naratriptan: clinical use

Prescribing considerations

• Confirm a clear migraine diagnosis and investigate new, atypical or changing neurological symptoms.
• Not indicated for hemiplegic, basilar or ophthalmoplegic migraine; effectiveness during aura before headache onset is unestablished.
• Assess cardiovascular risk before prescribing to patients with significant risk factors, including heavy smoking or nicotine-replacement use.
• Use requires caution in renal or hepatic impairment; exposure rises when clearance is reduced.
• Use is not recommended below age 18 or above age 65 for the selected product.
• Consider medication-overuse headache where acute treatments are used frequently.

Contraindications and cautions

• Previous myocardial infarction, ischaemic heart disease, coronary vasospasm or peripheral vascular disease
• Previous stroke or transient ischaemic attack
• Moderate or severe hypertension, or mild uncontrolled hypertension
• Severe renal or hepatic impairment
• Concomitant ergot derivatives or another triptan/5-HT1 receptor agonist
• Hypersensitivity to naratriptan or an excipient

Monitoring

• Review persistent or intense chest symptoms and stop further use pending assessment.
• Monitor blood pressure where clinically appropriate.
• Observe for serotonin syndrome when combined with an SSRI, SNRI or another serotonergic agent.
• Review headache frequency and acute-treatment use for possible medication-overuse headache.

Clinical pharmacology

Naratriptan is a selective 5-HT1B/1D agonist with low plasma-protein binding and an elimination half-life of about six hours. Renal excretion, including active tubular secretion, is the main elimination route; metabolism involves several CYP isoenzymes, making major metabolic interactions unlikely.

Formulation and product differences

• The selected product is a green, D-shaped film-coated oral tablet.
• It contains anhydrous lactose and is essentially sodium-free.
• The tablet should be swallowed whole with water.

Tablet

Route: Oral

Strengths: 2.5 mg