Almotriptan

Almotriptan (trade names: Axert (US-Canada), Almogran (Belgium, Denmark, Finland, France, Germany, Italy, Ireland Portugal, Spain, the United Kingdom, the Netherlands, Sweden, Switzerland, South Korea… ) + also Almotrex (Italy) and Amignul (Spain)), is a triptan drug discovered and developed by Almirall for the treatment of migraine headache. It is available in 12.5 mg in most countries and also 6.25 mg in US and Canada.

Indications
Almotriptan is prescribed to treat the acute headache phase of migraine attacks with or without aura.

Almotriptan is the only oral triptan approved in the USA for the treatment of migraine in adolescent from 12 to 17 years of age.

Mechanism of action
Almotriptan is a selective and potent serotonin 5-HT1B/1D agonist. Because of the particular distribution of the 5-HT1B/1D receptors, almotriptan basically constricts the human meningeal arteries; therefore it has a limited effect on arteries supplying blood to the brain, and little effect on cardiac and pulmonary vessels.

Pharmacokinetics
Almotriptan has no clinically relevant pharmacokinetic drug interactions and is metabolized through different pathways, requiring no dosage adjustment in patients with non-severe renal or hepatic impairment. There are also no clinically relevant differences between men and women or between the young and the elderly.

Efficacy
The efficacy of almotriptan in the acute treatment of migraine attacks was established in clinical trials involving more than 3000 patients who were administered 12.5 mg and it was found to have a fast onset of action and high efficacy to reach pain free status (see references). Almotriptan relieves nausea, vomiting, photophobia (light hypersensitivity) and phonophobia (sound hypersensitivity) associated with migraine attacks pain. In the recent Act When Mild study, it was proven that taking almotriptan at the first sign of a migraine attack, while pain is still mild, provides optimal outcomes to ensure patients’ suffering is minimised. (see references)

Contraindications
(see SmPC) Hypersensitivity to the active substance or to any of the excipients.

As with other 5-HT1B/1D receptor agonists, almotriptan should not be used in patients with a history, symptoms or signs of ischaemic heart disease (myocardial infarction, angina pectoris, documented silent ischaemia, Prinzmetal’s angina) or severe hypertension and uncontrolled mild or moderate hypertension.

Patients with a previous cerebrovascular accident (CVA) or transient ischaemic attack (TIA). Peripheral vascular disease.

Concomitant administration with ergotamine, ergotamine derivatives (including methysergide) and other 5-HT1B/1D agonists is contraindicated.

Patients with severe hepatic impairment.

Side effects
(see SmPC) Almotriptan has proved to have an adverse effects profile similar to placebo when used following the Summary of Product Characteristics instructions (see references).

"For rare adverse events, please refer to the manufacturer´s webpage"