Frovatriptan

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Contents

[edit] BRAND NAMES

[edit] STRUCTURE

Frovatriptan.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.

Frovatriptan is a triptan drug. Triptans are 5-HT receptor agonists, they bind with high affinity to 5HT1B and 5HT1D receptors.

The agonist effects of Frovatriptan on these receptors results in extracerebral intracranial blood vessels constriction and in the inhibition of pro-inflammatory neuropeptide release from nerve endings.

Frovatriptan has a uniquely long-half life (26 hours) , five times that of other triptans[1], making it an option for the treatment of menstrual migraine attacks, which are typically longer in duration and more susceptible to relapse than migraine not related to menstruation.[2]

[edit] INDICATIONS

  • Acute treatment of migraine attacks with or without aura in adults.
  • Short-term prevention of menstrual migraine [3]

[edit] DOSAGE

Frovatriptan comes in 2,5 mg tablets. The recommended dose is a single tablet (2.5 mg) taken orally with fluids as early as possible after the onset of migraine.

If the headache recurs after initial relief, a second tablet may be taken, providing there is an interval of at least 2 hours between doses. The total daily dose of frovatriptan should not exceed 3 tablets (7.5 mg per day).

[edit] CONTRAINDICATIONS

  • Ischemic heart disease, coronary artery vasospasm, or other significant underlying cardiovascular 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.
  • Hemiplegic or basilar migraine

[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 Frovatriptan 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 Frovatriptan if occurs
  • Cerebral hemorrhage, subarachnoid hemorrhage, and stroke: Discontinue Frovatriptan 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

  • Pregnancy Category C (US), frovatriptan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • It is not known whether frovatriptan is excreted in human milk. Therefore, caution should be exercised when considering the administration to a nursing woman.

[edit] SIDE EFFECTS

Frovatriptan is generally well tolerated. The most common side effects were: Dizziness, paresthesia, headache, dry mouth, fatigue, flushing, hot or cold sensation and pressure sensation in the chest or throat

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

[edit] RELATED LINKS

[edit] BIBLIOGRAPHY

http://www.endo.com/File%20Library/Products/Prescribing%20Information/FROVA_Prescribing_Information.html

[edit] REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515913/
  2. http://www.internalmedicinenews.com/single-view/frovatriptan-shown-advantageous-in-menstrual-migraine/a982477bb73436f076ce056dd45f869e.html
  3. http://www.ncbi.nlm.nih.gov/pubmed/19811503
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)