Dosing & Uses
Dosage Forms & Strengths
tablet
- 6.25mg
- 12.5mg
Migraine
Indicated for acute treatment of migraine attacks in patients with a history of migraine with or without aura
Initial 6.25-12.5 mg PO at onset; may repeat once after 2 hours
Not to exceed 25 mg/day
Renal Impairment, Severe
CrCl <30 mL/min: Initial 6.25 mg PO
Not to exceed 12.5 mg/day
Hepatic Impairment
Initial: 6.25 mg PO
Not to exceed 12.5 mg/day
Dosing considerations
Only for use where clear diagnosis of migraine established; if a patient has no response for first migraine attack, reconsider diagnosis before administering to treat any subsequent attacks
As individuals may vary in their response to different doses of this drug, the choice of dose should be made on an individual basis
The safety of treating an average of more than four migraines in a 30-day period, not established
Not for treatment of cluster headaches
Dosage Forms & Strengths
tablet
- 6.25mg
- 12.5mg
Migraine
Indicated for acute treatment of migraine headache pain in adolescents with a history of migraine attacks with or without aura usually lasting ≥4 hr (when untreated)
<12 years: Safety and efficacy not established
≥12 years: 6.25-12.5 mg PO at onset of headache; may repeat once after 2 hr
Not to exceed 25 mg/day
Dosing considerations
Efficacy on migraine-associated symptoms (nausea, photophobia, and phonophobia) not established
Not intended for prophylactic therapy of migraine or for use in management of hemiplegic or basilar migraine
Only for use where clear diagnosis of migraine established; if a patient has no response for first migraine attack, reconsider diagnosis before administering to treat any subsequent attacks
As individuals may vary in their response to different doses of this drug, the choice of dose should be made on an individual basis
The safety of treating an average of more than four migraines in a 30-day period has not been established
Not for treatment of cluster headaches
Migraine: See adult dosing
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (15)
- bromocriptine
bromocriptine, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Vasoconstrictive effects of triptans and bromocriptine may be additive. Drugs should not be used within 24h of one another.
- cabergoline
cabergoline, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- dihydroergotamine
dihydroergotamine, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- dihydroergotamine intranasal
dihydroergotamine intranasal, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- eletriptan
almotriptan, eletriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- ergoloid mesylates
ergoloid mesylates, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- ergotamine
ergotamine, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- frovatriptan
almotriptan, frovatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- methylergonovine
methylergonovine, almotriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- naratriptan
almotriptan, naratriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- procarbazine
procarbazine increases levels of almotriptan by serotonin levels. Contraindicated. Concurrent use or use within 2 weeks of MAOI therapy is contraindicated. If procarbazine is required, naratriptan, eletriptan or frovatriptan may be a suitable 5-HT1D agonist to employ. Monitor for signs and symptoms of serotonin toxicity/serotonin syndrome during such therapy.
- rizatriptan
almotriptan, rizatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- sumatriptan
almotriptan, sumatriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- sumatriptan intranasal
almotriptan, sumatriptan intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
- zolmitriptan
almotriptan, zolmitriptan. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Additive vasospasm. Sep. by 24h.
Serious - Use Alternative (35)
- carbamazepine
carbamazepine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- citalopram
citalopram, almotriptan. Mechanism: unknown. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome. If concomitant treatment with citalopram and a triptan is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases.
- clarithromycin
clarithromycin will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- cyclobenzaprine
almotriptan and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.
- desvenlafaxine
almotriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.
- dolasetron
dolasetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- erythromycin base
erythromycin base will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- erythromycin stearate
erythromycin stearate will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- granisetron
granisetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- isocarboxazid
almotriptan and isocarboxazid both increase serotonin levels. Avoid or Use Alternate Drug.
isocarboxazid increases levels of almotriptan by decreasing metabolism. Contraindicated. - itraconazole
itraconazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Start almotriptan dose at 6.25 mg when coadministered with potent CYP3A4 inhibitors. Do not exceed 12.5 mg/day. Avoid concomitant use of almotriptan and potent CYP3A4 inhibitors in patients with renal or hepatic impairment.
- ketoconazole
ketoconazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. In patients concomitantly using strong CYP3A4 inhibitors, start almotriptan at 6.25 mg/day; not exceed 12.5 mg/day. Avoid coadministration of almotriptan and strong CYP3A4 inhibitors in patients with renal or hepatic impairment.
