frovatriptan succinate monohydrate: clinical use

Prescribing considerations

• Establish a clear migraine diagnosis and reassess atypical or newly changed headache symptoms.
• Use is not recommended for hemiplegic, basilar or ophthalmoplegic migraine, during aura before headache, in children or in older adults because evidence is insufficient.
• Assess cardiovascular risk, particularly in heavy smokers, nicotine-replacement users, postmenopausal women and men over 40 with risk factors.
• Review frequent or daily headache for medication-overuse headache.
• Review pregnancy, breastfeeding, hepatic function, cardiovascular history and interacting medicines.

Contraindications and cautions

• Hypersensitivity to frovatriptan or an excipient.
• Previous myocardial infarction, ischaemic heart disease, coronary vasospasm or peripheral vascular disease.
• Symptoms or signs compatible with ischaemic heart disease.
• Moderately severe or severe hypertension, or uncontrolled mild hypertension.
• Previous stroke or transient ischaemic attack.
• Severe hepatic impairment.
• Concomitant ergotamine, ergot derivatives, methysergide or another triptan.

Monitoring

• No routine laboratory monitoring is specified.
• Monitor clinical response, adverse effects and headache frequency.
• Investigate chest pain or tightness that could represent myocardial ischaemia; do not re-expose after serious hypersensitivity.
• Monitor for serotonin toxicity when clinically relevant serotonergic combinations cannot be avoided.

Clinical pharmacology

Frovatriptan is a selective 5-HT1B/1D agonist, primarily metabolised through CYP1A2. It has low protein binding and a terminal elimination half-life of about 26 hours; food does not materially change bioavailability.

Formulation and product differences

• The products are lactose-containing oral film-coated tablets.
• The generic product and Migard differ in tablet markings, excipient quantities, blister materials, available pack sizes and storage instructions.
• Check the specific product information when lactose intolerance, storage or identification is clinically relevant.

Tablet

Route: Oral

Strengths: 2.5 mg