Antimigraine

During a migraine headache attack, changes in brain activity induce inflammation of blood vessels and nerves in the head. Attacks may be triggered by alcohol, certain foods, too much or too little sleep, menstruation, emotional stress, or environmental factors.

Eletriptan should not be used in patients with severe hepatic or severe renal impairment. Blood pressure effects of eletriptan are increased in renal impairment and therefore the dose should be reduced in patients with mild to moderate renal impairment. No dosage adjustment is needed in mild or moderate hepatic impairment.

Slightly soluble in water and in methyl alcohol; practically insoluble in chloroform and in ether. A 0.2% solution in water has a pH of 3.7 to 4.7. Store at a temperature of 2° to 8°.

This post reviews the management of headache, in particular migraine and cluster headache, and the drugs used mainly for their treatment. The mechanisms of head pain or headache are not fully understood but may involve neurovascular changes (as in migraine and cluster headache), muscle contraction (tension headache), nerve lesions (neuralgias), direct head injury, infection (meningitis), or referred pain (sinusitis, toothache, eye disorders).

Almotriptan should not be used in patients with severe hepatic impairment since clearance is likely to be markedly impaired, and should be given with caution, and in reduced doses, to patients with mild to moderate hepatic impairment. The dose of almotriptan should also be reduced in patients with severe renal impairment.

Frovatriptan should not be used in patients with severe hepatic impairment. No dosage adjustment is needed in mild or moderate hepatic impairment. After oral doses, peak plasma-frovatriptan concentrations are attained in 2 to 4 hours, and bioavailability is about 20% in men and 30% in women.

Toxic epidermal necrolysis has also been reported with rizatriptan. Rizatriptan should not be used in patients with severe hepatic or renal impairment and should be given with caution to patients with mild or moderate hepatic or renal impairment. After oral doses, peak plasma-rizatriptan concentrations are obtained in about 1 to 1.5 hours or 1.6 to 2.5 hours depending on the formulation.

A white or slightly yellowish-white, odourless or almost odourless, crystalline powder. Very slightly soluble in water; slightly soluble in alcohol and in chloroform; sparingly soluble in methyl alcohol.

Zolmitriptan should also be avoided in patients with Wolff-Parkinson-White syndrome or arrhythmias associated with accessory cardiac conduction pathways. It should be given with caution in patients with moderate to severe hepatic impairment.

It may contain 2 molecules of methanol of crystallisation. Aqueous solutions slowly become cloudy owing to hydrolysis; this may be prevented by the addition of tartaric acid.

A white to pale yellow powder. Very slightly soluble in water. A white to pale yellow powder.

Store in airtight containers at a temperature not exceeding 30°. Naratriptan should not be used in patients with severe hepatic or renal impairment (creatinine clearance less than 15 mL/minute) and should be used with caution in mild or moderate renal or hepatic impairment.