- levoketoconazole
levoketoconazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. In patients concomitantly using strong CYP3A4 inhibitors, start almotriptan at 6.25 mg/day; not exceed 12.5 mg/day. Avoid coadministration of almotriptan and strong CYP3A4 inhibitors in patients with renal or hepatic impairment.
- linezolid
almotriptan and linezolid both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.
linezolid increases levels of almotriptan by decreasing metabolism. Contraindicated. - lorcaserin
almotriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.
- methylene blue
almotriptan and methylene blue both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.
- nefazodone
nefazodone will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- netupitant/palonosetron
netupitant/palonosetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ondansetron
ondansetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ozanimod
ozanimod increases toxicity of almotriptan by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- palonosetron
palonosetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- phenelzine
almotriptan and phenelzine both increase serotonin levels. Avoid or Use Alternate Drug.
phenelzine increases levels of almotriptan by decreasing metabolism. Contraindicated. - procarbazine
almotriptan and procarbazine both increase serotonin levels. Avoid or Use Alternate Drug.
- rasagiline
almotriptan and rasagiline both increase serotonin levels. Avoid or Use Alternate Drug. Avoid combination within 14 days of MAOI use
- rifabutin
rifabutin will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- rifampin
rifampin will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- saquinavir
saquinavir increases levels of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid use in patients with renal or hepatic impairment.
- St John's Wort
St John's Wort will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- tedizolid
tedizolid, almotriptan. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- tranylcypromine
almotriptan and tranylcypromine both increase serotonin levels. Avoid or Use Alternate Drug.
tranylcypromine increases levels of almotriptan by decreasing metabolism. Contraindicated. - vilazodone
almotriptan, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .
- vortioxetine
almotriptan, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.
Monitor Closely (141)
- 5-HTP
almotriptan and 5-HTP both increase serotonin levels. Use Caution/Monitor.
- amitriptyline
almotriptan and amitriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- amoxapine
almotriptan and amoxapine both increase serotonin levels. Modify Therapy/Monitor Closely.
- aprepitant
aprepitant will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- aripiprazole
almotriptan, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- armodafinil
armodafinil will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- asenapine
almotriptan, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- atazanavir
atazanavir will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, almotriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- bosentan
bosentan will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- budesonide
budesonide will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- buspirone
almotriptan and buspirone both increase serotonin levels. Modify Therapy/Monitor Closely.
- butabarbital
butabarbital will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- butalbital
butalbital will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cariprazine
almotriptan, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- clomipramine
almotriptan and clomipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- clozapine
almotriptan, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- cocaine topical
almotriptan and cocaine topical both increase serotonin levels. Modify Therapy/Monitor Closely.
- conivaptan
conivaptan will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cortisone
cortisone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cyclosporine
cyclosporine will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cyproheptadine
cyproheptadine decreases effects of almotriptan by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of serotonin agonists.
- darifenacin
darifenacin will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- darunavir
darunavir will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dasatinib
dasatinib will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- deferasirox
deferasirox will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- desipramine
almotriptan and desipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- dexamethasone
dexamethasone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dexfenfluramine
almotriptan and dexfenfluramine both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine
almotriptan and dextroamphetamine both increase serotonin levels. Use Caution/Monitor.
- dextroamphetamine transdermal
almotriptan, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
- dextromethorphan
almotriptan and dextromethorphan both increase serotonin levels. Modify Therapy/Monitor Closely.
- DHEA, herbal
DHEA, herbal will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- dihydroergotamine
almotriptan and dihydroergotamine both increase serotonin levels. Use Caution/Monitor.
- dihydroergotamine intranasal
almotriptan and dihydroergotamine intranasal both increase serotonin levels. Use Caution/Monitor.
- dosulepin
almotriptan and dosulepin both increase serotonin levels. Modify Therapy/Monitor Closely.
- doxepin
almotriptan and doxepin both increase serotonin levels. Modify Therapy/Monitor Closely.
- dronedarone
dronedarone will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- droxidopa
almotriptan and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension
- duloxetine
almotriptan and duloxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- efavirenz
efavirenz will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- eletriptan
almotriptan and eletriptan both increase serotonin levels. Use Caution/Monitor.
- ergotamine
almotriptan and ergotamine both increase serotonin levels. Use Caution/Monitor.
- escitalopram
almotriptan, escitalopram. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely. Exercise caution when concomitantly using agents that enhance serotonin activity. Monitor for the development of serotonin toxicity/serotonin syndrome during such therapy.
