Names and pronunciation
(froh-vah-trip′tan) Frova
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Drug reference
(froh-vah-trip′tan) Frova
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Func. class.: Antimigraine agent F
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Chem. class.: 5-HT1-Receptor agonist
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ACTION: Binds selectively to the vas- cular 5-HT1B, 5-HT1D receptor subtypes; exerts antimigraine effect; binds to ben- zodiazepine receptor sites, causes vaso- constriction in cranium
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USES: Acute treatment of migraine with/without aura
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CONTRAINDICATIONS: Hyper- sensitivity, angina pectoris, history of MI, documented silent ischemia, Prinzmet- al’s angina, ischemic heart disease; con- current ergotamine-containing prepara- tions; uncontrolled hypertension; basilar or hemiplegic migraine; ischemic bowel disease; peripheral vascular disease, severe hepatic disease, prophylactic migraine treatment Precautions: Pregnancy, breastfeeding, children, geriatric patients, postmeno- pausal women, men >40 yr, risk factors for CAD, hypercholesterolemia, obesity, diabetes, impaired hepatic function, sei- zure disorder
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SIDE EFFECTS CNS: Hot/cold sensation, paresthesia, dizziness, headache, fatigue, insomnia, anxiety, somnolence, seizures CV: Flushing, chest pain, palpitation, coronary artery vasospasm, MI, myocar- dial ischemia, ventricular tachycardia, ventricular fibrillation GI: Dry mouth, dyspepsia, abdominal pain, diarrhea, vomiting, nausea MS: Skeletal pain
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INTERACTIONS Increase: frovatriptan levels—CYP1A2 inhibitors (cimetidine, ciprofloxacin, erythromycin), estrogen, propranolol, hormonal contraceptives Increase: toxicity—SSRIs, other sero- tonin agonists (dextromethorphan, MAOIs, antidepressants)
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DOSAGE AND ROUTES • Adult: PO 2.5 mg; a 2nd dose may be taken after ≥2 hr; max 3 tabs (7.5 mg/ day) Available form: Tabs 2.5 mg
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Administer: • Swallow tabs whole; do not break, crush, or chew • With fluids • 2 days/wk or less; rebound headache may occur
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Assess: • Migraine symptoms: aura, unable to view light; ingestion of tyramine-contain- ing foods (pickled products, beer, wine, aged cheese), food additives, preserva- tives, colorings, artificial sweeteners, chocolate, caffeine, which may precipi- tate these types of headaches • Serious cardiac reactions: may occur within a few hours of taking a 5-HT1 agent; dysrhythmias, ventricular tachycar- dia, ventricular fibrillation leading to death • B/P; signs, symptoms of coronary vaso- spasms • For stress level, activity, recreation, coping mechanisms • Quiet, calm environment with de- creased stimulation from noise, bright light, excessive talking • Serotonin syndrome: agitation, confu- sion, diaphoresis, increased B/P, nausea, vomiting, diarrhea; product should be dis- continued • Pregnancy/breastfeeding: use only if benefit outweighs fetal risk; do not breastfeed, excretion unknown
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Evaluate: • Therapeutic response: decrease in fre- quency, severity of migraine
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report any side effects to pre- scriber • To inform prescriber if pregnant or planning to become pregnant • To consult prescriber if breastfeeding • Serious cardiac reactions: to report immediately pain, chest tightness • Serotonin syndrome: to report agita- tion, confusion, sweating, nausea, vomit- ing, diarrhea • Short-term use only: That abortive migraine agents used >10 days/mo may lead to a worsening of headaches, medi- cation overuse HIGH ALERT
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PHARMACOKINETICS Onset of pain relief 2-3 hr, terminal half- life 25-29 hr, protein binding 15%, metabolized in liver by CYP1A2
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• Adult: PO 2.5 mg; a 2nd dose may be taken after ≥2 hr; max 3 tabs (7.5 mg/ day) Available form: Tabs 2.5 mg
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