Adult: Treatment of the headache phase of migraine attacks with or without aura: 6.25 or 12.5 mg as a single dose, may repeat after ≥2 hours if symptoms recur. Max: 25 mg daily. Child: Treatment of the headache phase of migraine attacks with or without aura: ≥12 years Same as adult dose. Dosage recommendations may vary among countries and individual products (refer to detailed product guidelines).
6.25 mg as a single dose; may repeat after ≥2 hours if symptoms recur. Max: 12.5 mg daily.
Hepatic Impairment
6.25 mg as a single dose; may repeat after ≥2 hours if symptoms recur. Max: 12.5 mg daily. Dosage recommendations may vary among countries and individual products (refer to detailed product guidelines).
Administration
May be taken with or without food.
Contraindications
Hypersensitivity. Basilar, hemiplegic, or ophthalmoplegic migraine, or migraine with brainstem aura; history of TIA or CVA; peripheral vascular disease (including ischaemic bowel disease), known or suspected ischaemic heart disease (e.g. MI, coronary artery vasospasm, documented silent ischaemia, angina pectoris, Prinzmetal’s angina), uncontrolled mild or moderate hypertension, severe hypertension; use within 24 hours of another 5-HT1 agonist (e.g. triptans) and ergot-derived medications (e.g. dihydroergotamine, ergotamine tartrate, methysergide).
Special Precautions
Patient with known hypersensitivity to sulfonamides; risk factors for coronary artery disease (e.g. hypercholesterolaemia, hypertension, diabetes, strong family history of coronary artery disease, menopause, smoker, obesity, male >40 years of age). Not intended for use as migraine prophylaxis or treatment of cluster headaches. Use only after a clear diagnosis of migraine has been established. Hepatic and moderate to severe renal impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Peripheral vascular ischaemia, colonic ischaemia; sensations of tightness, pain, pressure, and heaviness in the precordium, neck, jaw, and throat; medication overuse headache (≥10 days of use/month). Rarely, increased blood pressure, including hypertensive crisis. Very rarely, transient and permanent blindness, partial vision loss. Cardiac disorders: Palpitations. Ear and labyrinth disorders: Tinnitus. Eye disorders: Blurred vision, visual impairment. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, dyspepsia, dry mouth. General disorders and administration site conditions: Fatigue, asthenia, chest pain. Immune system disorders: Hypersensitivity reactions, anaphylactic reactions. Musculoskeletal and connective tissue disorders: Myalgia, bone pain. Nervous system disorders: Dizziness, somnolence, headache, paraesthesia, seizures. Potentially Fatal: Cerebral or subarachnoid haemorrhage, stroke. Rarely, MI, cardiac rhythm disturbances (e.g. ventricular tachycardia or fibrillation).
This drug may cause somnolence, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood pressure; headache severity, signs and symptoms of angina. Evaluate CV status of triptan-naive patients who have multiple CV risk factors (e.g. diabetes, hypertension, smoking, increased age, strong family history of coronary artery disease). Monitor ECG with 1st dose in patients with multiple CV risk factors who have negative CV evaluation and consider periodic CV evaluation if they are intermittent long-term users.
Overdosage
Symptoms: Somnolence. Management: Symptomatic treatment. Monitor vital functions for at least 12 hours or while signs or symptoms persist.
Drug Interactions
Increased serum concentration with potent CYP3A4 inhibitors (e.g. ketoconazole). Potentially Fatal: May cause serotonin syndrome with selective SSRIs or selective noradrenaline reuptake inhibitors. May cause prolonged vasospastic reactions with ergot-containing drugs (e.g. dihydroergotamine, ergotamine tartrate, methysergide) and other 5-HT1 receptor agonists (e.g. triptans).
Action
Description: Almotriptan is a selective serotonin (5-HT1B and 5-HT1D) agonist which causes vasoconstriction and reduces sterile inflammation associated with the antidromic neuronal transmission, thereby relieving migraine. Pharmacokinetics: Absorption: Well absorbed from the gastrointestinal tract. Bioavailability: Approx 70%. Time to peak plasma concentration: 1-3 hours. Distribution: Volume of distribution: Approx 180-200 L. Plasma protein binding: Approx 35%. Metabolism: Metabolised via MAO type A oxidative deamination (approx 27% of dose) and CYP3A4 and CYP2D6 (approx 12% of dose) to inactive metabolites. Excretion: Mainly via urine (approx 75%; approx 40%, as unchanged drug); faeces (approx 13%, as unchanged drug and metabolites). Elimination half-life: Approx 3.5 hours.
Chemical Structure
Almotriptan Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 123606, Almotriptan. https://pubchem.ncbi.nlm.nih.gov/compound/Almotriptan. Accessed May 26, 2022.
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