- etravirine
etravirine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fenfluramine
almotriptan and fenfluramine both increase serotonin levels. Use Caution/Monitor.
fenfluramine, almotriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome. - fluconazole
fluconazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fludrocortisone
fludrocortisone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fluoxetine
almotriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- fluphenazine
almotriptan, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fluvoxamine
fluvoxamine and almotriptan both increase serotonin levels. Modify Therapy/Monitor Closely.
- fosamprenavir
fosamprenavir will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fosaprepitant
fosaprepitant will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fosphenytoin
fosphenytoin will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- frovatriptan
almotriptan and frovatriptan both increase serotonin levels. Use Caution/Monitor.
- grapefruit
grapefruit will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- griseofulvin
griseofulvin will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- haloperidol
almotriptan, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- hydrocodone
hydrocodone, almotriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- hydrocortisone
hydrocortisone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- iloperidone
almotriptan, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- imipramine
almotriptan and imipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- indinavir
indinavir will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoniazid
isoniazid will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
almotriptan and isoniazid both increase serotonin levels. Use Caution/Monitor. - L-tryptophan
almotriptan and L-tryptophan both increase serotonin levels. Use Caution/Monitor.
- lapatinib
lapatinib will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- letermovir
letermovir increases levels of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levomilnacipran
almotriptan and levomilnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.
- lisdexamfetamine
almotriptan and lisdexamfetamine both increase serotonin levels. Use Caution/Monitor.
- lithium
almotriptan and lithium both increase serotonin levels. Use Caution/Monitor.
- lofepramine
almotriptan and lofepramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- loxapine
almotriptan, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- loxapine inhaled
almotriptan, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lsd
almotriptan and lsd both increase serotonin levels. Use Caution/Monitor.
- lumefantrine
lumefantrine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lurasidone
almotriptan, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- maprotiline
almotriptan and maprotiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- marijuana
marijuana will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- meperidine
almotriptan and meperidine both increase serotonin levels. Modify Therapy/Monitor Closely.
- methylprednisolone
methylprednisolone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- metronidazole
metronidazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- miconazole vaginal
miconazole vaginal will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- milnacipran
almotriptan and milnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.
- mirtazapine
almotriptan and mirtazapine both increase serotonin levels. Use Caution/Monitor.
- molindone
almotriptan, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- morphine
almotriptan and morphine both increase serotonin levels. Use Caution/Monitor.
- naratriptan
almotriptan and naratriptan both increase serotonin levels. Use Caution/Monitor.
- nefazodone
almotriptan and nefazodone both increase serotonin levels. Modify Therapy/Monitor Closely.
- nelfinavir
nelfinavir will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nevirapine
nevirapine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nifedipine
nifedipine will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nortriptyline
almotriptan and nortriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- olanzapine
almotriptan, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- oliceridine
almotriptan, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- paliperidone
almotriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- paroxetine
almotriptan and paroxetine both increase serotonin levels. Modify Therapy/Monitor Closely.
- pentazocine
almotriptan and pentazocine both increase serotonin levels. Use Caution/Monitor.
- pentobarbital
pentobarbital will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- perphenazine
almotriptan, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- phenobarbital
phenobarbital will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- phenytoin
phenytoin will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- pimavanserin
almotriptan, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- pimozide
almotriptan, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- posaconazole
posaconazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- prednisone
prednisone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- primidone
primidone will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- protriptyline
almotriptan and protriptyline both increase serotonin levels. Modify Therapy/Monitor Closely.
- quetiapine
almotriptan, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- remifentanil
remifentanil increases toxicity of almotriptan by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.
- ribociclib
ribociclib will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifapentine
rifapentine will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- risperidone
almotriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- ritonavir
ritonavir will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rizatriptan
almotriptan and rizatriptan both increase serotonin levels. Use Caution/Monitor.
- rufinamide
rufinamide will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- SAMe
almotriptan and SAMe both increase serotonin levels. Use Caution/Monitor.
- secobarbital
secobarbital will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- selegiline
almotriptan and selegiline both increase serotonin levels. Modify Therapy/Monitor Closely.
- selegiline transdermal
almotriptan and selegiline transdermal both increase serotonin levels. Modify Therapy/Monitor Closely.
- sertraline
almotriptan and sertraline both increase serotonin levels. Modify Therapy/Monitor Closely.
- St John's Wort
almotriptan and St John's Wort both increase serotonin levels. Modify Therapy/Monitor Closely.
- sufentanil SL
sufentanil SL, almotriptan. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.
