Triptans for the treatment of headaches and migraines – the rules of choice

The use of triptans is preferable for patients suffering from moderate to high-intensity headaches, which drastically reduce their ability to work. The choice of triptan depends on some differences in pharmacokinetics and the preferred mode of administration.
Based on the analysis of data provided by pharmaceutical companies on the results of double-blind randomized trials, a comparative characteristic of triptans was carried out. This analysis showed that of the quick-acting oral triptans, first of all, preference should be given to rizatriptan®, eletriptan or almotriptan.

Despite good tolerability, frovatriptan and naratriptan are less effective than oral triptans.

The vast majority of patients respond to triptan therapy in at least one in three clinical trials. Migraine attacks, accompanied by more severe symptoms, are more difficult to correct, therefore, before drawing conclusions about treatment failure, patients should first stop several migraine attacks with just one triptan.

The combination of triptan with analgesic can increase the resistance of the analgesic effect. For example, during randomized double-blind trials, when the efficacy of 85 mg of sumatriptan in combination with 500 mg of naproxen was compared with the effectiveness of each drug individually or with placebo, more persistent relief was found in those who took sumatriptan with naproxen (23-25% of patients) , compared with sumatriptan monotherapy (14-16%), naproxen (10%) or placebo (7-8%).

Triptans are contraindicated in patients with cardiovascular diseases, ischemic bowel disease, uncontrolled arterial hypertension or severe liver disease. It is also undesirable to use triptans in patients who take monoamine oxidase inhibitors, or ergotamines. Triptans are contraindicated in hemiplegic or basilar migraine – a rare type of migraine, accompanied by loss of consciousness and impaired stem functions.

local_offerevent_note January 23, 2019

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