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TriptanAka: Sumatriptan, Zomig, Naratriptan, Amerge, Eletriptan, Relpax, Frovatriptan, Frova, Treximet, Imitrex, Rizatriptan, Maxalt, Zolmitriptan

Class
1. Serotonin Agonists
Indications
1. Migraine Abortive Treatment
Contraindications
1. Coronary Artery Disease
2. Uncontrolled Hypertension
3. Basilar Artery Migraine
4. Familial Hemiplegic Migraine
5. Ischemic Cerebrovascular Accident
6. Prinzmetal's Angina
7. Pregnancy
8. Concurrent Medication use (absolute contraindications)
  1. MAO inhibitor use
  2. Ergotamine use in prior 24 hours
Controversial cohorts in whom Triptan use is thought safe
1. Controlled Diabetes Mellitus
2. Controlled Hypertension
3. Controlled Hyperlipidemia
4. Postmenopausal women
5. Men over age 40 years
Drug Interactions
1. See absolute contraindications above
  1. Ergotamine
  2. MAO inhibitors
2. Lithium
3. Selective Serotonin Reuptake Inhibitor (SSRI)
  1. Risk of Serotonin Syndrome
4. Propranolol with Rizatriptan
  1. Requires reducing Rizatriptan dose
Dosing: General
1. Screen for cardiac disease before use!
2. Limit to no more than twice weekly
Dosing: Sumatriptan (Imitrex)
1. Subcutaneous Sumatriptan
  1. Initial: 6 mg SC
  2. Repeat in 12 hours prn
  3. Maximum: 12 mg/day
2. Oral Sumatriptan
  1. Initial: 25 mg PO
  2. Repeat 25 to 100 mg PO every 2 hours prn
  3. Maximum: 300 mg/day
3. Intranasal Sumatriptan
  1. Initial: 5, 10 or 20 mg intranasal
    1. Dose responsive (20 mg more effective)
  2. Repeat after 2 hours prn
  3. Maximum: 40 mg/day
  4. Safety of use in over 4 Headaches per month not known
4. Treximet (combination with Naproxen)
  1. Contains Sumatriptan 85 mg with Naproxen 500 mg
  2. Released as Sumatriptan becomes generically available
  3. Cheaper to purchase generic Sumatriptan (when available) and Naproxen separately
Dosing: Rizatriptan (Maxalt, Maxalt MLT)
1. Initial: 5 to 10 mg PO (MLT form is lingual)
2. Repeat dose in 2 hours
3. Maximum: 30 mg in 24 hours
Dosing: Naratriptan (Amerge)
1. Initial: 1 to 2.5 mg PO
2. Repeat in 4 hours
3. Maximum: 5 mg in 24 hours
Dosing: Zolmitriptan (Zomig)
1. Oral
  1. Initial: 1.25 to 2.5 mg PO
  2. Repeat dose every 2 hours
  3. Maximum: 10 mg in 24 hours
2. Intranasal
  1. Dose: 5 mg spray (single dose unit)
  2. Onset: 15 minutes (faster than oral preparations)
Dosing: Eletriptan (Relpax)
1. Initial: 20 to 40 mg PO
2. May repeat dose in 2 hours
3. Maximum: 40 mg/dose or 80 mg/day
Dosing: Almotriptan (Axert)
1. Initial: 6.25 to 12.5 mg PO; may repeat in 2 hours
2. Maximum: 2 doses in 24 hours
Dosing: Frovatriptan (Frova)
1. Initial dosing: 2.5 mg PO; may repeat in 2 hours
2. Maximum dose: 7.5 mg per day
Adverse reactions
1. Tingling, Flushing or burning sensation at injection
2. Heavy chest
  1. Generally benign in low risk populations
  2. Risk of Coronary Artery Disease exacerbation
3. Terrible taste with intranasal preparations
Efficacy: Sumatriptan
1. Efficacy dependent on mode of drug delivery
  1. Subcutaneous effective in 80% of patients
  2. Intranasal effective in 70% of patients
  3. Oral effective in 60% of patients
2. Oral form does not prevent Migraine recurrence
  1. Rapoport (1995) Neurology 45:1505
Efficacy
1. Most effective oral agents (c/w Imitrex 100 mg PO)
  1. Rizatriptan (Maxalt) 10 mg PO
  2. Eletriptan (Relpax) 80 mg PO
  3. Almotriptan (Axert) 12.5 mg PO (least side effects)
2. References
  1. Ferrari (2001) Lancet 358:1668
References
1. Jamieson (2002) Am J Med 112:138

Sumatriptan (C0075632)
Definition (MSH)	A serotonin agonist that acts selectively at 5HT1 receptors. It is used in the treatment of MIGRAINE DISORDERS.
Definition (CSP)	sulfonamide serotonin agonist and vasoconstrictor that acts selectively at 5HT1 receptors; frequently used in treating migraines.
Definition (NCI)	A sulfonamide triptan with vasoconstrictor activity. Sumatriptan selectively binds to and activates serotonin 5-HT1D receptors in the central nervous system (CNS), thereby constricting cerebral blood vessels. This may lead to a relief in pain from vascular headaches. Sumatriptan may also relieve vascular headaches by decreasing the release of vasoactive neuropeptides from perivascular trigeminal axons in the dura mater during a migraine, by reducing extravasation of plasma proteins, and by decreasing the release of other mediators of inflammation from the trigeminal nerve.
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	D018170
English	Sumatriptan, SUMATRIPTAN PREPARATION, Sumatriptan product
Spanish	sumatriptan, sumatriptano
Parent Concepts	indole (C0021236), Sulfonamides (C0038760), Vasoconstrictor Agents (C0042397), Tryptamines (C0041248), Serotonin Agonists (C0162757), Indoles (C0021242), Agent for migraine (C0355614), 5-HT1 Agonists (C0162754), Duplicate concept (C1274013), Triptans (C1567966)
Sources	CSP, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

