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
- Children
- Severe hepatic Impairment (relative contraindication)
- 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
- Frovatriptan (Frova) tablets 2.5 mg
VII. Dosing
- Only approved for use in adults
- Initial Dose: 2.5 mg orally
- May repeat in 2 hours, however second dose of Frovatriptan has not been shown to offer additional benefit
- Maximum dose: 7.5 mg per day
- Consider for longer lasting Migraines (but have delayed onset)
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
- See absolute contraindications above
- Lithium
-
Selective Serotonin Reuptake Inhibitor (SSRI)
- Risk of Serotonin Syndrome when combined with SSRI, SNRI or MAO Inhibitors
XI. Management: Overdose or Toxicity
- See Triptan Overdose
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Related Studies
| frovatriptan (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FROVATRIPTAN SUCC 2.5 MG TAB | Generic | $8.77 each |
| frova (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FROVA 2.5 MG TABLET | Generic | $8.77 each |