Pharm
Almotriptan
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Almotriptan
, Axert
See Also
Migraine Abortive Treatment
Triptan Overdose
Indications
Migraine Abortive Treatment
(age 12 years and older)
Cluster Headache
(off-label except for
Sumatriptan
)
Controversial cohorts in whom
Triptan
use is now thought safe (
Cardiovascular Risk Factor
s)
Controlled
Diabetes Mellitus
Controlled
Hypertension
Controlled
Hyperlipidemia
Postmenopausal women
Men over age 40 years
Contraindications
Sulfa Allergy
(relative contraindication)
Almotriptan is a
Sulfonamide
with risk of
Sulfa Allergy
Coronary Artery Disease
Prinzmetal's Angina
Uncontrolled Hypertension
Basilar Artery
Migraine
Familial Hemiplegic
Migraine
Ischemic
Cerebrovascular Accident
Pregnancy
Concurrent Medication use (absolute contraindications)
MAO Inhibitor
use
Ergotamine
use in prior 24 hours
Mechanism
Serotonergic
5-HT
1 receptor
Agonist
s
Inhibits sensory dural nerve fiber neuropeptide release
Intracranial extracerebral artery
Vasocon
striction
Mediated by
Triptan
direct effect on cerebrovascular
Smooth Muscle
Dosing
Gene
ral
Screen for cardiovascular disease before use!
Limit to no more than twice weekly
Medications
Almotriptan (Axert) tablets 6.25 mg, 12.5 mg
Dosing
Indicated in adults and children age 12 years and older
Initial: 6.25 to 12.5 mg orally; may repeat in 2 hours
Maximum: 2 doses (or 25 mg total) in 24 hours
Indications to limit to 6.25 mg (lower dose)
Hepatic
Impairment
Severe renal
Impairment
Adverse Effects
See
Triptan Overdose
Sulfa Allergy
Almotriptan is a
Sulfonamide
with risk of
Sulfa Allergy
Vasospasm
Gene
rally benign in low risk populations
Avoid in
Coronary Artery Disease
,
Cerebrovascular Disease
,
Peripheral Arterial Disease
Also avoid in hemiplegic
Migraine
or basilar
Migraine
Medication Overuse Headache
s
Highest risk with >10 doses per month
Limit to two doses weekly
Safety
Unknown safety in
Lactation
Pregnancy Category C (most
Triptan
s, but generally avoided in pregnancy)
See
Migraine Medications in Pregnancy
Not recommended for routine use in pregnancy
Consult obstetrics before use
May be considered if
Migraine
s are uncontrolled, debilitating
If used,
Sumatriptan
has the longest safety data
Adverse effects in pregnancy
Avoid in first trimester (fetal malformations and adverse pregnancy outcomes)
Risk of uterine atony and peripartum
Hemorrhage
(but may be considered in debilitating
Headache
)
Associated with hyperactivity and emotionality at age 3 in exposed children (AHRQ)
References
Nezvalova-Henriksen (2010) Headache 50(4): 563-75 +PMID: 20132339 [PubMed]
Drug Interactions
See absolute contraindications above
Ergotamine
MAO Inhibitor
s
Lithium
Selective Serotonin Reuptake Inhibitor
(
SSRI
)
Risk of
Serotonin Syndrome
when combined with
SSRI
,
SNRI
or
MAO Inhibitor
s
Efficacy
Gene
ral
Most effective oral agents (compared with
Imitrex
100 mg PO)
Rizatriptan
(
Maxalt
) 10 mg orally
Eletriptan
(
Relpax
) 80 mg orally
Almotriptan (Axert) 12.5 mg orally (least side effects)
References
Ferrari (2001) Lancet 358:1668-75 [PubMed]
Management
Overdose
or Toxicity
See
Triptan Overdose
Resources
Almotriptan (DailyMed)
https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6fa380c4-c885-4743-85bf-88819ae68645
Triptan
s (StatPearls)
https://www.ncbi.nlm.nih.gov/books/NBK554507/
Where do
Triptan
s act in the treatment of
Migraine
? (PMC)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1850935/
References
Jamieson (2002) Am J Med 112:138 [PubMed]
Ahn (2005) Pain 115(1-2):1-4 +PMID: 15836963 [PubMed]
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