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
Images: Related links to external sites (from Bing)
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 |