ALMOTRIPTAN

ALMOTRIPTAN
(al-mo-trip'tan)
Axert
Classifications: serotonin 5-ht1 receptor agonist;
Therapeutic: antimigraine

Prototype: Sumatriptan
Pregnancy Category: C

Availability

6.25 mg, 12.5 mg tablets

Action

Selective agonist that binds with high affinity to serotonin receptors found on extracerebral and intracranial blood vessels. Due primarily to its effects on 5-HT1D and 5-HT1B serotonin receptors on cranial blood vessels, it causes vasoconstriction and decreases inflammation and neurotransmission.

Therapeutic Effect

Deactivation of the serotonin receptors results in constriction of cranial vessels that become dilated during a migraine attack and reduces signal transmission in the pain pathways.

Uses

Treatment of migraine headache with or without aura.

Contraindications

Hypersensitivity to almotriptan malate. Significant cardiovascular disease such as ischemic heart disease, coronary artery vasospasms, MI, angina, arteriosclerosis, cardiac arrhythmias, diabetes mellitus, colitis, history of cerebrovascular events, or uncontrolled hypertension; stroke, smoking, Wolff-Parkinson-White syndrome, within 24 h of receiving another 5-HT1 agonist or an ergotamine-containing or ergot-type drug; basilar or hemiplegic migraine; pregnancy (category C).

Cautious Use

Significant risk factors for coronary artery disease unless a cardiac evaluation has been done; hypertension; risk factors for cerebrovascular accident; peripheral vascular disease, impaired liver or kidney function, Raynaud's disease, children, elderly, lactation.

Route & Dosage

Migraine Headache
Adult: PO 6.25–12.5 mg. If headache returns, may repeat after at least 2 h (max: 2 tabs/24 h)

Renal Impairment
Clcr <10 mL/min: 6.25 mg (max: 12.5 mg/d)

Hepatic Impairment
6.25 mg (max: 12.5 mg/d)

Administration

Oral
  • Do not give within 24 h of an ergot-containing drug.
  • Administer any time after symptoms of migraine appear.
  • Do not administer a second dose without consulting the physician for any attack during which the FIRST dose did NOT work.
  • Give a second dose if headache was relieved by first dose but symptoms return; however, wait at least 2 h after the first dose before giving a second dose.
  • Do not give more than two doses in 24 h.
  • Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Flushing. CNS: Drowsiness, headache, paresthesia. CV: Palpitations, tachycardia, serious cardiac events (including MI) have been reported within a few hours after administration. GI: Nausea, vomiting, dry mouth.

Interactions

Drug: Dihydroergotamine, methysergide, other 5-ht1 agonists may cause prolonged vasospastic reactions; ssris, sibutramine have rarely caused weakness, hyperreflexia, and incoordination; maois should not be used with 5-ht1 agonists.

Pharmacokinetics

Absorption: Well absorbed, 70% reaches systemic circulation. Peak: 1–3 h. Distribution: 35% protein bound. Metabolism: 27% metabolized by monoamine oxidase. Elimination: 75% renally, 13% in feces. Half-Life: 3–4 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor cardiovascular status carefully following first dose in patients at relatively high risk for coronary artery disease (e.g., postmenopausal women, men over 40 years old, persons with known CAD risk factors) or who have coronary artery vasospasms.
  • Report to physician immediately chest pain or tightness in chest or throat that is severe or does not quickly resolve following a dose of almotriptan.
  • Pain relief usually begins within 10 min of ingestion, with complete relief in approximately 65% of all patients within 2 h.
  • Monitor BP, especially in those being treated for hypertension.

Patient & Family Education

  • Review patient information leaflet provided by the manufacturer carefully.
  • Notify physician immediately if symptoms of severe angina (e.g., severe or persistent pain or tightness in chest, back, neck, or throat) or hypersensitivity (e.g., wheezing, facial swelling, skin rash, or hives) occur.
  • Do not take any other serotonin receptor agonist (e.g., Imitrex, Maxalt, Zomig, Amerge) within 24 h of taking almotriptan.
  • Advise physician of any drugs taken within 1 wk of beginning almotriptan.
  • Check with physician regarding drug interactions before taking any new OTC or prescription drugs.
  • Report any other adverse effects (e.g., tingling, flushing, dizziness) at next physician visit.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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© 2006-2017 medpill.info Last Updated On: 09/15/2017 (0.01)
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