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Drug Profile

The information on this site is intended to supplement and enhance, not replace, the advice of a physician who is familiar with your medical history. Decisions about your health should always be made ONLY after detailed conversation with your doctor.

Limited Use [what does this mean?]
Generic drug name: almotriptan (AL moh trip tan)
Brand name(s): AXERT
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: eletriptan (EL eh trip tan)
Brand name(s): RELPAX
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: frovatriptan (FRO vah trip tan)
Brand name(s): FROVA
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: naratriptan (NAR a trip tan)
Brand name(s): AMERGE
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: rizatriptan (RYE za trip tan)
Brand name(s): MAXALT, MAXALT MLT
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: sumatriptan (SOO ma trip tan)
Brand name(s): IMITREX, ONZETRA XSAIL
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: zolmitriptan (ZOLL ma trip tan)
Brand name(s): ZOMIG, ZOMIG ZMT
GENERIC: not available FAMILY: Serotonin Stimulators
Find the drug label by searching at DailyMed.

Pregnancy and Breast-feeding Warnings [top]

Pregnancy Warning

The triptans caused harm to developing fetuses in animal studies, including malformations of bone, blood vessels and kidneys as well as fetal death. Use during pregnancy only for clear medical reasons. Tell your doctor if you are pregnant or thinking of becoming pregnant before you take these drugs.

Two pharmaceutical companies have Pregnancy Registries to monitor fetal outcomes of pregnant women who are taking these drugs:

Merck & Co., Inc: (800) 986-8999
GlaxoSmithKline: (800) 336-2176

Breast-feeding Warning

The triptans have been shown to be excreted in high levels in rat and/or human milk. Because of the potential for serious adverse effects in nursing infants, you should not take these drugs while nursing.

Safety Warnings For This Drug [top]

Warning: Effects on the Heart

The triptans have caused serious effects on the heart, some of which have been fatal. These drugs can cause the vessels of the heart to contract and should not be taken by people with heart disease, including chest pain (angina) and/or history of heart attack.

Facts About This Drug [top]

These drugs belong to the newest family of drugs for migraines called triptans. These drugs are used to relieve migraine headaches, with or without aura, in adults. Triptans are thought to work by narrowing swollen blood vessels in the brain that, when overdilated, cause migraine pain.

Triptans do not prevent or cure migraines, do not reduce frequency of migraines, and are not recommended for migraines described as basilar or hemiplegic. About 25 percent of patients do not respond to any...

These drugs belong to the newest family of drugs for migraines called triptans. These drugs are used to relieve migraine headaches, with or without aura, in adults. Triptans are thought to work by narrowing swollen blood vessels in the brain that, when overdilated, cause migraine pain.

Triptans do not prevent or cure migraines, do not reduce frequency of migraines, and are not recommended for migraines described as basilar or hemiplegic. About 25 percent of patients do not respond to any of the triptans.[1] Triptans should only be used after determining that acetaminophen (TYLENOL), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (MOTRIN, ADVIL) fail to work or cannot be taken due to allergies.

The first triptan to be approved was sumatriptan (IMITREX), first marketed in 1995. Currently, seven triptans are available on the U.S. market. Safety, effectiveness and adverse effects among triptans are similar. Only the injectable form of sumatriptan is also approved to treat cluster headaches.

The main differences among triptans include how fast the drug is absorbed and how long it stays in the body. Generally, the faster a triptan is absorbed, the more quickly it may relieve the migraine but the shorter the time it remains in the body. Injections and nasal sprays are more quickly absorbed. Disintegrating tablets and wafers are convenient, dissolving quickly on the tongue, but are more expensive. Rizatriptan (MAXALT, MAXALT MLT) acts quickly, but migraines may recur not long after.[2] Frovatriptan (FROVA) and naratriptan (AMERGE) do not act as quickly as other triptans but stay longer in the body, so migraines may be less apt to recur.[2]

Drug interactions may differ among triptans.[3]

Older people using frovatriptan may need a lower dose.

