eletriptan

Contraindicated in:

Hypersensitivity;
Hemiplegic or basilar migraine;
Ischemic heart disease or Prinzmetal's angina;
Uncontrolled hypertension
Wolff-Parkinson-White syndrome or other arrhythmias involving conduction pathways
Stroke or transient ischemic attack;
Peripheral vascular disease;
Ischemic bowel disease
Concurrent use or use within 24 hr of other 5-HT₁ agonists or ergot-type compounds (dihydroergotamine);
Concurrent use or use within 72 hr of strong CYP3A4 inhibitors;
Severe hepatic impairment.

Use Cautiously in:

OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Doses up to 80 mg daily not expected to cause adverse effects in breastfed infants >2 mo;
Pedi: Safety and effectiveness not established in children;
Geri: ↑risk of ↑ BP in older adults.

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 1st dose is administered under supervision.

Adv. Reactions/Side Effects ⬆ ⬇

CV: angina, chest tightness/pressure, coronary vasospasm, ECG changes, MI, transient hypertension, VENTRICULAR FIBRILLATION, VENTRICULAR TACHYCARDIA

GI: abdominal pain, dry mouth, dysphagia, nausea

Neuro: dizziness, drowsiness, paresthesia, weakness

Misc: ANAPHYLAXIS

Interactions ⬆ ⬇

Drug-drug:

Strong CYP3A4 inhibitors, including ketoconazole, itraconazole, nefazodone, clarithromycin, ritonavir, and nelfinavir may ↑ levels and risk of toxicity; use within 72 hr is contraindicated.
Ergot-containing drugs, including dihydroergotamine may result in prolonged vasospastic reactions; use within 24 hr is contraindicated.
↑risk of serotonin syndrome with SSRIs, SNRIs, TCAs, meperidine, bupropion, or buspirone; avoid concurrent use.

Availability ⬆ ⬇

(Generic available)

Tablets: 20 mg; 40 mg

Route/Dosage ⬆ ⬇

PO (Adults ): 20 or 40 mg as a single dose; may be repeated in 2 hr if initial response is inadequate (not to exceed 80 mg/24 hr or treatment of 3 headaches/mo).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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

Therapeutic effects:

Cranial vessel vasoconstriction with resultant decrease in migraine headache.

Classifications ⬆ ⬇

Therapeutic Classification: vascular headache suppressants

Pharmacologic Classification: five ht1 agonists

Pharmacokinetics ⬆ ⬇

Absorption: 50% absorbed after oral administration.

Distribution: Well distributed to tissues.

Metabolism/Excretion: Mostly metabolized by the liver via the CYP3A4 isoenzyme.

Half-Life: 4 hr.

Time/Action Profile ⬆ ⬇

(decreased migraine pain)

ROUTE	ONSET	PEAK	DURATION
PO	within 2 hr	2 hr	up to 24 hr

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of eletriptan. Instruct patient that eletriptan should only be used during a migraine attack, not for prevention. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
Instruct patient to take eletriptan at the 1st sign of a migraine, but may be administered at any time during attack. Allow ≥2 hr between doses and do not use >80 mg/day or for >3 attacks/mo.
Caution patient not to take eletriptan within 24 hr of other vascular headache suppressants.
Advise patient that lying down in a darkened room after eletriptan administration may further help relieve headache.
Advise patients and family to call 911 and seek urgent treatment if pain or tightness in the chest occurs. If feelings of tingling, heat, flushing, heaviness, pressure, nausea, drowsiness, dizziness, tiredness, or sickness develop, discuss with health care provider at next visit and before next dose of eletriptan.
Warn patient to report symptoms of arrhythmias (fast heart beat, skipped beats, palpitations, dizziness, lightheaded, trouble breathing, faintness).
May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Instruct 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 avoid alcohol, which aggravates headaches, during therapy.
Advise patient that overuse (use >10 days/month) may lead to exacerbation of headache (migraine-like daily headaches, or as a marked ↑ in frequency of migraine attacks). May require gradual withdrawal of eletriptan and treatment of symptoms (transient worsening of headache).
Instruct patient to notify health care professional if signs of serotonin syndrome (mental status changes: agitation, hallucinations, coma; autonomic instability: tachycardia, labile BP, hyperthermia; neuromuscular aberrations: hyperreflexia, incoordination; and/or gastrointestinal symptoms: nausea, vomiting, diarrhea) occur.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