Almotriptan

Indications

Almotriptan is used for: Migraine headache, Acute migraine attacks

Adult Dose

Oral Acute migraine attacks Adult: Initially, 6.25-12.5 mg. May repeat 2 hr later if needed. Max: 2 doses/24 hr. Hepatic Impairment Initially, 6.25 mg as a single dose. Max: 12.5 mg/24 hr. Avoid in severe impairment.

Child Dose

Oral Child: Migraine Indicated for acute treatment of migraine headache pain in adolescents with a history of migraine attacks with or without aura usually lasting >4 hr (when untreated) <12 years: Safety and efficacy not established >12 years: 6.25-12.5 mg PO at onset of headache; may repeat once after 2 hr Not to exceed 25 mg/day

Renal Dose

Renal Impairment Initially, 6.25 mg as a single dose. Max: 12.5 mg/24 hr.

Administration

May be taken with or without food.

Contra Indications

Underlying CV disease e.g. ischaemic heart disease or coronary artery vasospasm. Uncontrolled hypertension. Severe hepatic or renal impairment. Prophylaxis of migraine, hemiplegic or basilar migraine; cluster headache. Use within 24 hr of another 5-HT1 agonist; use within 24 hr of ergotamine derivative; concurrent use or within 2 wk of discontinuing an MAOI.

Precautions

Hypersensitivity to sulfonamides. Hepatic or moderate-severe renal impairment. Caution when used in patients with a history of seizures. May significantly increase BP. May cause drowsiness. Children <18 yr. Pregnancy, lactation. Lactation: excretion in milk unknown; use with caution

Pregnancy-Lactation

Pregnancy Category: C Lactation: excretion in milk unknown; use with caution

Interactions

Increased risk of serotonin syndrome when used with SSRIs or serotonin norepinephrine reuptake inhibitors. Increased plasma concentrations when used with verapamil, ketoconazole or other potent CYP450 inhibitors. Potentially Fatal: Severe vasospastic reactions may occur when given within 24 hr of treatment with another 5-HT1 agonist, or an ergotamine-containing or ergot-like medication. Avoid usage with or within 2 wk of stopping treatment with a MAOI.

Adverse Effects

Side effects of Almotriptan : 1-10% Somnolence (1-5%), Dizziness (3-4%), Nausea (1-3%), Vomiting (2%), Dry mouth (1-2%), Headache (1-2%), Nausea (1-2%), Paresthesia (1-2%), Paresthesia (1%), Somnolence (>1%) <1% Infrequent (0.01-0.001%) Anxiety, asthenia, chills, CNS stimulation, fatigue, hypesthesia, tremor, Pruitus, rash, Diaphoresis, dysmenorrhea, hyperglycemia, increased thirst, Abdominal cramp, gastroenteritis Back pain, myalgia, neck pain, rigid neck, Increased CPK, Bronchitis, chest pain, dyspnea, pharyngitis, rhinitis, sinusitis, Conjunctivitis, tinnitis, vertigo Potentially Fatal: Serious cardiac events.

Mechanism of Action

Almotriptan is a selective serotonin agonist which acts mainly on the 5-HT1 receptors and produces cranial vasodilation. It is used for the acute treatment of migraine.