- sumatriptan
almotriptan and sumatriptan both increase serotonin levels. Use Caution/Monitor.
- sumatriptan intranasal
almotriptan and sumatriptan intranasal both increase serotonin levels. Use Caution/Monitor.
- tapentadol
almotriptan and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely.
- thiothixene
almotriptan, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- topiramate
topiramate will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tramadol
almotriptan and tramadol both increase serotonin levels. Use Caution/Monitor.
- trazodone
almotriptan and trazodone both increase serotonin levels. Modify Therapy/Monitor Closely.
- trifluoperazine
almotriptan, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- trimipramine
almotriptan and trimipramine both increase serotonin levels. Modify Therapy/Monitor Closely.
- venlafaxine
almotriptan and venlafaxine both increase serotonin levels. Modify Therapy/Monitor Closely.
- verapamil
verapamil will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- voriconazole
voriconazole will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- zafirlukast
zafirlukast will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ziprasidone
almotriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- zolmitriptan
almotriptan and zolmitriptan both increase serotonin levels. Use Caution/Monitor.
Minor (11)
- amobarbital
amobarbital will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- duloxetine
duloxetine, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- escitalopram
escitalopram, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fluoxetine
fluoxetine, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- milnacipran
milnacipran, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- nefazodone
nefazodone, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- paroxetine
paroxetine, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- sertraline
sertraline, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- trazodone
trazodone, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
- venlafaxine
venlafaxine, almotriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.
Adverse Effects
1-10%
Somnolence (1-5%)
Dizziness (3-4%)
Nausea (1-3%)
Vomiting (2%)
Dry mouth (1-2%)
Headache (1-2%)
Nausea (1-2%)
Paresthesia (1-2%)
Paresthesia (1%)
Somnolence (>1%)
<1%
Infrequent (0.01-0.001%)
- Anxiety, asthenia, chills, CNS stimulation, fatigue, hypesthesia, tremor
- Pruitus, rash
- Diaphoresis, dysmenorrhea, hyperglycemia, increased thirst
- Abdominal cramp, gastroenteritis
- Back pain, myalgia, neck pain, rigid neck, Increased CPK
- Bronchitis, chest pain, dyspnea, pharyngitis, rhinitis, sinusitis
- Conjunctivitis, tinnitis, vertigo
Rare (<0.001%)
- Hypertension, syncope
- Fever, insomnia, nervousness, nightmares
- Erythema, photosensitivity
- Colitis, esophegeal reflux, gastritis
- Arthralgia, arthritis, muscle weakness, myopathy
- Laryngitis, sneezing
- Eye abnormalities, nystagmus
- Hypercholesteremia, hyperventilation, increased gamma glutamyl transpeptidase, increased salvation
Postmarketing Experience
Hypersensitivity reactions (including angioedema, anaphylactic reactions and eye disorders including visual impairment, vision blurred) reported
Warnings
Contraindications
Hypersensitivity, severe hepatic or renal impairment, migraine prophylaxis
Ischemic heart disease, coronary artery vasospasm, including Prinzmetal's variant angina, uncontrolled HTN, hemiplegic or basilar migraines, cluster HA, cerebrovascular syndromes, PVD
Do not use within 24 hr of another 5-HT1 agonist or ergot derivative, or within 2 weeks of MAOIs
Ergotamine-containing and ergot-type medications
Concomitant Use With 5-HT1 Agonists (eg, Triptans)
Cautions
Transient and permanent blindness and partial vision loss have been reported with 5-HT-1 agonists
Use caution when prescribing to patient with known hypersensitivity to sulfonamides due to sulfonyl group in chemical structure of drug; sulfonyl group is structurally different from a sulfonamide; cross-sensitivity to almotriptan not systematically evaluated
Administer with caution to patients with diseases that may alter absorption, metabolism, or excretion of drugs, such as those with impaired hepatic or renal function
Adverse cardiac events
- Serious adverse cardiac events, including acute myocardial infarction, reported within a few hours following administration of the drug; life-threatening disturbances of cardiac rhythm and death have been reported within a few hours following administration of other triptans; considering the extent of use of triptans in patients with migraine, the incidence of these events is extremely low
- May cause coronary vasospasm, patients who experience signs or symptoms suggestive of angina following dosing should be evaluated for presence of coronary artery disease (CAD) or a predisposition to Prinzmetal’s variant angina before receiving additional doses of medication, and should be monitored electrocardiographically if dosing is resumed and similar symptoms recur
- Because of potential of this class of compound (5-HT1 agonists) to cause coronary vasospasm, drug should not be given to patients with documented ischemic or vasospastic coronary artery disease
- It is strongly recommended that drug not be given to patients in whom unrecognized CAD is predicted by presence of risk factors (eg, hypertension, hypercholesterolemia, smoker, obesity, diabetes, strong family history of CAD, female with surgical or physiological menopause, or male over 40 years of age) unless a cardiovascular evaluation provides satisfactory clinical evidence that the patient is reasonably free of coronary artery and ischemic myocardial disease or other significant underlying cardiovascular disease
