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Pharmacologic class: Selective 5-hydroxytryptamine1 (5-HT1) agonist
Therapeutic class: Vascular headache suppressant, antimigraine drug
Pregnancy risk category C
Binds with specific 5-HT1 receptors in intracranial blood vessels and sensory trigeminal nerves, leading to vasoconstriction and migraine relief
Tablets: 1 mg, 2.5 mg
Indications and dosages
➣ Migraine headache
Adults: 1 or 2.5 mg P.O. as single dose; may repeat in 4 hours. Don't exceed 5 mg in 24 hours; don't use to treat more than four headaches per month.
• Mild to moderate renal or hepatic impairment
• Hypersensitivity to drug or its components
• Hemiplegic or basilar headaches
• Severe renal, cardiovascular or hepatic impairment
• History of cerebrovascular or peripheral vascular conditions
• Ischemic bowel disease
• Uncontrolled hypertension
• Use of ergot-type drugs (such as dihydroergotamine) and other 5-HT1 agonists within 24 hours
• MAO inhibitor use within past 14 days
Use cautiously in:
• mild to moderate renal or hepatic impairment, cardiovascular risk factors
• elderly patients (not recommended)
• pregnant or breastfeeding patients
• children (safety not established).
• Know that drug does not prevent migraine.
• Give only if patient's cardiovascular status has been evaluated and determined to be safe, and if first dose can be given under supervision.
CNS: dizziness, drowsiness, malaise, fatigue, paresthesia, cerebral hemorrhage, subarachnoid hemorrhage, stroke, other cerebrovascular events
CV: significant blood pressure elevation including hypertensive crisis (rare), coronary artery vasospasm, myocardial infarction, ventricular fibrillation or tachycardia
GI: nausea, vomiting, colonic ischemia with abdominal pain, bloody diarrhea
Other: pain or pressure sensation in throat or neck, peripheral vascular ischemia, serotonin syndrome, hypersensitivity including anaphylaxis or anaphylactoid reactions
Drug-drug. Ergot-type compounds (dihydroergotamine, methysergide): prolonged vasospastic reaction
Hormonal contraceptives: increased naratriptan blood level and effects
MAO inhibitors: increased systemic exposure to naratriptan, increased risk of adverse reactions
Selective serotonin reuptake inhibitors: weakness, hyperreflexia, incoordination Sibutramine: serotonin syndrome
Drug-herbs. S-adenosylmethionine (SAM-e), St. John's wort: increased risk of adverse serotonergic effects
Drug-behaviors. Cigarette smoking: increased naratriptan metabolism
• Maintain especially close monitoring in patients with cardiovascular risk factors (such as hypertension, hypercholesterolemia, obesity, diabetes mellitus, cigarette smoking, strong family history), postmenopausal women, and men older than age 40.
• Assess vital signs and ECG.
• Monitor neurologic status closely. Institute safety measures as needed to prevent injury.
Discontinue drug if serotonin syndrome is suspected.
• Tell patient to take at first sign of headache.
• Advise patient to take second dose (if approved) at least 4 hours after first dose if headache has not gone away completely or has returned.
• Caution patient not to take more than two tablets in a 24-hour period.
Instruct patient how to recognize and immediately report signs and symptoms of stroke and other neurologic conditions, serotonin syndrome, hypersensitivity, or bloody diarrhea.
• Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient to avoid cigarette smoking and to discuss herb use with prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.