II. 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 Factors)
- Controlled Diabetes Mellitus
- Controlled Hypertension
- Controlled Hyperlipidemia
- Postmenopausal women
- Men over age 40 years
III. 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
IV. Mechanism
- Serotonergic 5-HT1 receptor Agonists
- Inhibits sensory dural nerve fiber neuropeptide release
- Intracranial extracerebral artery Vasoconstriction
- Mediated by Triptan direct effect on cerebrovascular Smooth Muscle
V. Dosing: General
- Screen for cardiovascular disease before use!
- Limit to no more than twice weekly
VI. Medications
- Almotriptan (Axert) tablets 6.25 mg, 12.5 mg
VII. 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
VIII. Adverse Effects
- See Triptan Overdose
-
Sulfa Allergy
- Almotriptan is a Sulfonamide with risk of Sulfa Allergy
- Vasospasm
- Generally 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 Headaches
- Highest risk with >10 doses per month
- Limit to two doses weekly
IX. Safety
- Unknown safety in Lactation
- Pregnancy Category C (most Triptans, 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 Migraines 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
X. Drug Interactions
- See absolute contraindications above
- Lithium
-
Selective Serotonin Reuptake Inhibitor (SSRI)
- Risk of Serotonin Syndrome when combined with SSRI, SNRI or MAO Inhibitors
XI. Efficacy: General
- 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
XII. Management: Overdose or Toxicity
- See Triptan Overdose
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Related Studies
almotriptan (on 1/18/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ALMOTRIPTAN MALATE 12.5 MG TAB | Generic | $21.98 each |
ALMOTRIPTAN MALATE 6.25 MG TAB | Generic | $17.11 each |
Ontology: almotriptan (C0914729)
Definition (NCI) | A sulfonamide triptan with extracerebral, intracranial vasoconstrictor activity. Almotriptan selectively binds to and activates serotonin 5-HT 1B and 1D receptors in the central nervous system (CNS), thereby causing extracerebral, intracranial blood vessel constriction. This may lead to pain relief from vascular headaches. Almotriptan may also relieve vascular headaches by preventing the release of vasoactive neuropeptides from perivascular trigeminal axons in the dura mater during a migraine, by reducing extravasation of plasma proteins, and by decreasing the release of other mediators of inflammation from the trigeminal nerve. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C409045 |
SnomedCT | 363569003, 391738001, 134529000 |
English | Almotriptan product, almotriptan (medication), almotriptan [Chemical/Ingredient], almotriptan, Almotriptan - chemical (substance), Almotriptan - chemical, Almotriptan (product), Almotriptan (substance), Almotriptan, Almotriptan product (substance), ALMOTRIPTAN |
Spanish | almotriptán - sustancia química (sustancia), almotriptán - sustancia química, almotriptán (producto), almotriptán (sustancia), almotriptán |