Almotriptan

FDA label

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Renal Severe impairment: start 6.25 mg; max 12.5 mg/day

Hepatic Impairment: start 6.25 mg; max 12.5 mg/day

May repeat after 2 h; max 25 mg/24 h (12.5 mg/24 h in hepatic or severe renal impairment)

Instructions

• May repeat once after 2 hours if headache returns (efficacy of second dose not established); do not exceed 25 mg/day
• Safety of treating more than ~4 migraines per 30 days not established

Contraindications

• Ischemic or vasospastic coronary artery disease, or other significant cardiovascular disease
• Cerebrovascular syndromes (e.g., stroke or TIA)
• Peripheral vascular disease (including ischemic bowel disease)
• Uncontrolled hypertension
• Use within 24 hours of an ergotamine/ergot-type medication or another 5-HT1 agonist (triptan)
• Hemiplegic or basilar migraine

Cautions

• MAOIs due to risk of serotonin syndrome
• Myocardial ischemia/infarction and coronary vasospasm
• Chest/throat/neck/jaw pain, tightness, pressure
• Cerebrovascular events (some fatal)
• Peripheral and GI vasospastic ischemia
• Medication overuse headache
• Increases in blood pressure
• Caution in patients with sulfonamide hypersensitivity

Adverse reactions

• Adults: nausea, dry mouth, paresthesia, somnolence, headache
• Adolescents: dizziness, somnolence, headache, paresthesia, nausea, vomiting

Pregnancy Pregnancy Category C. Animal developmental toxicity at high doses; use only if potential benefit justifies risk.

Lactation Unknown whether excreted in human milk; use with caution (rat-milk levels up to 7x plasma).