Generic Name and Formulations:
Almotriptan (as malate) 6.25mg, 12.5mg; tabs.
Janssen Pharmaceuticals, Inc.
Indications for AXERT:
Acute treatment of migraine attacks in adults. Acute treatment of migraine headache pain in adolescents age 12–17yrs with a history of migraine attacks lasting ≥4hrs (when untreated).
Limitations Of use:
Confirm diagnosis. Not established for adolescents with migraine-associated symptoms or in older males for cluster headaches. Do not use for migraine prophylaxis.
6.25–12.5mg single dose; may repeat once after 2hrs; max 25mg/24hrs. Hepatic or severe renal impairment (CrCl 10–30mL/min) or concomitant potent CYP3A4 inhibitors (eg, ketoconazole): initially 6.25mg once; max 12.5mg/24hrs. The safety of treating an average of more than 4 migraines over 30 days is not established.
Ischemic heart disease (eg, angina pectoris, silent ischemia, history of MI). Coronary artery vasospasm (eg, Prinzmetal's variant angina). Other significant cardiovascular disease. Uncontrolled hypertension. Cerebrovascular events (eg, stroke, TIA). Peripheral vascular disease (eg, ischemic bowel disease). Basilar or hemiplegic migraine. Within 24hrs of other 5-HT1 agonists or ergot-type drugs.
Reevaluate if angina or ischemia symptoms (eg, ischemic bowel syndrome, Raynaud's syndrome) occur, or if no response after 1st dose. Exclude underlying cardiovascular disease, supervise 1st dose, and consider monitoring ECG in patients with likelihood of unrecognized coronary artery disease (eg, postmenopausal women, men over age 40, hypertension, hypercholesterolemia, obesity, diabetes, smokers, strong family history). Monitor cardiovascular function in long-term intermittent use. Cerebrovascular events (eg, stroke, hemorrhage, TIA), peripheral vascular or colonic ischemia following other 5-HT1 agonists. May exacerbate headache with overuse. Hepatic or renal dysfunction. Sulfonamide hypersensitivity. Elderly. Labor & delivery. Pregnancy (Cat.C). Nursing mothers.
Methysergide, other ergotamines, or other 5-HT1 agonists: see Contraindications. Monitor for serotonin syndrome with SSRIs (eg, fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram), SNRIs (eg, venlafaxine, duloxetine). Potentiated by ketoconazole, other potent CYP3A4 inhibitors (avoid if concomitant hepatic or renal impairment).
Selective 5-HT1B/1D receptor agonist.
Nausea, dry mouth, paresthesia, somnolence, dizziness, headache, vomiting, throat/neck/chest pain, pressure or tightness; rare: serious cardiac events, vision loss.
Tabs 6.25mg—6; 12.5mg—12
Psychiatry Advisor Articles
- ACOG Update: Marijuana Use Discouraged During Pregnancy, Breastfeeding
- Asenapine Prevents Recurrence of Mood Events in Bipolar Disorder
- Depression Profiles in Patients With Type 1 Diabetes vs Type 2 Diabetes
- No Evidence of Personality Changes Prior to Developing Cognitive Impairment, Dementia
- Retirement Saving Behavior Associated With Psychological Distress
- Suicidal Behavior, Thoughts Associated With Perfectionist Tendencies
- Physicians Spend Nearly 6 Hours on EHR Tasks Per Day
- CBT, Acceptance Commitment Therapy Helpful for Those With Chronic Pain
- Depression Reduced by Social Belonging, Feelings of Inclusion
- Sleep Disturbance May Be Causal Factor in Psychotic Experiences
- Venlafaxine XR Safe, Effective in Treating Generalized Anxiety Disorder
- Enhanced Vaccination Effectiveness in Older Adults Linked to Positive Mood
- Subjective Cognitive Decline Linked to Alzheimer Biomarker
- Unnecessary Costs Associated With Low-Cost, Low-Value Health Services
- Is Hypertension Linked to an Increased Risk of Dementia?