What it is5-HT1B/1D agonist; acute migraine.
Why this oneIt is the high-efficacy oral triptan whose selection is most often limited by CYP3A4 interactions.
What limits itStrong CYP3A4 inhibitors are contraindicated. Coronary vasospasm precludes use in ischemic or vasospastic disease.
FDA-approved for
FDA label
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| FDA dosing | Population | Start | Target | Max |
| Acute migraine (with or without aura) | Adults | 20 or 40 mg PRN | 40 mg PRN | 40 mg single dose; 80 mg/24h |
Renal Undefined
Hepatic Severe: not recommended (not evaluated); mild-moderate not specifically addressed
Second dose no sooner than 2 h after first; max 80 mg per 24 h
Instructions
- May repeat once ≥2 h after first dose if no response or recurrence; do not exceed 80 mg in 24 h.
- Do not treat an average of more than 3 migraine attacks per 30 days (not established).
Contraindications
- Ischemic coronary artery disease or coronary vasospasm (incl. Prinzmetal's angina)
- Wolff-Parkinson-White syndrome or arrhythmias with other accessory conduction pathway disorders
- History of stroke or TIA, or hemiplegic or basilar migraine
- Peripheral vascular disease
- Ischemic bowel disease
- Uncontrolled hypertension
- Use within 24 h of another 5-HT1 agonist or ergotamine/ergot-type medication
- Use within 72 h of potent CYP3A4 inhibitors (ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, nelfinavir)
Cautions
- Myocardial ischemia/infarction and Prinzmetal's angina — cardiac evaluation in high-risk patients
- Arrhythmias — discontinue if they occur
- Chest/throat/neck/jaw pain or pressure
- Cerebrovascular events
- GI and peripheral vasospastic reactions
- Medication overuse headache
- MAOIs due to risk of serotonin syndrome
- Blood pressure increase
Adverse reactions
- Asthenia
- Nausea
- Dizziness
- Somnolence
Pregnancy Insufficient human data; animal developmental toxicity at clinically relevant doses.
Lactation Excreted in human milk; minimize infant exposure by avoiding breastfeeding for 24 h after treatment.
Principal riskCoronary vasospasm; CYP3A4-dependent
Cost, est. cash$10–$300/month
Generic entry2017
Classes and tags
Clinical profile
Therapeutic safety burden1 / 4
Overdose danger1 / 4
Weight-gain liability0 / 4
Sedation liability0 / 4
QT / Torsades0 / 4
Direct muscarinic antagonism0 / 4
Embryofetal risk1 / 4
Legacy pregnancy categoryC
Defining liabilityAgent-specific vascular, serotonergic or hepatic risks; acute overdose is usually limited outside ergot or cardiovascular agents.
Mechanism of action: Eletriptan ballicule
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