Almotriptan

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[edit] BRAND NAMES

[edit] STRUCTURE

Almotriptan.jpg

[edit] MECHANISM OF ACTION

Theories on the etiology of migraine headache suggest that symptoms are due to local cranial vasodilatation and/or to the release of vasoactive and pro-inflammatory peptides from sensory nerve endings in an activated trigeminal system.

Almotriptan is a triptan drug. Triptans, all bind with high affinity to three serotonin (5-HT) subtypes, the 5HT1B, 5HT1D and 5HT1F. The agonist effects of Almotriptan on these receptors results in extracerebral intracranial blood vessels constriction and in the inhibition of pro-inflammatory neuropeptide release from nerve endings.

[edit] INDICATIONS

  • Acute treatment of migraine attacks with or without aura in Adults
  • In the US Almotriptan is approved for the acute treatment of migraine headache pain with or without aura in adolescents age 12 to 17 years who have migraine attacks usually lasting 4 hours or more.

Almotriptan should not be used for migraine prophylaxis.

[edit] DOSAGE

  • Adults: 6.25-12.5 mg as early as possible after the onset of migraine, may repeat after 2 hours if headache returns. Maximum daily dose 25 mg
  • Adolescents age 12 to 17 years (approved in US) : 6.25-12.5 mg as early as possible after the onset of migraine, may repeat after 2 hours if headache returns. Maximum daily dose 25 mg
  • Hepatic impairment: starting dose is 6.25 mg, maximum daily dose is 12.5 mg.

[edit] CONTRAINDICATIONS

  • Ischemic heart disease (Triptans can produce a small contraction of human coronary arteries)
  • Cerebrovascular syndromes (e.g. history of stroke or transient ischaemic attack)
  • Peripheral Vascular Disease (including ischemic bowel disease)
  • Uncontrolled hypertension
  • Concomitant administration within 24 hours of an ergotamine derivative or another triptan.
  • Severe hepatic impairment

[edit] WARNINGS AND PRECAUTIONS

  • Perform cardiac evaluation in patients with multiple cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, smoker, obesity, diabetes, strong family history of coronary artery disease (CAD), female with surgical or physiological menopause, male over 40 years of age).
  • In case of chest discomfort, including pain, pressure, heaviness and tightness following Almotriptan administration, patients should be evaluated for the presence of Coronary artery disease (CAD) or a predisposition to Prinzmetal variant angina before receiving additional doses.
  • Arrhythmias: Discontinue Almotriptan if occurs
  • Cerebral hemorrhage, subarachnoid hemorrhage, and stroke: Discontinue Almotriptan if occurs
  • Medication overuse headache: Overuse of acute migraine drugs for 10 or more days per month may lead to exacerbation of headache. Medication overuse headache may present as migraine-like daily headaches or as a marked increase in frequency of migraine attacks. Detoxification of patients, including withdrawal of the overused drugs, and treatment of withdrawal symptoms (which often include a transient worsening of headache) may be necessary.

[edit] INTERACTIONS

[edit] PREGNANCY AND LACTATION

[edit] SIDE EFFECTS

Common adverse reactions are: Dry mouth, paresthesia, dizziness, somnolence, nausea, vomiting and fatigue

Almotriptan may cause mild, transient increases in blood pressure.

In very rare cases, coronary vasospasm and myocardial infarction have been reported.

[edit] RELATED LINKS

Axert PRESCRIBING INFORMATION

[edit] BIBLIOGRAPHY

[edit] REFERENCES

Antimigraine preparations
5 HT1 agonists (Triptans) Almotriptan (Almogran, Axert)   Eletriptan (Relpax)   Frovatriptan (Frova, Migard, Menatriptan)   Rizatriptan (Maxalt)   Sumatriptan (Imigran)   Zolmitriptan (Zomig)
Ergot alkaloids Dihydroergotamine   Ergotamine
NSAIDs/ Analgesics Indometacin   Acetylsalicylic acid (Aspirin)   Diclofenac (Voltaren)   Ibuprofen (Advil, Brufen, Dolgit, Nurofen)   Ketorolac (Toradol)   Naproxen (Naprosyn, Aleve)   Nimesulide   Paracetamol (Efferalgan, Panadol...)
Prophylaxis Cinnarizine (Stugeron, Stugeron forte)   Flunarizine (Sibelium)   Nifedipine (Adalat)   Pizotifen   Propranolol (Inderal)   Topiramate (Topamax)