Generic Name

Frovatriptan Succinate

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Classification

FDA Approved Indications

• Acute treatment of migraine headaches with or without aura

Mechanism of Action

Frovatriptan is a selective 5-HT1B/1D receptor agonist. It causes vasoconstriction of intracranial blood vessels and inhibits the release of pro-inflammatory neuropeptides, thereby alleviating migraine symptoms.

Dosage and Administration

Adult: Initially 2.5 mg taken orally once. Dose may be repeated after 2 hours if needed, but not exceeding 7.5 mg in 24 hours.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Use with caution; start at lower end of dosing range due to potential increased sensitivity.

Renal Impairment: Use with caution; may require dose adjustment based on severity.

Hepatic Impairment: Use with caution, especially in severe hepatic impairment.

Pharmacokinetics

Absorption: Rapidly absorbed with peak plasma concentration in approximately 2-3 hours.

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

Metabolism: Primarily via hepatic CYP1A2 metabolism.

Excretion: Excreted mainly in urine, including metabolites.

Half Life: Frovatriptan has a half-life of approximately 26 hours, contributing to its comparatively long duration of action.

Contraindications

• History of coronary artery disease, uncontrolled hypertension, cerebrovascular disease, peripheral vascular disease.
• Use with monoamine oxidase inhibitors (MAOIs) or ergot alkaloids within 24 hours.
• Hypersensitivity to Frovatriptan or other triptans.

Precautions

• Risk of coronary vasospasm especially in patients with risk factors for cardiovascular disease.
• Use cautiously in patients with risk factors for stroke or cerebrovascular disease.
• Patients should be advised to seek emergency care if they experience chest pain or symptoms suggestive of myocardial ischemia.

Adverse Reactions - Common

• Dizziness (Less common)
• Fatigue (Less common)
• Nausea (Less common)
• Sensations of pressure or tightness in the chest or throat (Common)

Adverse Reactions - Serious

• Serious cardiovascular events (myocardial infarction, arrhythmia) (Rare)
• Serotonin syndrome (especially with concomitant serotonergic drugs) (Rare)

Drug-Drug Interactions

• Other serotonergic drugs (SSRIs, SNRIs, MAOIs), ergot alkaloids, other triptans
• Caution with CYP1A2 inhibitors

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Instruct patient to take the medication at first sign of migraine.
• Do not exceed recommended dose within 24 hours.
• Seek immediate medical attention if chest pain, jaw pain, or symptoms of cardiovascular ischemia occur.

Special Considerations

Black Box Warnings:

• Coronary vasospasm, myocardial infarction, and other ischemic events have been reported with triptan use.
• Use only if a clear diagnosis of migraine has been established.
• Not recommended for patients with ischemic cardiac or cerebrovascular disease.

Genetic Factors: Pharmacogenomic variations in CYP1A2 may affect metabolism, but routine testing is not standard.

Lab Test Interference: None noted.

Overdose Management

Signs/Symptoms: Serious cardiovascular symptoms, CNS effects such as hallucinations or agitation.

Treatment: Supportive care, manage symptoms, and consider ICU admission for significant toxicity.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable for the duration of the expiration date on the package.