almotriptan malate

almotriptan malate

Axert

Pharmacologic class: Serotonin (5-hydroxytryptamine [5-HT]) receptor agonist

Therapeutic class: Vascular headache suppressant, antimigraine drug

Pregnancy risk category C

Action

Promotes vascular constriction and relieves migraine by stimulating specific 5-HT receptors in intracranial blood vessels and sensory trigeminal nerves

Availability

Tablets: 6.25 mg, 12.5 mg

⊘Indications and dosages

➣ Acute migraine

Adults: Single dose of 6.25 to 12.5 mg P.O. at first sign or symptom of migraine; may be repeated after 2 hours. Don't exceed two doses in a 24-hour period.

Contraindications

• Hypersensitivity to drug
• Ischemic heart disease, myocardial infarction (MI), cerebrovascular accident, uncontrolled hypertension
• Ischemic bowel disease
• Basilar or hemiplegic migraine
• MAO inhibitor use in past 14 days
• Use of other 5-HT agonists or ergotamine-containing or ergot-type drugs within past 24 hours

Precautions

Use cautiously in:
• impaired renal or hepatic function
• cardiovascular risk factors
• pregnant or breastfeeding patients
• children younger than age 18 (use not recommended).

Administration

• Give with or without food.
• Wait at least 2 hours after initial dose before giving repeat dose.
• Don't exceed two doses in 24 hours.
☞ Don't give within 14 days of MAO inhibitors or within 24 hours of other 5-HT agonists or ergotamine-containing or ergot-type drugs.

Route	Onset	Peak	Duration
P.O.	Variable	1-3 hr	Unknown

Adverse reactions

CNS: headache, anxiety, dizziness, fatigue, malaise, weakness, cold or hot sensations, sedation, numbness, burning or tingling sensations

CV: blood pressure changes, palpitations, tachycardia, coronary artery vasospasm, MI, ventricular fibrillation, ventricular tachycardia

EENT: vision changes; nasal, throat, and mouth discomfort

GI: nausea, abdominal distress, dysphagia, dry mouth

Musculoskeletal: weakness, stiff neck, muscle pain

Respiratory: chest tightness or pressure

Skin: sweating, flushing

Interactions

Drug-drug. CYP2D6 inhibitors (erythromycin, itraconazole, ritonavir): increased almotriptan effect

Ergot derivatives, other 5-HT agonists: prolonged vasoactive action

Ketoconazole and other CYP3A inhibitors: increased almotriptan blood level, leading to toxicity

MAO inhibitors: decreased almotriptan absorption

Selective serotonin reuptake inhibitors: weakness, hyperreflexia, poor coordination

Patient monitoring

• Assess patient's cardiovascular status, noting chest tightness or pressure.
• Monitor vital signs.

Patient teaching

☞ Tell patient to immediately report chest tightness or pressure.
• Inform patient that he may take drug with or without food.
• If second dose is needed, tell patient to take it at least 2 hours after first.
• Caution patient not to take more than two doses in 24 hours.
• Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.