Names and pronunciation
(al-moh-trip′tan)
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Drug reference
(al-moh-trip′tan)
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Func. class.: Antimigraine agent, abortive
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Chem. class.: 5-HT1-receptor agonist, triptan
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ACTION: Binds selectively to the vas- cular 5-HT1B/1D/1F-receptors, exerts anti- migraine effect
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USES: Acute treatment of migraine with or without aura (adult/adolescent/ child ≥12 yr)
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CONTRAINDICATIONS: Hyper- sensitivity, acute MI, angina, CV disease, CAD, stroke, vasospastic angina, ischemic heart disease or risk for, peripheral vas- cular syndrome, uncontrolled hyperten- sion, basilar or hemiplegic migraine Precautions: Pregnancy, postmenopausal women, men >40 yr, breastfeeding, chil- dren <18 yr, geriatric patients, risk factors for CAD, MI; hypercholesterolemia, obesity, diabetes, impaired renal/hepatic function, sulfonamide hypersensitivity, cardiac dys- rhythmias, Raynaud’s disease, tobacco smoking, Wolff-Parkinson-White syndrome
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SIDE EFFECTS CNS: Dizziness, headache, seizures, paresthesias CV: Coronary artery vasospasm, MI, ven- tricular fibrillation, ventricular tachycardia GI: Nausea, xerostomia INTEG: Sweating, rash
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INTERACTIONS Increase: serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, sibutra mine Increase: vasospastic effects—ergot, ergot derivatives, other 5-HT1 agonists; avoid concurrent use Increase: almotriptan effect—MAOIs; do not use together Increase: plasma concentration of almotriptan—(CYP3A4 inhibitors) itra- conazole, ritonavir, erythromycin, keto- conazole; avoid concurrent use in renal/ hepatic disease Drug/Herb • Avoid use with feverfew Increase: serotonin syndrome—St. John’s wort
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DOSAGE AND ROUTES • Adult, adolescent, and child ≥12 yr: PO 6.25 or 12.5 mg; may repeat dose after 2 hr; max 2 doses/24 hr or 4 treat- ment cycles within any 30-day period; max of 25 mg/day Hepatic/renal dose • Adult: PO (CCr 10-30 mL/min) 6.25 mg initially, max 12.5 mg
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Available forms: Tablets 6.25, 12.5 mg
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Administer: • Avoid using more than 2×/24 hr; re- bound headache may occur • Swallow tablets whole; do not break, crush, chew tablets, without regard to food
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Assess: • Migraine: pain location, aura, dura- tion, intensity, nausea, vomiting; quiet, calm environment with decreased stimu- lation from noise, bright light, excessive talking • Serotonin syndrome: in those taking SSRIs, SNRIs; agitation, confusion, hallu- cinations, diaphoresis, hypertension, diar- rhea, fever, tremors; usually occurs when dose is increased • B/P; signs/symptoms of coronary va- sospasms • For stress level, activity, recreation, coping mechanisms • Neurologic status: LOC, blurring vi- sion, nausea, vomiting, tingling, hot sensation, burning, feeling of pres- sure, numbness, flushing preceding headache • Tyramine foods (pickled products, beer, wine, aged cheese), food addi- tives, preservatives, colorings, artifi- cial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
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Evaluate: • Therapeutic response: decrease in se- verity of migraine
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report chest pain, drowsiness, diz- ziness, tingling, flushing • To notify prescriber if pregnancy is planned or suspected; to avoid breast- feeding • That if 1 dose does not relieve mi- graine, to take another after 2 hr, max 4 treatment cycles in 30 days; do not take MAOIs for ≥24 hr • That product does not prevent or re- duce number of migraine attacks; use to relieve attack only • Serotonin syndrome: To report imme diately signs of serotonin syndrome • To report immediately chest tightness or pain • Not to drive or operate machinery until reaction is known, drowsiness, dizziness may occur • To inform all health care professionals of all OTC, Rx, herbals, supplements taken HIGH ALERT
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PHARMACOKINETICS Onset of pain relief 2 hr; peak 1-3 hr; duration 3-4 hr; bioavailability 70%; pro- tein binding 35%; metabolized in the liver (metabolite), metabolized by MAO- A, CYP2D6, CYP3A4; excreted in urine (40%), feces (13%); half-life 3-4 hr
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• Adult, adolescent, and child ≥12 yr: PO 6.25 or 12.5 mg; may repeat dose after 2 hr; max 2 doses/24 hr or 4 treat- ment cycles within any 30-day period; max of 25 mg/day Hepatic/renal dose
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• Adult: PO (CCr 10-30 mL/min) 6.25 mg initially, max 12.5 mg
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