Almotriptan pharmacokinetics

The effect of fluoxetine 60 mg/day for 8 days on the pharmacokinetics of almotriptan has been studied in 14 healthy volunteers (43). Fluoxetine produced a significant increase in the peak concentration of almotriptan, but the AUC was not altered. These results suggest that CYP2D6 plays a minor role in the metabolism of almotriptan. The combined treatment was reported to be well tolerated, but this does not exclude the possibility of occasional cases of serotonin toxicity in some individuals. 

Fleishaker JC, Ryan KK, Jansat JM, et al. (2001) Effect of MAO-A inhibition on the pharmacokinetics of almotriptan, an antimigraine agent in humans. Br J Clin Pharmacol 51 437-441. 

Some of the triptans are metabolized by monoamine oxidase and they should not be used with monoamine oxidase inhibitors. This includes almotriptan (34), rizatriptan (35), sumatriptan (36), and zolmitriptan (28). The effect of moclobemide on the pharmacokinetics of almotriptan was less than with other triptans (34). 

Twelve healthy subjects were given propranolol 80 mg twice daily for 7 days followed by a single 12.5-mg dose of almotriptan. Although some small changes were noted in the pharmacokinetics of almotriptan, these were not considered to be clinically significant and concurrent use of the combination was well tolerated. ... 

Erythromycin markedly raises the plasma levels of eletriptan. Clarithromycin, josamycin and troleandomycin are predicted to interact similarly. Almotriptan levels may be raised by erythromycin. Clarithromycin does not significantly alter the pharmacokinetics of sumatriptan. 

Fleishaker JC, Sisson TA, Carel BJ, AzieNE. Pharmacokinetic interaction between verapamil and almotriptan in healthy volunteers. Clin Pharmacol Ther (2000) 67, 498-503. 

A study in 21 women found that a single 12.5-mg dose of almotriptan had no clinically significant effect on the pharmacokinetics of a combined oral contraceptive containing ethinylestradiol 30 micrograms and des-... 

Although data are limited, the minor to modest possible ineieases in frov-atriptan, naratriptan, sumatriptan and zoimitriptan pharmacokinetics described are not likely to produce clinically relevant adverse effects. Almotriptan, rizatriptan and sumatriptan do not appear to have any clinically important effect on levels of contraceptive steroids. The significance of the single case report of ischaemic colitis associated with concurrent use of naratriptan and a combined oral contraceptive is unclear. Note that ischaemic colitis has, rarely, been reported with naratriptan itself The manufacturers have found no cases of ischaemic colitis in approximately 450 women on oral contraceptives and taking naratriptan for prophylaxis for 5 to 6 days. However, caution may be needed with concurrent use in those patients with risk factors for ischaemic colitis, such as those with a history of abdominal surgery, low blood pressure, diabetes, cardiovascular disease or stroke. 

Cabarrocas X, Macher J-P. Lack of a pharmacokinetic interaction between almotriptan and oral contraceptives a double-blind, placebo-controUed, crossover study in healthy female volunteers. Cephald a (2003) 23, 716. 

Jansat, J.M. Costa, J. Salva, P. Fernandez, F.J. Martinez-Tobed, A. Absolute bioavailability, pharmacokinetics, and urinary excretion of the novel antimigraine agent almotriptan in healthy male volunteers, J.Clin.PharmacoL, 2002, 42, 1303-1310. 

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