almotriptan: clinical use

Prescribing considerations

• Confirm a clear migraine diagnosis and investigate new, atypical or substantially changed headache features before prescribing.
• Do not use for hemiplegic, basilar or ophthalmoplegic migraine.
• Evaluate possible underlying cardiovascular disease in patients with relevant risk factors.
• Review hepatic and renal function where impairment is known or suspected; product-specific restrictions apply.
• Consider medication-overuse headache when attacks become frequent or daily despite regular acute treatment.
• Safety and effectiveness have not been established in children, and experience in people older than 65 years is limited.

Contraindications and cautions

• Ischaemic heart disease, coronary vasospasm or symptoms suggestive of cardiac ischaemia
• Severe hypertension or uncontrolled mild-to-moderate hypertension
• Previous stroke or transient ischaemic attack
• Peripheral vascular disease
• Severe hepatic impairment
• Concurrent ergotamine, ergot derivatives or another 5-HT1B/1D agonist
• Hypersensitivity to almotriptan or an excipient

Monitoring

• Response and recurrence pattern across attacks
• Headache frequency and signs of medication overuse
• Blood pressure where clinically indicated
• Chest or throat symptoms and other evidence of vascular ischaemia
• Serotonin-syndrome symptoms when serotonergic medicines are co-prescribed

Clinical pharmacology

Almotriptan is a selective 5-HT1B/1D agonist with oral bioavailability of about 70%; food does not materially affect absorption. Elimination includes substantial unchanged renal excretion, MAO-A metabolism and smaller CYP3A4 and CYP2D6 contributions.

Formulation and product differences

• The selected UK product is a film-coated oral tablet.
• It contains mannitol and is considered essentially sodium-free.
• No special storage conditions are required.