- The sensitivity of cardiac diagnostic procedures to detect cardiovascular disease or predisposition to coronary artery vasospasm is modest, at best; if, during the cardiovascular evaluation, the patient’s medical history, electrocardiographic or other investigations reveal findings indicative of, or consistent with, coronary artery vasospasm or myocardial ischemia, the drug should not be administered
- For patients with risk factors predictive of CAD, who are determined to have a satisfactory cardiovascular evaluation, it is strongly recommended that administration of first dose of therapy take place in the setting of a physician’s office or similar medically staffed and equipped facility unless patient has previously received the drug
- Because cardiac ischemia can occur in the absence of clinical symptoms, consideration should be given to obtaining on first occasion of use an ECG during interval immediately following the dose, in these patients with risk factors
- It is recommended that patients who are intermittent long-term users and who have or acquire risk factors predictive of CAD, as described above, undergo periodic interval cardiovascular evaluation as they continue to use the drug
- The systematic approach described above is intended to reduce likelihood that patients with unrecognized cardiovascular disease will be inadvertently exposed to the drug
- The ability of cardiac diagnostic procedures to detect all cardiovascular diseases or predisposition to coronary artery vasospasm is modest at best
- Cardiovascular events associated with triptan treatment have occurred in patients with no cardiac history and with documented absence of coronary artery disease
Sensations of pain, tightness, pressure of the chest and/or throat neck, and jaw
- Sensations of tightness, pain, pressure, and heaviness in precordium, throat, neck, and jaw reported after treatment; because 5- HT1 agonists may cause coronary vasospasm
- Patients who experience signs or symptoms suggestive of angina following dosing should be evaluated for presence of CAD or a predisposition to Prinzmetal’s variant angina before receiving additional doses of medication, and should be monitored electrocardiographically if dosing is resumed and similar symptoms occur
- Patients shown to have CAD and those with Prinzmetal’s variant angina should not receive 5-HT1 agonists
Cerebrovascular events and fatalities
- Cerebral hemorrhage, subarachnoid hemorrhage, stroke, and other cerebrovascular events reported in patients treated with other triptans and some resulted in fatalities
- In a number of cases, it appeared possible that the cerebrovascular events were primary, the triptan having been administered in the incorrect belief that the symptoms experienced were a consequence of migraine, when they were not
- As with other acute migraine therapies, before treating headaches in patients not previously diagnosed as migraineurs and in migraineurs who present with atypical symptoms, care should be taken to exclude other potentially serious neurological conditions
- It should be noted that patients with migraine may be at increased risk of certain cerebrovascular events (eg, stroke, hemorrhage, and transient ischemic attack)
Vasospasm-related events, including peripheral vascular ischemia and Colonic Ischemia
- Therapy may cause vasospastic reactions other than coronary artery vasospasm, such as peripheral and gastrointestinal vascular ischemia with abdominal pain and bloody diarrhea
- Very rare reports of transient and permanent blindness and significant partial vision loss reported with use of triptans; visual disorders may also be part of a migraine attack
- Patients who experience symptoms or signs suggestive of decreased arterial flow following use of any triptan, such as ischemic bowel syndrome or Raynaud’s syndrome, are candidates for further evaluation
Serotonin syndrome
- The development of a potentially life-threatening serotonin syndrome may occur with triptans, including the drug, particularly during combined use with selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)
- If concomitant treatment with the drug and an SSRI (eg, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram) or SNRI (eg, venlafaxine, duloxetine) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases
- Serotonin syndrome symptoms may include mental status changes (eg, agitation, hallucinations, coma), autonomic instability (eg, tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (eg, hyperreflexia, incoordination) and/or gastrointestinal symptoms (eg, nausea, vomiting, diarrhea)
Medication overuse headache
- Overuse of acute migraine drugs (eg, ergotamine, triptans, opioids, or combination of these drugs for 10 or more days per month) may lead to exacerbation of headache (medication overuse headache)
- Medication overuse headache may present as migraine-like daily headaches or as a marked increase in frequency of migraine attacks
- Detoxification of patients, including withdrawal of overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary
Increases in blood pressure
- As with other triptans, significant elevations in systemic blood pressure have been reported on rare occasions in patients with and without a history of hypertension; very rarely these increases in blood pressure have been associated with significant clinical events