rizatriptan (C0297635)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C093622
English	rizatriptan, RIZATRIPTAN PREPARATION, Rizatriptan product
Spanish	rizatriptan, rizatriptano
Parent Concepts	Serotonin Agonists (C0162757), Triazoles (C0040880), Agent for migraine (C0355614), 5-HT1 Agonists (C0162754), Triazole derivative (C1689939), Triptans (C1567966)
Sources	MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

zolmitriptan (C0528166)
Definition (NCI)	A member of the triptan class agents with anti-migraine property. Zolmitriptan selectively binds to and activates serotonin (5-HT) 1B expressed in intracranial arteries and 5_HT 1D receptors located on peripheral trigeminal sensory nerve terminals in the meninges and central terminals in brain stem sensory nuclei. Receptor binding results in constriction of cranial vessels, reduction of the vessel pulsation and inhibition of nociceptive transmission, thereby providing relief of migraine headaches. Zolmitriptan may also relief migraine headaches by inhibition pro-inflammatory neuropeptide release.
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C089750
English	zolmitriptan, ZOLMITRIPTAN PREPARATION, Zolmitriptan product
Spanish	zolmitriptan, zolmitriptano
Parent Concepts	Serotonin Agonists (C0162757), Agent for migraine (C0355614), Oxazolidinones (C0887953), 5-HT1 Agonists (C0162754), Triptans (C1567966)
Sources	LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

naratriptan (C0540623)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C106783
English	naratriptan, NARATRIPTAN PREPARATION, Naratriptan product
Spanish	naratriptan, naratriptano
Parent Concepts	Serotonin Agonists (C0162757), Indoles (C0021242), Piperidines (C0031960), Agent for migraine (C0355614), 5-HT1 Agonists (C0162754), Triptans (C1567966)
Sources	MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

Zomig (C0594405)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C089750
English	AscoTop, Astra brand of zolmitriptan, AstraZeneca brand of zolmitriptan, Zeneca brand of zolmitriptan, Zomig, Zomigoro
Sources	MSH, NCI, RXNORM Derived from the NIH UMLS (Unified Medical Language System)

Amerge (C0594660)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C106783
English	Amerge, Glaxo Wellcome brand of naratriptan hydrochloride, GlaxoSmithKline brand of naratriptan hydrochloride, Naramig, Schwarz brand of naratriptan hydrochloride
Sources	MSH, MTH, NCI, RXNORM Derived from the NIH UMLS (Unified Medical Language System)

Imitrex (C0721044)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
English	Imitrex
Sources	CSP, NCI, RXNORM Derived from the NIH UMLS (Unified Medical Language System)

Maxalt (C0721599)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C093622
English	Maxalt
Sources	MSH, NCI, RXNORM Derived from the NIH UMLS (Unified Medical Language System)

frovatriptan (C0754647)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C108128
English	frovatriptan, FROVATRIPTAN PREPARATION, Frovatriptan product
Spanish	frovatriptan, producto con frovatriptano
Parent Concepts	Serotonin Agonists (C0162757), Agent for migraine (C0355614), Unclassified Ingredients (C1372954), 5-HT1 Agonists (C0162754), Duplicate concept (C1274013), Triptans (C1567966)
Sources	MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF Derived from the NIH UMLS (Unified Medical Language System)

eletriptan (C0759933)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C115647
English	eletriptan, ELETRIPTAN PREPARATION
Spanish	eletriptan
Parent Concepts	Serotonin Agonists (C0162757), Agent for migraine (C0355614), Unclassified Ingredients (C1372954), 5-HT1 Agonists (C0162754)
Sources	MSH, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, VANDF Derived from the NIH UMLS (Unified Medical Language System)

Frova (C1099778)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C108128
English	Elan brand of frovatriptan succinate, Frova, UCB brand of frovatriptan succinate
Sources	MSH, NCI, RXNORM Derived from the NIH UMLS (Unified Medical Language System)

Relpax (C1171655)
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	C115647
English	Mack brand of eletriptan hydrobromide, Pfizer brand of eletriptan hydrobromide, Relpax
Sources	MSH, NCI, RXNORM Derived from the NIH UMLS (Unified Medical Language System)

Triptans (C1567966)
Definition (MSH)	Derivatives of TRYPTAMINES that are SEROTONIN AGONISTS acting at 5-HT1 RECEPTORS. Some are used to treat MIGRAINE DISORDERS.
Concepts	Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH	D014363
English	Triptans
Parent Concepts	Drugs used for the treatment of acute migraine (C1579373)
Sources	MSH, USPMG Derived from the NIH UMLS (Unified Medical Language System)

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Autonomic Nervous System Disorders

Cognitive Disorders

Headache Disorders

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TriptanAka: Sumatriptan, Zomig, Naratriptan, Amerge, Eletriptan, Relpax, Frovatriptan, Frova, Treximet, Imitrex, Rizatriptan, Maxalt, Zolmitriptan

Sumatriptan (C0075632)

rizatriptan (C0297635)

zolmitriptan (C0528166)

naratriptan (C0540623)

Zomig (C0594405)

Amerge (C0594660)

Imitrex (C0721044)

Maxalt (C0721599)

frovatriptan (C0754647)

eletriptan (C0759933)

Frova (C1099778)

Relpax (C1171655)

Triptans (C1567966)

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