Studies say…

In 2005, an article in Prescrire International looked at the use of nasal sumatriptan for adolescents with migraine. The article stated that there was too little benefit and an unfavorable risk-benefit balance in adolescents. According to the article, clinical assessment of sumatriptan in adolescents is inadequate. All trials were placebo controlled. There were no trials comparing sumatriptan with nonspecific analgesics such as acetaminophen and non steroidal anti-inflammatory drugs. [4]

An advantage of sumatriptan is longer clinical experience. The amount of published information available also differs among triptans. This prompted The Lancet, a leading medical journal, to comment that what little information was available about frovatriptan suggested it may be less effective than other triptans.[5]

An article published in Prescrire International on a trial comparing frovatriptan and sumatriptan showed that frovatriptan was less effective than sumatriptan. According to the article, after the first intake and initial relief of pain, frovatriptan did not reduce the frequency of pain recurrence. The article also states that side effects were more frequent with frovatriptan.[6]

Side effects…

Common side effects of triptan include tingling, numbness, tightness in the chest and neck, and a sensation of warmth. Twenty percent of patients treated with triptans experience these chest symptoms.[3] Other common side effects include dizziness, dry mouth, fatigue, nausea and skeletal pain. Generally, higher doses lead to more adverse effects.[2]

Long-term use may affect your eyesight.

Overuse may lead to withdrawal.[7] Overuse may also lead to a condition referred to as medication overuse headache (MOH). A patient with MOH may experience an increase in the frequency of migraine headaches or may experience daily migraine headaches.[8]

See 2012 FDA advisory below.

Serotonin Syndrome with triptans and SSRIs/SNRIs. When triptans are taken in combination with antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs), a condition called serotonin syndrome may result.
Serotonin syndrome develops when the body is exposed to too much of the naturally occurring chemical serotonin. Serotonin is found in the brain, blood and gastrointestinal tract. The combination of triptans, SSRIs and SNRIs can increase serotonin to extremely high levels that could result in serotonin syndrome.

Symptoms of Serotonin Syndrome

  • restlessness
  • hallucinations
  • loss of coordination
  • rapid heartbeat
  • rapid changes in blood pressure
  • increased body temperature
  • overactive reflexes
  • nausea, vomiting and diarrhea[9]

 

Heart Problems. Serious cardiovascular events, including acute myocardial infarction (heart attack), have been reported within a few hours following administration of almotriptan (AXERT).

 

Almotriptan can also cause a spasm-like contraction of blood vessels in the heart; at least one of these events occurred in a patient with no cardiac history and with documented absence of coronary artery disease.

The uncontrolled nature of postmarketing surveillance, however, makes it impossible to definitively determine the proportion of the reported cases that were actually caused by almotriptan or to reliably assess causation in individual cases.[10]

There have also been multiple cases of myocardial infarction (heart attack) reported with the use of sumatriptan.[11]

Patients who frequently use medication to relieve headache pain may develop a condition known as medication overuse headache (MOH). According to a 2004 review published in the medical journal Lancet Neurology,[12] there is substantial evidence that all headache drugs can cause MOH in patients who use these drugs excessively. Narcotic or opioid painkillers that are derivatives of morphine and codeine can cause MOH.[12]

The March 2013 issue of Worst Pills, Best Pills News discussed two recent studies dealing with MOH. In the first study, the treatment for MOH was simple: basic information, tailored to the individual patient, including a discussion with the patient’s doctor both of the role of drugs in developing MOH and the likelihood that stopping painkiller overuse would lead to an improvement. The second study involved a review of MOH treatment guidelines, including evidence concerning the manner in which the previously overused painkillers were discontinued.

Based on the results of both studies, patients should discuss with their doctors the important details of MOH and, depending on their individual case, the type of withdrawal from the MOH-causing drugs that is best for them.[13]

Do not take if…

Liver Problems. Patients with severe liver problems should do not take almotriptan, eletriptan, frovatriptan or naratriptan.[14],[15] Even patients with less severe liver problems should be cautious of taking any triptan.

