II. Indications: General
- Migraine Abortive Treatment (adults)
- 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
- Severe hepatic insufficiency
- Children
- 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. Precautions
- Screen for cardiovascular disease before use!
- Limit to no more than twice weekly
VI. Medications
- Eletriptan (Relpax) tablets 20 mg, 40 mg
VII. Dosing
- Only approved for use in adults
- Initial: 20 to 40 mg orally
- May repeat dose in 2 hours
- Maximum: 40 mg/dose or 80 mg/day
VIII. Adverse Effects
- See Triptan Overdose
- 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
- Strong CYP3A4 Inhibitors
- Avoid within 72 hours of Eletriptan
- 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
| eletriptan (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ELETRIPTAN HBR 20 MG TABLET | Generic | $3.07 each |
| ELETRIPTAN HBR 40 MG TABLET | Generic | $2.60 each |
| relpax (on 3/15/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| RELPAX 40 MG TABLET | Generic | $2.60 each |