9 Acute Migraine Medications Specific MOA ergotamineDHE triptans Nonspecific

9 acute migraine medications specific moa

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Acute Migraine Medications Specific MOA ergotamine/DHE triptans Nonspecific MOA combination analgesics corticosteroids neuroleptics/antiemetics NSAIDs opioids MOA=mechanism of action DHE=dihydroergotamine Snow V et al. Ann Intern Med. 2002;137:840-852. 10
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Comparison of Triptans Name Formulation Usual Oral Dose (mg) Most Common AEs Serious Risks/Class Almotriptan (Axert ® ) Oral tablet 12.5 Nausea, dry mouth, paresthesia Myocardial infarction, cerebro- vascular events, increased blood pressure Eletriptan (Relpax ® ) Oral tablet 40 Asthenia, nausea, dizziness, somnolence Frovatriptan (Frova ® ) Oral tablet 2.5 Dizziness, fatigue, headache, paresthesia Naratriptan (Amerge ® ) Oral tablet 2.5 Nausea, pain/pressure, paresthesia Rizatriptan (Maxalt ® ) Oral tablet or MLT 10 Dizziness, somnolence, nausea, paresthesia Sumatriptan (Imitrex ® ) Oral tablet, SQ, IN 50/100* Paresthesia, pain/pressure Zolmitriptan (Zomig ® ) Oral tablet, ZMT, IN 2.5 Dizziness, paresthesia, pain/pressure, somnolence Source: Package Inserts * While the PI states that the recommended dosage for this agent is 50 mg, common use is 100 mg. 11
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Safety of Triptans Most AEs are mild and not clinically serious occur early after administration and are short lived “triptan sensations” (eg, chest pressure) CNS side effects (eg, dizziness, fatigue, somnolence) Serious but rare CV and neurologic events contraindicated in patients with CV disease uncontrolled HTN Welch KMA. Cephalalgia . 2001;21(suppl 1):25-28. Dodick DW et al. Cephalalgia . 2004;24:417-424. Snow V et al. Ann Intern Med. 2002;137:840-849. AEs=adverse events CNS=central nervous system CV=cardiovascular HTN=hypertension 12
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Early Intervention With Triptans: Clinically More Effective Adapted from Cady RK. Clinical Cornerstone. 1999; 1:21-32. Presented: Rome, Italy; 2000. *Triptan clinical trials Aggregate data on all approved triptans Efficacy and Safety 32 60 0 10 20 30 40 50 60 Pain-free Response (2-hr) 13 14 33 29 0 10 20 30 40 50 60 Recurrence Adverse Event Percent of Patients Mild Pain Phase* Moderate/Severe Pain Phase Mild Pain Phase* Moderate/Severe Pain Phase 13 Percent of Patients
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Headache Recurrence Recurrence = return of episodic headache within 24 hours of initial treatment response Prevention of recurrence treat early, add NSAID use optimal dose if HA continues to recur, use a long-acting triptan Tfelt-Hansen P et al. Drugs. 2000;60:1259-1287. Capobianco DJ et al. Headache. 2001;41:500-502. 14
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* While the PI states that the recommended dosage for this agent is 50 mg, common use is 100 mg. Triptans: Long-acting vs Fast-acting Triptan Usual Oral Dose (mg) 2 Hour Response (%) T 1/2 (hr) Long-acting Frovatriptan 2.5 37-46 26 Naratriptan 2.5 6 Fast-acting Almotriptan 12.5 57-65 3-4 Eletriptan 40 54-65 4 Rizatriptan 10 67-77 2-3 Sumatriptan 50/100* 50-61 2.5 Zolmitriptan 2.5 62-65 3 Source: Package Inserts 15
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Migraine Recurrence For Triptans 0 10 20 30 40 50 60 Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan Sumatriptan Zolmitriptan *Frovatriptan 7%-25% Rizatriptan 44%-47% 1 Axert ® [package insert].
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