II. 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
III. Indications: General
- Migraine Abortive Treatment
- Cluster Headache
- 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
IV. Contraindications
- 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
V. Drug Interactions
- See absolute contraindications above
- Lithium
-
Selective Serotonin Reuptake Inhibitor (SSRI)
- Risk of Serotonin Syndrome
-
Propranolol with Rizatriptan
- Requires reducing Rizatriptan dose
VI. Dosing: General
- Screen for cardiac disease before use!
- Limit to no more than twice weekly
VII. Dosing: Sumatriptan (Imitrex)
- Subcutaneous Sumatriptan
- Initial: 6 mg SC
- Repeat in 12 hours prn
- Maximum: 12 mg/day
- Even generic dosing approaches $100/dose
- Oral Sumatriptan
- Dose 25 to 100 mg orally every 2 hours prn
- Start at max single dose, 100 mg orally for best efficacy in young adult without contraindications
- Maximum: 300 mg/day
- Generic dosing may be as low as $3/dose
- Dose 25 to 100 mg orally every 2 hours prn
- Intranasal Sumatriptan
- Initial: 5, 10 or 20 mg intranasal
- Dose responsive (20 mg more effective)
- Repeat after 2 hours prn
- Maximum: 40 mg/day
- Safety of use in over 4 Headaches per month not known
- Initial: 5, 10 or 20 mg intranasal
- Treximet (combination with Naproxen)
- Other Sumatriptan formulations
- Zecurity patch
- Removed from market 2016 due to serious adverse effects including burns
- http://www.fda.gov/Drugs/DrugSafety/ucm504588.htm
- Zecurity patch
VIII. Dosing: Rizatriptan (Maxalt, Maxalt MLT)
- Initial: 5 to 10 mg orally (MLT form is lingual)
- Start at max single dose, 10 mg orally for best efficacy in young adult without contraindications
- Repeat dose in 2 hours
- Maximum: 30 mg in 24 hours
IX. Dosing: Naratriptan (Amerge)
X. Dosing: Zolmitriptan (Zomig)
- Oral
- Initial: 1.25 to 2.5 mg orally
- Repeat dose every 2 hours
- Maximum: 10 mg in 24 hours
- Intranasal
- Dose: 5 mg spray (single dose unit)
- Onset: 15 minutes (faster than oral preparations)
XI. Dosing: Eletriptan (Relpax)
- Initial: 20 to 40 mg orally
- May repeat dose in 2 hours
- Maximum: 40 mg/dose or 80 mg/day
XII. Dosing: Almotriptan (Axert)
- Initial: 6.25 to 12.5 mg orally; may repeat in 2 hours
- Maximum: 2 doses in 24 hours
XIII. Dosing: Frovatriptan (Frova)
- Initial dosing: 2.5 mg orally; may repeat in 2 hours
- Maximum dose: 7.5 mg per day
- Consider for longer lasting Migraines (but have delayed onset)
XIV. Adverse Effects: General
- Tingling, Flushing or burning Sensation at injection
- Heavy chest
- Generally benign in low risk populations
- Risk of Coronary Artery Disease exacerbation
- Terrible taste with intranasal preparations
XV. Efficacy: Sumatriptan
- Efficacy dependent on mode of drug delivery
- Subcutaneous effective in 80% of patients
- Intranasal effective in 70% of patients
- Oral effective in 60% of patients
- Oral form does not prevent Migraine recurrence
XVI. 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
XVII. Management: Overdose or Toxicity
- See Triptan Overdose
XVIII. References
Images: Related links to external sites (from Bing)
Related Studies
sumatriptan (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
SUMATRIPTAN 20 MG NASAL SPRAY | Generic | $19.13 each |
SUMATRIPTAN 4 MG/0.5 ML INJECT | Generic | $132.25 per ml |
SUMATRIPTAN 5 MG NASAL SPRAY | Generic | $36.07 each |
SUMATRIPTAN 6 MG/0.5 ML AUTOINJ | Generic | $65.60 per ml |
SUMATRIPTAN 6 MG/0.5 ML CART | Generic | $113.31 per ml |
SUMATRIPTAN 6 MG/0.5 ML INJECT | Generic | $65.02 per ml |
SUMATRIPTAN 6 MG/0.5 ML VIAL | Generic | $16.71 per ml |
SUMATRIPTAN SUCC 100 MG TABLET | Generic | $0.50 each |
SUMATRIPTAN SUCC 25 MG TABLET | Generic | $0.60 each |
SUMATRIPTAN SUCC 50 MG TABLET | Generic | $0.43 each |
SUMATRIPTAN-NAPROXEN 85-500 MG | Generic | $26.51 each |
imitrex (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
IMITREX 100 MG TABLET | Generic | $0.50 each |
IMITREX 20 MG NASAL SPRAY | Generic | $19.13 each |
IMITREX 5 MG NASAL SPRAY | Generic | $36.07 each |
IMITREX 50 MG TABLET | Generic | $0.43 each |
IMITREX 6 MG/0.5 ML CARTRIDGES | Generic | $113.31 per ml |
rizatriptan (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
RIZATRIPTAN 10 MG ODT | Generic | $0.74 each |
RIZATRIPTAN 10 MG TABLET | Generic | $0.45 each |
RIZATRIPTAN 5 MG ODT | Generic | $0.64 each |
RIZATRIPTAN 5 MG TABLET | Generic | $0.55 each |
zolmitriptan (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ZOLMITRIPTAN 2.5 MG ODT | Generic | $4.43 each |
ZOLMITRIPTAN 2.5 MG TABLET | Generic | $1.08 each |
ZOLMITRIPTAN 5 MG NASAL SPRAY | Generic | $72.00 each |
ZOLMITRIPTAN 5 MG ODT | Generic | $3.91 each |
ZOLMITRIPTAN 5 MG TABLET | Generic | $1.46 each |
zomig (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ZOMIG 5 MG NASAL SPRAY | Generic | $72.00 each |
naratriptan (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
NARATRIPTAN HCL 1 MG TABLET | Generic | $1.31 each |
NARATRIPTAN HCL 2.5 MG TABLET | Generic | $1.50 each |
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 |
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 |