Names and pronunciation
(el-ee-trip′tan) Relpax
PDF page 451
Loading InternPractice…
Drug reference
(el-ee-trip′tan) Relpax
PDF page 451
Func. class.: Antimigraine agent, abortive
PDF page 451
Chem. class.: 5-HT1-1B/1D receptor agonist, triptan
PDF page 451
ACTION: Binds selectively to the vas- cular 5-HT1-receptor subtype; causes vasoconstriction in cranial arteries
PDF page 452
USES: Acute treatment of migraine with/without aura
PDF page 452
CONTRAINDICATIONS: Hypersen- sitivity, coronary artery vasospasm, peripheral vascular disease, hemiple- gic/basilar migraine, uncontrolled hypertension; ischemic bowel, heart disease; severe renal/hepatic disease, acute MI, stroke, angina, postmeno- pausal women, men >40 yr; risk fac- tors of CAD, MI, or other cardiac dis- ease; hypercholesterolemia, obesity, diabetes Precautions: Pregnancy, breastfeeding, children, geriatric patients, impaired renal/hepatic function
PDF page 452
SIDE EFFECTS CNS: Dizziness, headache, anxiety, paresthesia, asthenia, somnolence, flushing, fatigue, hot/cold sensation, chills, vertigo, hypertonia, seizures, serotonin syndrome CV: Chest pain, palpitations, hyperten- sion, MI, sinus tachycardia, stroke, ven- tricular fibrillation/tachycardia, atrial fibrillation, AV block, bradycardia, chest pressure syndrome, coronary vasospasm GI: Nausea, dry mouth, vomiting MS: Weakness, back pain RESP: Chest tightness, pressure
PDF page 452
INTERACTIONS Increase: eletriptan effect—CYP3A4 inhibitors (clarithromycin, erythromy- cin, itraconazole, ketoconazole, nelfina- vir, ritonavir), propranolol; avoid use within 72 hr of these products Increase: serotonin syndrome—SSRIs, SNRIs, serotonin-receptor agonists, linezolid, MAOIs, TCAs, methylene blue Increase: vasospastic reactions—ergots, ergot-similar products; avoid use within 24 hr of these products Do not use with other 5-HT antagonists
PDF page 452
DOSAGE AND ROUTES • Adult: PO 20 or 40 mg, may increase if needed, max 40 mg (single dose); may repeat in 2 hr if headache im- proves but returns, max 80 mg/24 hr
PDF page 452
Available forms: Tablets 20, 40 mg
PDF page 452
Administer: • Swallow tablets whole; do not break, crush, or chew; use with 8 oz of water, without regard to food • At beginning of headache; if headache returns, repeat dose after 2 hr if first dose is ineffective; treat no more than 3 headaches per 30 days
PDF page 452
Assess: • Migraine: pain location, character, in- tensity, nausea, vomiting, aura; quiet, calm environment with decreased stimu- lation from noise, bright light, excessive talking • CV: B/P; signs, symptoms of coronary vasospasms, geriatric patients may be at higher risk • Tingling, hot sensation, burning, feel- ing of pressure, numbness, flushing • Stress level, activity, recreation, cop- ing mechanisms • Neurologic status: LOC, blurring vi- sion, nausea, vomiting, tingling in ex- tremities preceding headache • Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, color- ings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches • Patients with CAD risk factors; first dose should be administered in pre- scriber’s office or medical facility • Determine whether CYP3A4 inhibi- tors or other ergot-type products have been given
PDF pages 452, 453
Evaluate: • Therapeutic response: decrease in frequency, severity of migraine
PDF page 453
CLINICAL CONSIDERATIONS
PDF page 452
Patient and caregiver information: • To avoid driving or hazardous activity if dizziness occurs • To report chest pain, neck or jaw pain • To take whole with full glass of water • To take when migraine is starting; a second dose may be used if headache re- turns • To use contraception while taking product; to inform prescriber if pregnant or intending to become pregnant • To provide dark, quiet environment • That product does not prevent or re- duce number of migraine attacks • To use product only short term
PDF page 453
PHARMACOKINETICS Onset of pain relief ½ hr, peak 1½-2 hr, half-life 4 hr, metabolized in the liver, 70% excreted in urine and feces
PDF page 452
• Adult: PO 20 or 40 mg, may increase if needed, max 40 mg (single dose); may repeat in 2 hr if headache im- proves but returns, max 80 mg/24 hr
PDF page 452