Migraine and Cluster Headache Medications (cont.)
Joseph Carcione Jr, DO, MBA
Francisco Talavera, PharmD, PhD
Types of drugs in this class include almotriptan (Axert, Almogran), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge, Naramig), rizatriptan (Maxalt, Maxalt-MLT), sumatriptan (Imitrex, Imitrex Nasal, Imigran), and zolmitriptan (Zomig, Zomig-ZMT, Zomig Nasal).
- How triptans work: Triptans are used to treat migraine or cluster headaches once they occur. Triptans stimulate serotonin (a chemical needed to transmit various nerve signals to the brain), decrease inflammation, and reverse blood vessel dilation (expansion) around the brain, thereby relieving the migraine or cluster headache symptoms.
Some of the newer triptans, such as eletriptan (Relpax), rizatriptan (Maxalt), and zolmitriptan (Zomig), are considered more selective for the specific serotonin receptor (5-HT1D) than older triptans. The increased affinity for 5-HT1D may result in decreased toxicity.
- Who should not use these medications - Individuals with the following conditions should not use triptans:
- Use: Triptans are available in a variety of dosage forms designed to be swallowed, dissolved in the mouth, injected under the skin, or sprayed up the nose.
- Drug or food interactions
- Do not use triptans within 24 hours of taking ergot alkaloids such as methysergide (Sansert) or dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray), because excessive constriction (narrowing) of the blood vessels may occur.
- Do not use triptans with other drugs that affect serotonin, such as fluoxetine (Prozac), paroxetine (Paxil), and St. John’s wort.
- Do not use triptans within 2 weeks of taking a monoamine oxidase inhibitor (MAOI), such as phenelzine [Nardil]).
- Side effects: Triptans may increase the risk of chest pain, stroke, abnormal heart rhythms, or heart attack in susceptible individuals (see previous warnings regarding who should not use these medications). These drugs commonly cause a sensation of pressure or heaviness in various parts of the body, particularly the head, and may induce migraine headaches if overused or the dose is increased. Triptans may cause a bad or unusual taste in mouth, and the nasal spray may cause nose and throat irritation.
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