Almotriptan


Concise Prescribing Info
Indications/Uses
Acute migraine attacks.
Dosage/Direction for Use
Adult : PO Initial: 6.25 or 12.5 mg, may repeat after at least 2 hr if symptoms recur. Max: 25 mg/day.
Dosage Details
Oral
Acute migraine attacks
Adult: Initially, 6.25 or 12.5 mg, may repeat after at least 2 hr if symptoms recur (2nd dose should not be taken for same attack). Max: 25 mg daily.
Child: ≥12 yr Same as adult dose.
Elderly: Initially, 6.25 mg.
Special Patient Group
Patients receiving potent CYP3A4 inhibitors: Initially, 6.25 mg. Max: 12.5 mg daily.
Renal Impairment
CrCl (mL/min) Dosage
≤30 Initially, 6.25 mg. Max: 12.5 mg daily.
Hepatic Impairment
Initially, 6.25 mg. Max: 12.5 mg daily.
Administration
May be taken with or without food.
Contraindications
Known or suspected ischaemic heart disease (i.e. history of MI, angina pectoris, coronary artery vasospasm, documented silent ischaemia), peripheral vascular disease, severe HTN, uncontrolled mild/moderate HTN, previous CVA or TIA, hemiplegic or basilar migraine. Concomitant use w/ selective serotonin reuptake inhibitors (SSRI), selective norepinephrine reuptake inhibitors (SNRI), ergotamine-containing drugs (e.g. ergotamine tartrate, dihydroergotamine, methysergide), and other 5-HT1 agonists (e.g. triptans).
Special Precautions
Patient w/ history of CV disease, hypercholesterolaemia, DM, hypersensitivity to sulfonamides. Hepatic and severe renal (CrCl ≤30 mL/min) impairment. Childn, elderly. Pregnancy and lactation.
Adverse Reactions
Dizziness, somnolence, nausea, vomiting, fatigue; paraesthesia, headache, seizure; angioedema, anaphylactic reactions; visual impairment, tinnitus, palpitation, throat tightness; diarrhoea, dyspepsia, dry mouth, intestinal ischemia, ischaemia; myalgia, bone and chest pain, asthenia. Rarely, coronary vasospasm, tachycardia.
Potentially Fatal: Rarely, MI, disturbance of cardiac rhythm.
Patient Counseling Information
This drug may cause dizziness, somnolence, and visual disturbance, if affected, do not drive or operate machinery.
MonitoringParameters
Determine a clear diagnosis of migraine before treatment. Monitor CV status prior to initiation of treatment and periodically thereafter; hepatic and renal function.
Overdosage
Symptom: Somnolence, HTN or other more serious CV symptoms. Management: Symptomatic and supportive treatment. Establish a patent airway and ensure adequate oxygenation and ventilation.
Drug Interactions
Increased exposure w/ potent CYP3A4 inhibitors (e.g. ketoconazole).
Potentially Fatal: May cause serotonin syndrome w/ SSRIs, SNRIs. May cause prolonged vasospastic reactions w/ ergotamine-containing drugs or other 5-HT1 receptor agonists (e.g. triptans).
Action
Description: Almotriptan is a selective agonist of serotonin (5-HT1B/1D) receptors causing vasoconstriction of cranial arteries, reduction in transmission in trigeminal pain pathway, and inhibition of neuropeptide release.
Pharmacokinetics:
Absorption: Well absorbed. Bioavailability: Approx 70%. Time to peak plasma concentration: 1-3 hr.
Distribution: Volume of distribution: Approx 180-200 L. Plasma protein binding: Approx 35%.
Metabolism: Metabolised mainly by monoamine oxidase type A (MAOA) via oxidative deamination into indole acetic acid derivative, and to a lesser extent by CYP3A4 and CYP2D6 isoenzymes into γ-aminobutyric acid derivative.
Excretion: Via urine (>75%, approx 40% as unchanged drug) and faeces (approx 13% as unchanged drug and metabolites). Plasma elimination half-life: Approx 3-5 hr.
Chemical Structure

Chemical Structure Image
Almotriptan

Source: National Center for Biotechnology Information. PubChem Database. Almotriptan, CID=123606, https://pubchem.ncbi.nlm.nih.gov/compound/Almotriptan (accessed on Jan. 20, 2020)

Storage
Store at 25°C.
ATC Classification
N02CC05 - almotriptan ; Belongs to the class of selective serotonin (5HT1) agonists preparations. Used to relieve migraine.
References
Almotriptan Tablet, Film Coated (Ajanta Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 23/08/2016.

Anon. Almotriptan. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 23/08/2016.

Buckingham R (ed). Almotriptan Malate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 23/08/2016.

Joint Formulary Committee. Almotriptan. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 23/08/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Almotriptan Malate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 23/08/2016.

Disclaimer: This information is independently developed by MIMS based on Almotriptan from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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