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In human urine, the major metabolites of inorganic arsenicals such as arsenite (iAs III ) and arsenate (iAs V ) are monomethylarsonic acid (MMA V ) and dimethylarsinic acid (DMA V )

Commonly reported effects include: Drowsiness, particularly from diphenhydramine and some antiemetics Restlessness or akathisia, typically transient and often prevented by diphenhydramine pretreatment Mild lightheadedness, particularly when standing up after a session A warming sensation or flushing during magnesium administration A brief metallic or medication taste during infusion Bruising or tenderness at the IV site Rarely, allergic reactions to specific components How often can migraine IV therapy be used

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The increased cost and additional injection requirement mean the combination approach represents a step up in commitment

doi: 10.1038/ejcn.2014.46, 166

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