naratriptan (Rx)

Brand and Other Names:Amerge
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 1mg
  • 2.5mg

Migraine

1-2.5 mg PO at onset; may repeat once after 4 hours

Not to exceed 5 mg/day

Renal Impairment

Mild-to-moderate: Not to exceed 2.5 mg/day

Severe (<15 mL/min); Do not administer

Safety and efficacy not established

Not recommended

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Interactions

Interaction Checker

and naratriptan

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Dizziness

            Drowsiness

            Fatigue

            Paresthesias

            Pain/pressure sensation

            Nausea (1-5%)

            Throat/neck symptoms

            <1%

            Myocardial infarction

            Coronary artery vasospasm in pts with CAD risk factors

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            Warnings

            Contraindications

            Hypersensitivity, including angioedema and anaphylaxis

            Severe hepatic or renal impairment

            Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders

            Ischemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal’s angina)

            History of stroke or TIA, or history of hemiplegic or basilar migraine because such patients are at a higher risk of stroke

            Peripheral vascular disease

            Ischemic bowel disease

            Uncontrolled hypertension

            Do not use within 24 hr of another 5-HT1 agonist or ergot derivative

            Cautions

            Decrease dose with mild-moderate renal impairment

            Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for ≥10 days/month) may lead to exacerbation of headache (medication overuse headache)

            Serotonin syndrome: Potentially life-threatening serotonin syndrome may occur, particularly during combined use with SSRIs (eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRIs (eg, venlafaxine, duloxetine)

            Myocardial infarction, cardiac arrest, transient ischemia, coronary artery vasopasm reported

            Significant increase in blood pressure including hypertensive crisis with acute impairment of organ systems reported

            Anaphylaxis/anaphylactoid and hypersensitivity reactions, including angioedema reported (see Contraindications)

            May cause dizziness, weakness, or drowsiness (infrequent)

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            Pregnancy & Lactation

            Pregnancy: There are no adequate data on the developmental risk associated with use of naratriptan in pregnant women; several studies have suggested that women with migraine may be at increased risk of preeclampsia during pregnancy

            Lactation: There are no data on presence of naratriptan in human milk, effects of naratriptan on the breastfed infant, or effects of naratriptan on milk production; naratriptan is present in rat milk; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for naratriptan and any potential adverse effects on the breastfed infant from naratriptan or from the underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Selective 5-HT1 receptor agonist in cranial arteries

            Causes vasoconstriction and reduces inflammation associated with antidronic neuronal transmission associated with relief of migraine

            Absorption

            Bioavailability: 70%

            Peak Plasma Time: 3-4 hr

            Peak Plasma Concentration: 50-1,000 ng/ml; 50% higher in women

            Distribution

            Protein Bound: 28-31%

            Vd: 170 L

            Metabolism

            Via hepatic CYP450 enzymes

            Elimination

            Half-Life: 6 hr

            Excretion: Urine 50%

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.