Triptan, migraine drugs

The drugs dealt with in this section are the ergot derivatives and the triptans (or more properly the serotonin 5-HTj agonists), whose main use is in the treatment of migraine. Table 16.1 , (below) lists some of the drugs commonly used in migraine. Drugs such as propranolol, which are more commonly used in other conditions, are discussed elsewhere in the publication. 

The P-blockers propranolol and timolol are FDA-approved for migraine prophylaxis, but other drugs in the class are also as effective.46 Cautious dosage titration is advised for those patients who do not have other indications for P-blocker use. Rizatriptan interacts with propranolol and thus dosages must be titrated downward, or another triptan chosen for abortive therapy.36 Comorbid reactive airway disease is a relative contraindication to P-blocker prophylaxis, and patients with cardiac conduction disturbances should be closely monitored. Calcium channel antagonists are often used when patients cannot tolerate P-blockers. They are purported to beneficially... 

Triptans and dihydroergotamine are drugs of choice for moderate to severe migraine attacks nasal sumatriptan is usually considered the triptan of choice due to its rapid onset there are a number of oral triptans, including frovatriptan, with more favorable biopharmaceuticprofiles and high costs comparisons not available... 

Sumatriptan and several other "triptans" are selective agonists for 5-HTiD and 5-HTiB receptors. These receptor types are found in cerebral and meningeal vessels and mediate vasoconstriction. They are also found on neurons and probably function as presynaptic inhibitory receptors. These drugs have proved to be very effective in the treatment of acute migraine headache. The mechanism of action is discussed in more detail below under Clinical Pharmacology of Ergot Alkaloids. 

Drugs used in the treatment of acute migraine, such as sumatriptan and rizatriptan, are 5-HTiB/iD-receptor agonists and could theoretically interact pharmacodynami-cally with SSRIs to cause serotonin toxicity. Triptans are metabolized mainly by monoamine oxidase, which makes pharmacokinetic interactions with SSRIs unlikely. Although case series have suggested that sumatriptan can be safely combined with SSRIs (SEDA-22, 14), there are occasional reports of toxicity. 

Moreover, propranolol also has a number of useful side effects. It has been proven to be effective in migraine prevention, and any new drug for migraine prevention will also have to be better and cheaper than propranolol. Notwithstanding the success of the triptans introduced several years ago that work once the migraine attack has started, preventative migraine medication will not be found unless, of course, it is found to be the side effect of a new drug approved and made available for another indication. ... 

Tfelt-Hansen P, DeVries P, Saxena PR. Triptans in migraine A comparative review of pharmacology, pharmacokinetics, and efficacy. Drugs... 

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