Almotriptan: Pharmacological Differences and Clinical Results

Abstract

In this manuscript we review the key basic and clinical data of almotriptan, the new selective 5-HT(1B/D) agonist developed for the symptomatc treatment of migraine. Among triptans, almotriptan has the highest oral bioavailability, with more than two-thirds of the administered dose absorbed within the first hourboth inside and outside a migraine attack. Gender or the presence of food in the stomach do not influence this pharmacokinetic profile, and its clean metabolism results in no relevant interactions with other medications. The dose exhibiting the best efficacy/ tolerability ratio is 12.5 mg. Efficacy parameters with this dose are very comparable to those of sumatriptan 100 mg, with a recurrence rate in the lower range. The tolerability of almotriptan is similar to that for placebo. The incidence of chest symptoms is very low (<1%), even though this drug remains contraindicated in patients with ischaemic cardiomyopathy. In summary, almotriptan's promising basic profile together with its excellent tolerability/safety profile and good efficacy confirm this new 5-HT(1B/D) agonist as a drug of choice for the symptomatic treatment of migraine attacks.

An Otolaryngology, Neurology, Allergy, and Primary Care Consensus on Diagnosis and Treatment of Sinus Headache

“…Despite their slower onset of action and lower response rates, naratriptan and frovatriptan have longer elimination half-lives and are often used for migraine attacks associated with the menstrual cycle. Almotriptan and naratriptan demonstrate tolerability profiles similar to that of placebo 34–36 . Advising patients to take any of the triptans while pain is mild but destined to become more severe appears to dramatically improve efficacy while reducing headache recurrence, the need to re-dose, and the consumption of rescue analgesics 37,38 .…”

“…Almotriptan and naratriptan demonstrate tolerability profiles similar to that of placebo. [34][35][36] Advising patients to take any of the triptans while pain is mild but destined to become more severe appears to dramatically improve efficacy while reducing headache recurrence, the need to redose, and the consumption of rescue analgesics. 37,38 Advising against the use of any acute treatment medication (including OTC and symptomatic sinus medications) more than 2 to 3 days per week is recommended as the frequent use of immediate-relief medications can lead to medicationoveruse (rebound) headache.…”

Effects of Symptomatic Treatments on Cutaneous Hyperalgesia and Laser Evoked Potentials During Migraine Attack

“…In our series of patients, drug-induced headache relief was accompanied by reduced elaboration of experimental pain in the cortical areas devoted to the emotional and attentive compounds of pain processing. Both almotriptan and lysine-acetylsalicylate target on peripheral nociceptors and exert central inhibitory effects on trigeminal nociceptive firing to the cortex (22)(23)(24); the central inhibitory effect may be responsible for the reversion of LEPs increment due to migraine attack. Though the effect of drugs in reducing trigeminal nociception might not be prompt enough to reduce central sensitization at second-and third-order neurons it was sufficiently effective to reduce trigeminal inputs to the cortex and cortical processing of pain in our series.…”

Sinus Headache: A Neurology, Otolaryngology, Allergy, and Primary Care Consensus on Diagnosis and Treatment

“…Almotriptan and naratriptan have tolerability profiles similar to those of placebo. [39][40][41] Advising patients to take any of the triptans while pain is mild but destined to become more severe appears to substantially improve efficacy while reducing headache recurrence, the need to redose, and the consumption of rescue analgesics. 42,43 Advising against the use of any short-term treatment medication (including OTC and symptomatic sinus medications) for more than 2 to 3 days per week is recommended.…”