Kidney Problems. People who have severe kidney problems should not take naratriptan. People on dialysis should be cautious of using rizatriptan or sumatriptan. Patients with moderate or mild kidney problems may be prescribed a lower dose of naratriptan.

High Blood Pressure. People whose high blood pressure is not controlled should not take triptans. Patients whose blood pressure is controlled should be aware that triptans may cause blood pressure to rise.[16]

Phenylketonuria. People with phenylketonuria should not take these rapid forms of rizatriptan and zolmitriptan, as these contain aspartame.

Children. None of the triptans are approved by the FDA for use in children under the age of 18 years.

Regulatory actions surrounding triptans

2006: The Food and Drug Administration (FDA) issued a public health advisory on July 19, 2006, warning consumers about the possibility of life-threatening reactions — such as nausea, changes in blood pressure or hallucinations — that may be caused by the interaction of triptans and certain antidepressants (SSRIs and SNRIs).

2009: In October 2009, the FDA requested that all manufacturers of triptans, SSRIs and SNRIs update their prescribing information to warn of the possibility of serotonin syndrome when triptans and SSRIs or SNRIs are taken together.[17]

2012: In March 2012, the FDA issued an advisory that overuse of actue migraine drugs, including triptans, may lead to an exacerbation of headache known as medication overuse headache (MOH). Patients using these drugs for migraine headaches should be aware of MOH and are advised to keep records of headache frequency. [8]

2013: In October 2013 the FDA issued an advisory that eletriptan and naratriptan are contraindicated in patients with uncontrolled hypertension. There have been reports of increases in blood pressure, including hypertensive crisis, a sudden and severe increase in blood pressure, with acute impairment of organ systems in patients taking these medications. These reports were also noted for patients without a history of hypertension.

Life-threatening or fatal anaphylaxis and anaphylactoid and other severe allergic reactions, including angioedema (swelling of the face, lips and particularly the tongue), have also been reported in patients taking these medications.[18]

Before You Use This Drug [top]

Do not use if you have or have had:

  • coronary artery disease, especially angina, history of a myocardial infarction (heart attack), or ischemia
  • uncontrolled high blood pressure
  • basilar or hemiplagic migraines
  • breast-feeding

Tell your doctor if you have or have had:

  • allergies to other drugs, including aspartame (NutraSweet in zolmitriptan orally disintegrating tablets), or sulfa drugs (almotriptan, eletriptan, naratriptan, sumatriptan)[19]
  • ischemic bowel disease
  • family history of heart disease
  • heart problems (especially angina, coronary artery disease, fast heartbeat, ischemia, myocardial infarction [heart attack], or stroke)
  • high blood pressure
  • kidney problems
  • liver problems
  • peripheral vascular disease
  • phenylketonuria (for zolmitriptan)
  • pregnancy
  • risk factors for heart disease: diabetes, high blood pressure, high cholesterol, overweight, smoking, past menopause, men over 40 years old

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

When You Use This Drug [top]

  • Until you know how you react to this drug, do not drive or perform other activities requiring mental alertness.
  • Avoid alcohol, which aggravates headaches.
  • Avoid smoking.
  • Avoid triggers to your migraine.
  • Do not overuse pain relievers to prevent rebound headaches.
  • Protect yourself from sunlight (including tanning booths) with sunscreen or protective clothing.
  • Tell any doctor, dentist, emergency help, pharmacist, or surgeon you see that you take a triptan.

How to Use This Drug [top]

