FROVATRIPTAN

FROVATRIPTAN
(fro-va-trip'tan)
Frova
Classifications: serotonin 5-ht1 receptor agonist;
Therapeutic:antimigraine
; 5-ht1 receptor agonist
Prototype: Sumatriptan
Pregnancy Category: C

Availability

2.5 mg tablets

Action

Selective agonist that binds with high affinity to 5-HT1D, 5-HT1B, 5-HT1F serotonin receptors which are found on extracerebral and intracranial blood vessels, and on other structures in the central nervous system. This results in vasoconstriction and agonist effects on nerve terminals in trigeminal system.

Therapeutic Effect

Activation of 5-HT1 receptors results in constriction of cranial vessels which become dilated during a migraine attack, inhibition of neuropeptide release, and reduced signal transmission in the pain pathways.

Uses

Treatment of migraine headache with or without aura.

Contraindications

Hypersensitivity to frovatriptan; significant cardiovascular disease such as ischemic heart disease, coronary artery vasospasms, peripheral vascular disease, history of cerebrovascular events, or uncontrolled hypertension; within 24 h of receiving another 5-HT1 agonist or an ergotamine-containing or ergot-type drug; basilar or hemiplegic migraine, pregnancy (category C). Safety and efficacy in children <18 y are not established.

Cautious Use

Significant risk factors for coronary artery disease unless a cardiac evaluation has been done; hypertension; risk factors for cerebrovascular accident; impaired liver or kidney function; lactation.

Route & Dosage

Migraine Headache
Adult: PO 2.5 mg. If headache returns, may repeat after at least 2 h (max: 7.5 mg/24 h).

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: Fatigue, hot or cold sensation, flushing. CNS: Dizziness, headache, paresthesia, somnolence, insomnia, anxiety. CV: Chest pain, palpitation. GI: Dyspepsia, nausea, vomiting, diarrhea, dry mouth. Musculoskeletal: Skeletal pain. Special Senses: Abnormal vision. Skin: Sweating.

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. Herbal: Gingko, ginseng, echinacea, St. John's wort may increase triptan toxicity.

Pharmacokinetics

Absorption: 20–30% bioavailability. Peak: 2–4 h. Distribution: 15% protein bound. Metabolism: In liver by CYP1A2. Elimination: 30% renally, 60% in feces. Half-Life: 26 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 frovatriptan.
  • 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, itching, or hives) occur.
  • Do not take any other serotonin receptor agonist (e.g., Imitrex, Maxalt, Zomig, Amerge) within 24 h of taking frovatriptan.
  • Advise physician of any drugs taken within 1 wk of beginning frovatriptan.
  • 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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