frovatriptan

REMS

Acute treatment of migraine headache.

Contraindicated in:

Hypersensitivity;
Ischemic heart disease or vasospastic angina (e.g., Prinzmetal's angina);
Wolff-Parkinson-White Syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders;
History of stroke or transient ischemic attack;
History of hemiplegic or basilar migraine;
Uncontrolled hypertension;
Peripheral vascular disease;
Ischemic bowel disease;
Should not be used within 24 hr of other 5-HT₁ agonists or ergot-type compounds (dihydroergotamine).

Use Cautiously in:

OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may be more susceptible to adverse cardiovascular effects.

Exercise Extreme Caution in:

Cardiovascular risk factors (hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes, strong family history, menopausal women or men >40 yr); use only if cardiovascular status has been evaluated and determined to be safe and first dose is administered under supervision.

CV: chest pain, CORONARY ARTERY VASOSPASM, MI, myocardial ischemia, VENTRICULAR ARRHYTHMIAS

Derm: flushing

GI: dry mouth, dyspepsia, nausea

MS: pain

Neuro: dizziness, drowsiness, fatigue, paresthesia

Drug-drug:

↑risk of serious vasospastic reactions with dihydroergotamine or ergotamine; concurrent use contraindicated.
Hormonal contraceptives or propranolol may ↑ levels.
↑risk of serotonin syndrome when used with fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, escitalopram, venlafaxine, or duloxetine.

(Generic available)

Tablets: 2.5 mg

PO (Adults ): 2.5 mg; if there has been initial relief, a 2nd tablet may be taken after at least 2 hr (daily dose should not exceed 3 tablets and should not be used to treat more than 4 attacks/30 day period).

Acts as an agonist at specific 5-HT receptor sites in intracranial blood vessels and sensory trigeminal nerves.

Therapeutic effects:

Cranial vessel vasoconstriction with associated decrease in release of neuropeptides and resultant decrease in migraine headache.

Therapeutic Classification: vascular headache suppressants

Pharmacologic Classification: five ht1 agonists

Absorption: 20–30% following oral administration.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Mostly metabolized by the liver via the CYP1A2 isoenzyme; some metabolites eliminated in urine, <10% excreted unchanged.

Half-Life: 26 hr.

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–4 hr	unknown

Inform patient that frovatriptan should be used only during a migraine attack. It is meant to be used to relieve migraine attack but not to prevent or reduce the number of attacks.
- Instruct patient to administer frovatriptan as soon as symptoms appear, but it may be administered any time during an attack. If migraine symptoms return, a 2nd dose may be used. Allow at least 2 hr between doses, and do not use more than 3 tablets in any 24-hr period.
- If dose does not relieve headache, additional frovatriptan doses are not likely to be effective; notify health care professional.
- Caution patient not to take frovatriptan within 24 hr of another vascular headache suppressant.
- Advise patient that lying down in a darkened room following frovatriptan administration may further help relieve headache.
- May cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient that overuse (use more than 10 days/mo) may lead to exacerbation of headache (migraine-like daily headaches, or as a marked increase in frequency of migraine attacks). May require gradual withdrawal of frovatriptan and treatment of symptoms (transient worsening of headache).
- Advise patient to notify health care professional prior to next dose of frovatriptan if pain or tightness in the chest occurs during use. If pain is severe or does not subside, notify health care professional immediately. If wheezing; heart throbbing; swelling of eyelids, face, or lips; skin rash; skin lumps; or hives occur, notify health care professional immediately and do not take more frovatriptan without approval of health care professional. If feelings of tingling, heat, flushing, heaviness, pressure, drowsiness, dizziness, tiredness, or sickness develop, discuss with health care professional at next visit.
- Advise patient to avoid alcohol, which aggravates headaches, during frovatriptan use.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Advise patient to notify health care professional immediately if signs or symptoms of serotonin syndrome occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