on the 2 free sample doses offered by Amgen and Novartis, the cost is said to be out of pocket around $7,000.  This will definitely cause insurance to pause before approving the medication.  Not to mention, what will the copay be even if they do?

Side Effects

Since it is a relatively new drug on the market and one of the first of it’s kind the side effects are also new.  In my opinion, they are just emerging.  Always be aware of a potential allergy.  However commonly listed are:

  • constipation
  • pain, swelling and redness at the injection site

The Injection

It comes as a self injection in pre-measured auto injectors.  The setup of them is much like the standard Epi-Pen or some insulins.  My first injection is prescribed as 140mg, which means I have two 70mg injections to administer.  I’m unsure if they have a single 140mg injection or if it will always mean two separate injections.  To me this is important because the single most report side effect is irritation at the injection site.

Free Trial Dose Program

My Neurologist, during my last botox appointment, set up the paperwork to get me into the 2 dose trial program.  They took care of everything.  Eventually, I received a phone call from McKesson Pharmacy asking me when I would like it delivered and explaining the storage of the medication.  Sadly, the medication didn’t come as scheduled, but 2 weeks later they called me to inform me since I never scheduled the delivery they were sending it.  This time it came on time and in a cooler.

The Cooler

The cooler contains ice packs, instructions, and conveniently alcohol prep pads.  Everything necessary to administer it from home.  There is also a temperature indicator, which changes colors if the cooler temperature becomes unstable putting the medication at risk.

The Actual Injection

Within a few days of successful weaning, I sent my provider a message letting him know I had the medication.  He suggests his patients learn to administer it from a profession.  Options are:  his office (3 hours drive from me), the local pharmacy, the doctors office, or call McKesson and a nurse will come to your house.  I set up time with my local primary care physicians office.

Sites

My primary care office’s nurses were uneducated on the actual medication due to it’s recent emergence into the market.  After researching it, they set up time to go over the details with me.  The injection sites are:

  • stomach area
  • back of arm
  • thigh

My Experience

Knowing the side effects and not ok with an injection in my stomach or thigh, the only option was the back of my arm.  Sadly, they didn’t tell me to bring a friend.  Upon arrival, they said the only places I could administer this injection is my thigh or stomach.  HECK NO!  Ready to walk due to inability to inject in what I deem an acceptable spot for my lifestyle, the male nurse stops me, looks at the other two and says “maybe she can reach there, let’s see.”

As it turns out, I am able to easily reach that spot in my arm.  I knew this though because I can touch my hands behind my back, so why not?  Putting my arm up, as though about to pat myself on the back for a job well done, I swab the area on the outer most part of the back of my arm.  Then, taking the pen, I press firmly town.  The pen actually contracts some when you press firm enough.  Although the female nurse insisted I press the trigger with my thumb, that was impossible so I used my index finger.  I type all day so perhaps I just have strong fingers!

The trigger stays down until the medication fully releases, then clicks back up.  Once the click is heard, you remove the pen from your arm.  On the side of the pen there is a window, which goes from clear to yellow showing the medicine is fully dispensed.

Day 1

Yesterday I injected myself with Amovig.  So far I have zero side effects, except if I rub really hard where I injected it into my arm.  However, unless you’re checking for a bump or something, who just puts their arm in the air and rubs there?  The pain isn’t enough to even rate on a pain scale and is 100x’s better than getting your tetanus or MMR.

Conclusion

So far, so good.  No panic attacks, muscle weakness, passing out, trouble sleeping, trouble NOT sleeping, or anything note worthy to report that I have experienced on other medications.  I’m a little uneasy blocking CGRP, since this is the first time it has ever blocking it in the medical realm.  As it stands I do not have high blood pressure, diabetes, or any of the common health problems.  I am somewhat, post pregnancy, over weight, but that plus migraines and asthma due to seasonal allergies is the extent of my health conditions.  Concerning paying for Aimovig, I did find this helpful article from another patient on ways to pay for the drug.

References:
  1. https://www.drugs.com/aimovig.html
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392770/
  3. https://www.sciencenews.org/article/what-we-know-and-dont-know-about-new-migraine-drug
  4. https://www.webmd.com/migraines-headaches/triptans-migraines#2
  5. https://www.healthyplace.com/depression/antidepressants/tricyclic-antidepressants-how-tricyclics-work-side-effects
  6. https://www.sciencedaily.com/releases/2018/02/180226122554.htm
  7. https://www.healthline.com/health/mental-health/serotonin#functions
  8. https://www.livescience.com/42198-what-is-oxytocin.html

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