- Therapy is contraindicated in patients with uncontrolled hypertension In normotensive healthy subjects and patients with hypertension controlled by medication
Pregnancy & Lactation
Pregnancy Category: C
Lactation: excretion in milk unknown; use with caution
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.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
Pharmacokinetics
Half-Life: 3-4 hr
Peak Plasma Time: 1-3 hr
Bioavailability: 70%
Protein bound: 35%
Vd: 180-200 L
Absorption: Well absorbed
Metabolism: CYP3A4, CYP2D6
Excretion: Urine (75%)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| almotriptan malate oral - | 12.5 mg tablet |  | |
| almotriptan malate oral - | 6.25 mg tablet |  | |
| almotriptan malate oral - | 6.25 mg tablet |  | |
| almotriptan malate oral - | 12.5 mg tablet |  | |
| almotriptan malate oral - | 6.25 mg tablet |  | |
| almotriptan malate oral - | 12.5 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
almotriptan malate oral
ALMOTRIPTAN - ORAL
(AL-moe-TRIP-tan)
COMMON BRAND NAME(S): Axert
USES: Almotriptan is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Almotriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that narrows blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.Almotriptan does not prevent future migraines or lessen how often you get migraine attacks.
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking almotriptan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking almotriptan. He/she may also direct you to use your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.Take this medication by mouth with or without food as directed by your doctor at the first sign of a migraine. Do not take almotriptan to prevent a migraine.If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, you may take a second dose after 2 hours. Do not take more than 2 doses in a 24-hour period.The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).If you are using drugs for migraine attacks on 10 or more days each month, the drugs may actually make your headaches worse (medication overuse headache). Do not use medications more often or for longer than directed. Tell your doctor if you need to use this medication more often, or if the medication is not working as well, or if your headaches get worse.
SIDE EFFECTS: Drowsiness, dizziness, nausea, sensations of tingling/numbness/prickling, or dry mouth may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: blue fingers/toes/nails, cold sensation of hands/feet, hearing changes, mental/mood changes.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Almotriptan can commonly cause chest/jaw/neck tightness, pain, or pressure that is usually not serious. However, these side effects are like symptoms of a heart attack, which may include chest/jaw/left arm pain, shortness of breath, or unusual sweating. Get medical help right away if these or other serious side effects occur, including: fast/irregular heartbeat, fainting, severe stomach/abdominal pain, bloody diarrhea, signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: See also How to Use section.Before taking almotriptan, tell your doctor or pharmacist if you are allergic to it; or to other triptan migraine drugs; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (for example, in your legs, arms/hands, or stomach), certain types of headaches (hemiplegic or basilar migraine), heart problems (such as chest pain, irregular heartbeat, previous heart attack), stroke or "mini-stroke" (transient ischemic attack), kidney disease, liver disease.Certain conditions can increase your risk for heart problems. Tell your doctor if you have any of these conditions, including: diabetes, family history of heart disease, high blood pressure, high cholesterol, overweight, smoker, postmenopausal (women), age more than 40 years (men).This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).The risk of heart disease, liver disease, and high blood pressure increases with age. Older adults may be more sensitive to the side effects of this drug, especially increased blood pressure and heart problems.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.If you also take any ergotamine medication (such as dihydroergotamine) or other "triptan" drugs (such as zolmitriptan, rizatriptan), you will need to separate your almotriptan dose from your dose of these other medications to lessen the chance of serious side effects. Ask your doctor how long you should wait between your doses of these drugs.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Certain foods, beverages, or food additives (such as red wine, cheese, chocolate, monosodium glutamate) as well as lifestyle patterns such as irregular eating/sleeping habits or stress may bring on a migraine headache. Avoiding such "triggers" may help lessen migraine attacks. Consult your doctor for more details.Lab and/or medical tests (such as blood pressure) may be done while you are using this medication. Keep all medical and lab appointments.
MISSED DOSE: Not applicable. (See How to Use section.)
STORAGE: Store at room temperature away from light and moisture. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2021. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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- Compare formulary status to other drugs in the same class.
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