Nurses Compass
Drug Guide
Naratriptan Hydrochloride
Classification
Therapeutic: Antimigraine agent
Pharmacological: Selective serotonin receptor agonist (5-HT1B/1D receptor agonist)
FDA Approved Indications
- Migraine headache with or without aura
Mechanism of Action
Naratriptan selectively binds to 5-HT1B/1D receptors on intracranial blood vessels and sensory nerves, leading to vasoconstriction and inhibition of neuropeptide release, which alleviates migraine symptoms.
Dosage and Administration
Adult: Initial dose typically 2.5 mg orally, may repeat after 4 hours if needed, maximum 5 mg in 24 hours.
Pediatric: Safety and efficacy not established, generally not recommended for children.
Geriatric: Use with caution, no specific dose adjustment, monitor for adverse effects.
Renal Impairment: Adjust dose based on severity; consultation recommended.
Hepatic Impairment: Use with caution; no specific dose adjustment established.
Pharmacokinetics
Absorption: Rapid absorption, bioavailability approximately 70%.
Distribution: Widely distributed; crosses the blood-brain barrier.
Metabolism: Primarily metabolized in the liver via CYP1A2.
Excretion: Excreted mainly in urine as metabolites.
Half Life: Approximately 3 to 6 hours.
Contraindications
- History of ischemic heart disease, uncontrolled hypertension, or risk factors for cardiovascular disease.
- Use in patients with concurrent MAO inhibitor therapy.
- History of hypersensitivity to triptans.
Precautions
- Use with caution in patients with cerebrovascular disease, uncontrolled hypertension, or at risk for coronary artery disease.
- Assess cardiovascular status before administration, especially in patients over 40 or with risk factors.
Adverse Reactions - Common
- Dizziness (Common)
- Nausea (Common)
- Somnolence (Common)
Adverse Reactions - Serious
- Myocardial ischemia, infarction (Rare)
- Serotonin syndrome (with concomitant serotonergic drugs) (Rare)
- Allergic reactions (rash, edema, hypotension) (Rare)
Drug-Drug Interactions
- Other serotonergic drugs (SSRIs, SNRIs, MAOIs)
- Ergot alkaloids
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for cardiovascular symptoms, including chest pain, dizziness, and hypertension.
Diagnoses:
- Risk for cardiac ischemia
- Ineffective tissue perfusion
Implementation: Administer orally, assess symptom resolution, monitor for adverse effects.
Evaluation: Evaluate reduction in migraine intensity and duration, monitor for adverse effects, especially cardiovascular.
Patient/Family Teaching
- Instruct to report chest pain, chest tightness, or unusual symptoms immediately.
- Advise to take medication as soon as migraine symptoms begin.
- Warn against concurrent use with other serotonergic drugs or ergot alkaloids.
Special Considerations
Black Box Warnings:
- Use only where clearly indicated due to risk of coronary vasospasm and serious cardiovascular events.
Genetic Factors: None specific.
Lab Test Interference: None noted.
Overdose Management
Signs/Symptoms: Severe vasospasm, chest pain, hypertension, dizziness.
Treatment: Supportive care; cardiac monitoring; vasodilators may be used if vasospasm occurs.
Storage and Handling
Storage: Store at room temperature, 15-30°C (59-86°F).
Stability: Stable; protect from moisture and light.