frovatriptan succinate


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frovatriptan succinate

Frova, Migard (UK)

Pharmacologic class: Serotonin 5-hydroxytryptamine (5-HT)1-receptor agonist

Therapeutic class: Antimigraine agent

Pregnancy risk category C

Action

Binds selectively to serotonin receptors on cranial arteries, causing vasoconstriction and decreased blood flow

Availability

Tablets: 2.5 mg

Indications and dosages

Acute migraine

Adults: 2.5 mg P.O. as a single dose at first symptom of migraine. If migraine returns, may repeat after 2 hours. Maximum of three doses in 24 hours (7.5 mg/day).

Contraindications

• Hypersensitivity to drug or its components
• Cerebrovascular disorders
• Ischemic heart disease or history of myocardial infarction
• Uncontrolled hypertension
• Peripheral vascular disease
• Hemiplegic or basilar migraine
• Within 24 hours of another 5-HT1-receptor agonist or ergotamine-containing or ergot-type drug

Precautions

Use cautiously in:
• patients receiving selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Give one tablet with plenty of fluids at first symptom of migraine.
• If headache returns, administer another tablet after 2 hours.
• Don't exceed three tablets in 24-hour period.
• Give first dose under close supervision if patient has coronary artery disease or other risk factors.
• Don't give within 24 hours of another 5-HT1-receptor agonist or ergotamine-containing or ergot-type drug.

Adverse reactions

CNS: dizziness, headache, anxiety, malaise, fatigue, weakness, drowsiness, paresthesia, sensation loss

CV: palpitations, tightness in chest, myocardial infarction (MI)

EENT: abnormal vision, tinnitus, rhinitis

GI: nausea, diarrhea, dyspepsia, abdominal pain

Musculoskeletal: skeletal or muscle pain

Skin: flushing, diaphoresis, photosensitivity

Other: altered taste, hot or cold sensations

Interactions

Drug-drug.Ergot alkaloids, other serotonin 5-HT1-receptor agonists: prolonged vasoactive reactions

Hormonal contraceptives, propranolol: increased frovatriptan bioavailability

SSRIs, SNRIs: serotonin syndrome (including mental status changes, hyperreflexia, nausea, vomiting)

Drug-behaviors.Sun exposure: increased risk of photosensitivity

Patient monitoring

• Assess for cardiovascular reactions, especially signs and symptoms of MI.
• Monitor neurologic status, particularly for indications of cerebrovascular accident.
• Check for rash and itching.

Patient teaching

• Instruct patient to take one tablet with plenty of fluids at first symptom of migraine.
• Tell patient he may take second tablet 2 hours after first if migraine returns.

Advise patient to immediately report chest pain.
• Caution 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 and behaviors mentioned above.

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