Generic Name

Almotriptan Malate

---

Classification

FDA Approved Indications

• Acute treatment of migraine attacks with or without aura

Mechanism of Action

Almotriptan binds to serotonin (5-HT) receptors, specifically 5-HT1B and 5-HT1D, causing vasoconstriction of cranial blood vessels and inhibiting the release of pro-inflammatory neuropeptides, thereby alleviating migraine symptoms.

Dosage and Administration

Adult: Initially, 12.5 mg taken orally; if needed, can be repeated after 2 hours. Max dose is 25 mg in 24 hours.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Use with caution due to increased risk of vascular events; start with the lowest dose.

Renal Impairment: Use caution; consider dose adjustment due to reduced clearance.

Hepatic Impairment: Use with caution; dose adjustments may be needed, especially in severe impairment.

Pharmacokinetics

Absorption: Rapid, with peak plasma levels in approximately 1.5-3 hours.

Distribution: Widely distributed, crosses the blood-brain barrier.

Metabolism: Metabolized mainly via monoamine oxidase-A (MAO-A) and conjugation pathways.

Excretion: Excreted primarily in urine (about 60%) and feces.

Half Life: Approximately 3-4 hours.

Contraindications

• History of ischemic heart disease, cerebrovascular syndromes, uncontrolled hypertension, or other significant cardiovascular conditions.
• Use with concomitant ergot-containing drugs or other 5-HT1 agonists within 24 hours.

Precautions

• Use cautiously in patients with risk factors for cardiovascular disease, liver impairment, or a history of stroke.

Adverse Reactions - Common

• Dizziness (Common)
• Tingling or flushing sensation (Common)
• Nausea or somnolence (Common)

Adverse Reactions - Serious

• Serious cardiovascular events (e.g., myocardial infarction, ischemic stroke) (Rare)
• Allergic reactions, including anaphylaxis (Rare)

Drug-Drug Interactions

• Other serotonergic drugs, such as SSRIs, SNRIs, triptans, ergot derivatives, which may increase the risk of serotonin syndrome.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Instruct patient to take at the first sign of migraine.
• Warn about potential side effects like dizziness, flushing.
• Advise against use with other serotonergic drugs without healthcare provider approval.
• Report chest pain or unusual symptoms immediately.

Special Considerations

Black Box Warnings:

• Serious cardiovascular events have been reported; contraindicated in patients with ischemic cardiac; cerebrovascular disease.
• Potential for medication overuse headache.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Dizziness, nausea, vomiting, chest pain, drowsiness.

Treatment: Supportive care; no specific antagonist. Monitor cardiovascular status.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable until expiration date when stored properly.