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Triptan Medications

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Updated March 29, 2010

Triptans: The Migraine "Miracle" Drugs:

The selective serotonin receptor agonists, or triptans, are a class of medications that the FDA first approved in late 1992. These medications were considered “miracle” drugs for migraine sufferers, as they had the purported ability to stop a migraine headache at its earliest signs. Sumatriptan (Imitrex) was the first to be approved in its injectable form, but others quickly followed.

How Triptans Work:

Triptans work by binding to serotonin receptors in the brain. By mimicking the actions of serotonin, these drugs cause the blood vessels to constrict and prevent some nerves from transmitting signals to the brain, effectively blocking the pain associated with migraine headaches. Each triptan medication affects a slightly different number of serotonin receptors, but all work in similar fashion.

When You Should Not Use Triptans:

If you suffer from any of the following conditions, you should not use any of the triptans:
  • uncontrolled hypertension
  • family history of coronary artery disease or heart attacks
  • other risk factors for coronary artery disease
  • history of stroke
  • uncontrolled diabetes
  • high cholesterol levels
As with all medications, discuss their safe use with your healthcare provider.

Major Drug Interactions:

Many drugs will interact with one or more other drugs. This is true of the triptans, as well. The triptans have been implicated in the development of serotonin syndrome, especially when taken in combination with the SSRIs. Serotonin syndrome is a dangerous condition resulting from increased serotonin activity in the body, including symptoms such as restlessness, hallucinations, loss of coordination, fast heart beat, changes in blood pressure, increased body temperature, nausea, vomiting, and diarrhea. If you develop any of these symptoms while using of the triptans, contact your healthcare provider immediately.

Other Drug Interactions:

Other medications that may interact with the triptans include lithium, monoamine oxidase inhibitors (MAOIs), dihydroergotamine, ergotamine, and methylsergide.

Triptans on the Market:

Triptans on the market today include:
  • Axert (Almotriptan)
  • Relpax (Eletriptan)
  • Frova (Frovatriptan)
  • Amerge (Naratriptan)
  • Maxalt (Rizatriptan)
  • Imitrex (Sumatriptan)
  • Zomig (Zolmitriptan)
  • Treximet (Sumatriptan/naproxen sodium)

Sources:

Boyer EW, Shannon M. “The serotonin syndrome.” N Engl J Med. 2005 Mar 17;352(11):1112-20.

”Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) . . . .” FDA Public Health Advisory. Created July 19, 2006. Accessed March 18, 2009.

Ferrari, M. D.; Goadsby, P.J.; Roon, K. I.; Lipton, R.B. , "Triptans (serotonin, 5-HT1B/1D agonists) in migraine: detailed results and methods of a meta-analysis of 53 trials,” Cephalalgia 22: 633-658.

Imitrex package insert (Cerenex—US), New 1/93, Rec 2/93.

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