Fig. 2
Overview of the influence of diabetes mellitus on the efficacy of antimigraine drugs. Absorption: Delayed gastric emptying in DM and changes in subcutaneous blood flow might cause decreased absorption. Distribution: Presence of comorbid obesity can increase the distribution of lipophilic drugs; Elevated free fatty acids in DM increases unbound fraction of propranolol. Metabolism: DM might downregulate CYP3A4 and CYP2C19, decreasing metabolism of some drugs; Concerning gepants and CGRP mAbs, contradictory evidence exists on the role of CGRP in glucose metabolism. Elimination: Renal hyperfiltration in diabetes mellitus can cause an increased elimination of renally eliminated drugs