  • If you have risks for heart disease (such as diabetes, high blood pressure, high cholesterol, overweight, smoking, or family history of heart disease), it is advisable to take your first dose under medical supervision.[20]
  • Use a triptan at onset of a migraine, with or without aura. Do not take for a headache different from your usual migraines; instead, check with your doctor.
  • For regular, oral tablets, swallow dose with a glass of water. If tablets are scored, these may be cut in half. Do not crush or chew tablets. Eating food may delay relief from sumatriptan up to 30 minutes.
  • For oral disintegrating tablets, use dry, clean hands to peel back the foil of blister-pack. Place tablet on the tongue, where it dissolves rapidly. Do not eat, drink, smoke, or chew tobacco while this tablet dissolves. Do not remove disintegrating tablets from blister-pack prior to time needed.
  • For nasal spray, blow your nose to clear nasal passage. Hold head upright. Close one nostril with an index finger. Breathe through your mouth. Hold spray container with your other hand, using your thumb to support the bottle. Hold your other index and middle fingers on either side of the nozzle. Insert the nozzle into your open nostril about one-half inch. Tilt your head back slightly. Close your mouth while taking a breath through your nose, and press on the plunger to release your dose. Avoid contact with eyes. Remove nozzle from your nose. Hold head back for 10 to 20 seconds while breathing in through your nose and breathing out through your mouth. For large doses, you may spray some in each nostril. Clean nozzle, then recap container.
  • For injection, inspect the solution to be sure it is not discolored and has no particles floating in the solution. Wash your hands. Cleanse the injection site. Inject just below the skin (subcutaneously), in the upper thigh or outer upper arm. Do not inject into veins or muscles. An auto-injector syringe is available, which penetrates one-fourth inch below the skin. Be sure to select a site that accommodates this depth.
  • After taking your prescribed dose, lie down in a quiet, dark space if possible. Ice packs or massage on your forehead or temples may help alleviate pain. If you get no relief, do not take another dose. Call your doctor.
  • If you get partial relief, or symptoms return after two hours, you may repeat an additional dose. For frovatriptan and rizatriptan, you may take a third dose if you have inadequate relief from the second dose after another two hours. Do not exceed a total of 30 milligrams of rizatriptan within 24 hours. If you also take propranolol, do not take more than 15 milligrams of rizatriptan within 24 hours. For zolmitriptan you may take doses at two hour intervals as long as you do not exceed a total of 10 milligrams within 24 hours. Do not exceed more than 200 milligrams of oral sumatriptan within 24 hours. Do not inject more than 12 milligrams of sumatriptan injection within one or two days.
  • Do not take double doses of any triptan.
  • Have your blood pressure checked.
  • Generally, if you have more than three migraine headaches within 30 days, avoid using a triptan for additional headaches. For almotriptan, frovatriptan, naratriptan, rizatriptan, or sumatriptan, you may use for up to four migraines within 30 days.
  • Store tablets at controlled room temperature, out of the reach of children. Protect from heat, light, and moisture. Protect injection and nasal spray from light and freezing.

Interactions with Other Drugs [top]

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

Do not take these monoamine oxidase (MAO) inhibitors within 14 days of taking a triptan: ELDEPRYL, furazolidone, FUROXONE, isocarboxazid, MARPLAN, MATULANE, moclobemide, NARDIL, PARNATE, phenelzine, PROCARBAZINE, selegiline, tranylcypromine.

Do not take these drugs within 72 hours of almotriptan or eletriptan: BIAXIN, CALAN, clarithromycin, fluconazole, ISOPTIN, ketoconazole, nefazodone, nelfinavir, NIZORAL, NORVIR, ritonavir, SPORANOX, TAO, troleandomycin, verapamil, VIRACEPT.

Do not take any other triptan within 24 hours of the first triptan you use.

Also, do not take these drugs within 24 hours of taking a triptan: BELLERGAL-S, bromcriptine, cabergoline, CAFERFOT, CAFERGOT-PB, DHE-45, dihydroergotamine, DOSTINEX, ERGOMAR, ergonovine, ERGOSTAT, ergotamine, HYDERGINE, methylergonovine, methylsergide, pergolide, PERMAX, SANSERT, WIGRAINE.

 

The combination of a triptan with these drugs could cause incoordination, increase in reflexes, weakness, a serotonin syndrome, or other complications. Signs of serotonin syndrome include altered consciousness, irritability of the nervous system, shivering, and weakness. Avoid these drugs: CELEXA, citalopram, fluvoxamine, fluoxetine, LUVOX, MELLARIL (with sumatriptan), MERIDIA, paroxetine, PAXIL, PROZAC, sertraline, sibutramine, thioridazine, ZOLOFT.

