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Pharmacologic class: Serotonin (5-hydroxytryptamine [5-HT]) receptor agonist
Therapeutic class: Vascular headache suppressant, antimigraine drug
Pregnancy risk category C
Promotes vascular constriction and relieves migraine by stimulating specific 5-HT receptors in intracranial blood vessels and sensory trigeminal nerves
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.
• Severe renal or hepatic impairment
• Hypersensitivity to drug
• Ischemic heart disease, history of myocardial infarction (MI), documented silent ischemia, symptoms or findings consistent with ischemic heart disease, cerebrovascular accident, uncontrolled hypertension, coronary artery vasospasm
• 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
Use cautiously in:
• impaired renal or hepatic function
• cardiovascular risk factors
• pregnant or breastfeeding patients
• children younger than age 18 (use not recommended).
• 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.
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
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
• Assess patient's cardiovascular status, noting chest tightness or pressure.
• Monitor vital signs.
☞ 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.
AxertA selective serotonin 5-HT1B/1D receptor agonist, which is used for acute management of severe migraine in adults.
Nausea, somnolence, headache, paraesthesia, dry mouth.