Almotriptan

Names
Trade names	Axert
Other names	Almotriptan hydrogen malate[1]
IUPAC name N,N-dimethyl-2- [5-(pyrrolidin-1-ylsulfonylmethyl)- 1H-indol-3-yl]-ethanamine
Clinical data
Drug class	Triptan[1]
Main uses	Migraine headaches[1]
Side effects	Nausea, dry mouth, sleepiness, numbness[2]
Routes of use	By mouth
Typical dose	12.5 mg[1]
External links
AHFS/Drugs.com	Monograph
MedlinePlus	a603028
Legal
License data	US DailyMed: Almotriptan
Legal status	UK: POM (Prescription only) US: ℞-only [4][5] EU: Rx-only [3] In general: ℞ (Prescription only)
Pharmacokinetics
Bioavailability	70%
Protein binding	35%
Metabolism	Liver
Eliminationhalf-life	3–4 hours
Chemical and physical data
Formula	C17H25N3O2S
Molar mass	335.47 g·mol−1
3D model (JSmol)	Interactive image
SMILES CN(C)CCc2c[nH]c3ccc(CS(=O)(=O)N1CCCC1)cc23
InChI InChI=1S/C17H25N3O2S/c1-19(2)10-7-15-12-18-17-6-5-14(11-16(15)17)13-23(21,22)20-8-3-4-9-20/h5-6,11-12,18H,3-4,7-10,13H2,1-2H3 Y Key:WKEMJKQOLOHJLZ-UHFFFAOYSA-N Y

Almotriptan, sold under the brand nameAxert among others, is a medication used to treatmigraine headaches.^[1] It may be used in people over the age of 11.^[6] There is a lack of evidence forcluster headaches.^[6] It is taken by mouth.^[1]

Common side effects include nausea, dry mouth, sleepiness, and numbness.^[2] Other side effects may include heart problems,stroke,Raynaud syndrome,serotonin syndrome, andmedication overuse headaches.^[2] Use in pregnancy may harm the baby.^[2] It is atriptan.^[1]

Almotriptan was patented in 1992 and approved for medical use in 2000.^[7] It is available as ageneric medication.^[1] In the United Kingdom it costs theNHS about £2.80 a dose as of 2021.^[1] This amount in the United States is about 9 USD.^[8]

Medical uses

Almotriptan is prescribed to treat the acute headache phase of migraine attacks with or withoutaura.^[9]

Efficacy

The efficacy and tolerability of almotriptan has been studied in trials totaling more than 4800 adults with either moderate or severe attacks of migraine. Its efficacy is more than placebo and alleviatesnausea,photophobia andphonophobia linked to migraine attacks. Almotriptan has similar efficacy as a standard dose ofsumatriptan, another triptan drug, and fewer adverse effects.^[10]

Dosage

It is generally taken at a dose of 12.5 mg, with a second dose of 12.5 mg after two hours if needed.^[1] More than 25 mg in a 24 hour period should not be used.^[1] Low doses should be used in people with liver or kidney problems.^[2]

Contraindications

As with other triptans, almotriptan should not be used in patients with a history, symptoms or signs ofischaemic heart disease (myocardial infarction, angina pectoris, documented silent ischaemia, Prinzmetal’s angina) or severehypertension and uncontrolled mild or moderate hypertension.Other contraindications are previouscerebrovascular accident (CVA) ortransient ischaemic attack (TIA),peripheral vascular disease, severe hepatic impairment, concomitant administration ofergotamine, ergotamine derivatives (including methysergide) and other 5-HT1_B/D agonists.

Side effects

Almotriptan has proved to have an adverse effects profile similar toplacebo when used following theSummary of Product Characteristics instructions (see references).

Interactions

Almotriptan is metabolized mainly by MAO-A and to lesser extent by CYP3A4 and CYP2D6. Studies of drugs used as preventive against migraine (propranolol andverapamil), anti-depressants (moclobemide andfluoxetine) yielded results that showed significant altering of the pharmacokinetics of almotriptan though they were deemed not clinically relevant.^[10]

Pharmacology

Mechanism of action

Like all triptans, almotriptan has a high and specific affinity for serotonin5-HT_1B/1D receptors. Binding of the drug to the receptor leads tovasoconstriction of the cranial (brain) blood vessels and thus affects the redistribution of blood flow. Almotriptan significantly increases cerebral blood flow and reduces blood flow through extracerebral cranial vessels. Even though it affects cranial blood vessels a single standard dose of almotriptan has no clinically significant effect on blood pressure or heart rate in both young and elderly healthy volunteers. Larger doses seem to slightly increase blood pressure but not beyond clinical relevance.^[10]

Pharmacokinetics

Almotriptan has linearpharmacokinetics up to the 16-fold standard dose. Itsbiological half-life is 3 hours, and itsbioavailability 70%.C_max is observed 1.5–4 hours after oral administration, and approximately 50% of the drug is excreted unchanged in the urine. Metabolism is mediated through the enzymesMAO-A andCYP3A4 andCYP2D6 oxidation.Almotriptanclearance is moderately reduced in the elderly but does not require dose adjustment.Sex does not alter the pharmacokinetics of the drug. People with moderate-to-severe renal dysfunction are recommended to use only half the dose.^[11]

Society and culture

Brand names

Brand names includeAxert (US, Canada),Almogran (Belgium, Denmark, Finland, France, Germany, Italy, Ireland Portugal, Spain, the United Kingdom, the Netherlands, Sweden, Switzerland, South Korea…),Almotrex (Italy),Almozen (Bulgaria and Poland) andAmignul (Spain).

References

External links

• "Almotriptan".Drug Information Portal. U.S. National Library of Medicine.Archived from the original on 2020-09-27. Retrieved2021-02-18.Archived 2020-09-27 at theWayback Machine
• "Almotriptan malate".Drug Information Portal. U.S. National Library of Medicine.Archived from the original on 2021-03-18. Retrieved2021-02-18.Archived 2021-03-18 at theWayback Machine

• Pages using duplicate arguments in template calls
• Webarchive template wayback links
• CS1 maint: archived copy as title
• Drugs with non-standard legal status
• Chemical articles with unknown parameter in Infobox drug
• Chemical articles without CAS registry number
• Articles without EBI source
• Chemical pages without ChemSpiderID
• Chemical pages without DrugBank identifier
• Articles without KEGG source
• Articles without UNII source
• Chemicals using indexlabels
• Drugs missing an ATC code
• Drugboxes which contain changes to verified fields
• Articles with hatnote templates targeting a nonexistent page
• Articles with changed CASNo identifier
• Triptans
• Pyrrolidines
• 5-HT1D agonists
• Johnson & Johnson brands
• RTT