If you take this drug while on a triptan, your doctor may adjust your doses or prescribe alternative drugs:[21] cimetidine, INDERAL, oral contraceptives (for frovatriptan), propranolol, TAGAMET.

Doses of zolmitriptan should not exceed 5 milligrams per day if you take cimetidine (TAGAMET).[19]

 

Adverse Effects [top]

Call your doctor immediately if you experience (for all):

  • blood pressure increase or decrease
  • difficult, fast, or irregular breathing, or wheezing
  • severe chest pain
  • heaviness, tightness, or pressure in chest, throat, and/or neck
  • sensation of burning, warmth, or heat
  • sensation of numbness, tightness, or tingling
  • irregular or slow heartbeat

In addition, for zolmotriptan:

  • severe abdominal pain, diarrhea
  • loss of appetite
  • nausea
  • fever or chills
  • cough or hoarseness
  • lower back or side pain
  • painful or difficult urination

In addition, for sumatriptan:

  • changes in facial skin color, skin rash, hives, itching
  • swelling of eyes, face, or lips
  • seizures
  • difficulty swallowing

In addition, for almotriptan:

  • discharge from eye, redness of inner lining of eyelid
  • shortness of breath
  • tightness in the throat
  • skin rash
  • difficulty swallowing
  • heartburn
  • eye pain
  • fever
  • abdominal pain
  • irregular or rapid heartbeat
  • rapid breathing
  • diarrhea, nausea, vomiting
  • loss of vision
  • fainting
  • earache

Signs of overdose:

  • slow heartbeat
  • dizziness
  • severe and continuing headache
  • sleepiness
  • fainting
  • vomiting
  • arms or legs appear red
  • blood pressure increases
  • tension in neck
  • chest pain
  • difficult breathing
  • subdued or withdrawn behavior
  • seizures
  • problems with muscle control or coordination
  • lightheadedness
  • paralysis
  • skin appears blue-gray
  • skin sheds at site of injection
  • tension in neck
  • tremors.

If you suspect an overdose, call this number to contact your poison control center: (800) 222-1222.

Call your doctor if these symptoms continue:

  • agitation
  • anxiety
  • unusual tiredness or muscle weakness
  • depression
  • bleeding from ear, eye, nose, or throat
  • clumsiness
  • confusion
  • constipation
  • coughing up mucus
  • depression
  • discomfort in jaw, mouth, tongue, throat, nasal passages, or sinuses
  • dizziness or lightheadedness
  • drowsiness
  • dry mouth
  • buzzing or ringing in ears, hearing loss, or intense sense of hearing
  • dry or painful eyes
  • facial flushing
  • fainting
  • hallucinations
  • shaking or trembling hands or feet
  • headaches other than migraine or aggravation of migraine
  • indigestion, heartburn, belching
  • irritation at injection site (for those triptans that are injected)
  • nasal irritation (for those triptans that are nasal sprays) or discharge
  • difficulty swallowing
  • painful menstruation
  • mood changes
  • muscle or joint aches, cramps, pain, spasms, stiffness, or weakness
  • nausea or vomiting
  • nervousness
  • pain in bone or joints
  • restlessness, feelings of constant movement
  • increase in saliva
  • change in sense of smell
  • increased sensitivity to light and noise, decreased sensitivity to touch
  • burning, painful, or red skin at site of injection
  • skin rash, itching
  • sleeping problems
  • sneezing
  • sore throat
  • sunburn
  • profuse sweating
  • swelling of face, fingers, feet, or lower legs
  • change in sense of taste
  • difficulty talking
  • increased thirst
  • sudden increase in frequency and quantity of urination
  • blurred, doubled, or otherwise changed vision

Periodic Tests[top]

Ask your doctor which of these tests should be done periodically while you are taking this drug:

  • electrocardiogram (ECG or EKG)
  • blood pressure
  • cholesterol
  • creatine
  • gamma glutamyl transpeptidase (GGT)
  • glucose

last reviewed February 28, 2021