frovatriptan

frovatriptan

(froe-va-trip-tan) ,

Frova

(trade name)

Classification

Therapeutic: vascular headache suppressants
Pharmacologic: five ht1 agonists

Pregnancy Category: C

Indications

Acute treatment of migraine headache.

Action

Acts as an agonist at specific 5-HT receptor sites in intracranial blood vessels and sensory trigeminal nerves.

Therapeutic effects

Cranial vessel vasoconstriction with associated decrease in release of neuropeptides and resultant decrease in migraine headache.

Pharmacokinetics

Absorption: 20–30% following oral administration.

Distribution: Unknown.

Metabolism and Excretion: Mostly metabolized by the liver (P450 1A2 enzyme system); some metabolites eliminated in urine, <10% excreted unchanged.

Half-life: 26 hr.

Time/action profile (blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–4 hr	unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity;History, symptoms or findings consistent with;Cerebrovascular syndromes including;Uncontrolled hypertension;Hemiplegic or basilar migraine;Peripheral vascular disease, including ischemic bowel disease;Should not be used within 24 hr of any other 5-HT agonist or ergot-type compounds (e.g. dihydroergotamine, ergotamine); Pediatric: Children <18 yr.

Use Cautiously in: Concurrent use of SSRIs or SNRIs (↑ risk of serotonin syndrome); Geriatric: May be more susceptible to adverse cardiovascular effects; Obstetric / Lactation: Safety not established.

Exercise Extreme Caution in: Cardiovascular risk factors (hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes, strong family history, menopausal women or men >40 yr); use only if cardiovascular status has been evaluated and determined to be safe and first dose is administered under supervision.

Adverse Reactions/Side Effects

Central nervous system

• dizziness (most frequent)
• drowsiness
• fatigue

Cardiovascular

• coronary artery vasospasm (life-threatening)
• mi (life-threatening)
• ventricular fibrillation (life-threatening)
• ventricular tachycardia (life-threatening)
• chest pain
• myocardial ischemia

Gastrointestinal

• dry mouth
• dyspepsia
• nausea

Dermatologic

• flushing

Musculoskeletal

• skeletal pain

Neurologic

• paresthesia

Miscellaneous

• pain

Interactions

Drug-Drug interaction

Hormonal contraceptives or propranolol may ↑ levels.↑ risk of serious vasospastic reactions with dihydroergotamine or ergotamine (concurrent use contraindicated).↑ risk of serotonin syndrome when used with fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram, venlafaxine, or duloxetine.

Route/Dosage

Oral (Adults) 2.5 mg; if there has been initial relief, a second tablet may be taken after at least 2 hr (daily dose should not exceed 3 tablets and should not be used to treat more than 4 attacks/30 day period).

Availability

Tablets: 2.5 mg

Nursing implications

Nursing assessment

• Assess pain location, intensity, duration, and associated symptoms (photophobia, phonophobia, nausea, vomiting) during migraine attack.

Potential Nursing Diagnoses

Acute pain (Indications)

Implementation

• Oral: Tablets may be administered at any time after the headache starts.

Patient/Family Teaching

• Inform patient that frovatriptan should be used only during a migraine attack. It is meant to be used to relieve migraine attack but not to prevent or reduce the number of attacks.
  • Instruct patient to administer frovatriptan as soon as symptoms appear, but it may be administered any time during an attack. If migraine symptoms return, a second dose may be used. Allow at least 2 hr between doses, and do not use more than 3 tablets in any 24-hr period.
  • If dose does not relieve headache, additional frovatriptan doses are not likely to be effective; notify health care professional.
  • Advise patient that lying down in a darkened room following frovatriptan administration may further help relieve headache.
  • Caution patient not to use frovatriptan if she is pregnant, suspects she is pregnant, plans to become pregnant, or is breast feeding. Adequate contraception should be used during therapy.
  • May cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient that overuse (use more than 10 days/month) may lead to exacerbation of headache (migraine-like daily headaches, or as a marked increase in frequency of migraine attacks). May require gradual withdrawal of frovatriptan and treatment of symptoms (transient worsening of headache).
  • Advise patient to notify health care professional prior to next dose of frovatriptan if pain or tightness in the chest occurs during use. If pain is severe or does not subside, notify health care professional immediately. If wheezing; heart throbbing; swelling of eyelids, face, or lips; skin rash; skin lumps; or hives occur, notify health care professional immediately and do not take more frovatriptan without approval of health care professional. If feelings of tingling, heat, flushing, heaviness, pressure, drowsiness, dizziness, tiredness, or sickness develop, discuss with health care professional at next visit.
  • Advise patient to avoid alcohol, which aggravates headaches, during frovatriptan use.

Evaluation/Desired Outcomes

• Relief of migraine attack.

frovatriptan

A triptan-type selective serotonin receptor (5HT1B/1D receptor) agonist (SSRA) used in the acute management of migraine headaches and menstrual migraines.

Mechanism
Vasoconstriction of intracerebral arteries.

Adverse effects
Coronary artery vasospasm, transient myocardial ischaemia or infarction, ventricular tachycardia or fibrillation.

frovatriptan

A long-acting SEROTONIN agonist drug (see TRIPTANS) used to treat MIGRAINE. A brand name is Migard.