This article will discuss triptan migraine medications to help you discover the best migraine treatment for you. The comparisons will discuss side effects, relief onset and duration and will introduce you to a new injectable triptan called Sumavel.
Treximet is an oral combination of two drugs– a triptan (sumatriptan) and a non-steroidal anti-inflammatory drug (NSAID) called naproxen. This combination is usually more effective for migraines and lasts longer than if migraine sufferers take one of the triptans by itself. One reason for the long-lasting effect is that the naproxen stays in the system for an extended time. Another reason is that Treximet contains 85mg of sumatriptan. This dose is in the upper part of the dosage range. We already know that the 100mg sumatriptan tablets are usually more effective than the other available lower 25mg and 50mg doses. Of the orals, Treximet usually starts to work as fast as or faster than the other triptans (usually within 20 to 30 minutes).
Sumatriptan is the only ingredient in a brand called Imitrex (same as the triptan in Treximet) . Imitrex can be taken orally and it may begin to work as fast as Treximet but it won’t last as long. Imitrex probably won’t help as much either, unless you take it with a NSAID. Even with generic Imitrex plus generic naproxen, I don’t think you could reap a cost savings over taking Treximet.
An oral triptan called Relpax (eletriptan) might start to work for migraine relief as fast as Treximet. The relief also lasts a decent length of time, so it is a good choice if you cannot tolerate NSAID drugs. It is a powerful inhibitor of the metabolism of certain drugs, causing them to build up in the system to unpredictable and possibly toxic levels. These drugs include, among others, the antibiotic Biaxin (generic name is clarithromycin) and anti-HIV drugs such as Norvir (ritonavir) and Viracept (nelfinavir), and the antifungal Sporanox ( itraconazole). Relpax should not be taken with these drugs.
Frova is an oral triptan (frovatriptan) that gives the longest migraine relief, which might account for its better ability to keep headaches from coming back. However, it is quite slow to begin working, sometimes taking 2 to 3 hours to start helping.
Maxalt and Maxalt-MLT contain a triptan called rizatriptan. Maxalt-MLT is taken without water by dissolving it on the tongue. Maxalt has an onset of action between ½ hour and 2 hours. Compared to the other oral triptans for migraine, it has the best efficacy at 2 hours after it is taken, but headache recurrence rate is high with it.
Zomig and Zomig-ZMT are oral brands for zolmitriptan. Zomig-ZMT may be also dissolved on the tongue. Zomig takes longer to begin relieving a migraine, about 45 minutes after dosing.
Amerge is an oral brand of naratriptan. It has fewer side effects than Imitrex but it takes at least an hour to start helping and it may take as long as 3 hours to bring relief. Migraines don’t recur as often as with Imitrex.
Axert (almotriptan) can start to help anywhere between 30 minutes to 2 hours and it is also better tolerated than Imitrex.
Side Effects of Oral Triptans
Dizziness may occur less often with Axert and Imitrex. Dizziness increases with higher doses of Imitrex, but occurred in only about 2% with the higher dosage in patient trials. Dizziness may occur most frequently with Maxalt and Frova, with an incidence of 9% and 8%, respectively, in patient trials.
Nausea occurred in the fewest patients in trials with Frova and Imitrex (less than 1%) and it occurred the most often with Zomig (9%).
Zomig had the most common occurrence of neck, throat, or jaw discomfort in trials (7%) and the fewest patients had this problem with Frova, Relpax, and Axert (less than 2%).
Tingling and numbness were also more common with Zomig (7%) but were reported with the least frequency with Axert (1%), Amerge (2%), and Treximet (2%).
Nasal Spray Triptans
Zomig (zolmitriptan) is available in the nasal spray form. It has a faster onset of action than the orals, but Treximet runs a close second, possibly taking only five minutes more to act in some cases. This nasal form is generally more expensive than the oral triptans. Some patients (21% in trials) have complained about the taste. Zomig nasal spray’s side effect profile also includes a 10% incidence of tingling and numbness and a 4% incidence for both nausea and throat pain.
Imitrex nasal spray has the same quick onset as Zomig nasal spray but doesn’t last as long. Even more patients (24.5) have commented about the “unusual taste.” It causes a lot more nausea (13.5%) than Zomig spray but a little less throat pain (2.4%). Numbness and tingling were not significant.
Sometimes vomiting occurs with migraines and that is one of the reasons that nasal sprays and Injectables are sometimes used. They are also used for their typically rapid onset.
The newest Injectable triptan migraine reliever, expected to be available very early in 2010, is called Sumavel DosePro. Sumavel does not use a needle. The dose is injected with high-pressure nitrogen gas. Sumavel contains sumatriptan (in Treximet and Imitrex) and it works as rapidly as, and is as effective as, sumatriptan delivered by needle injections. The drawback is that Sumavel may cause more pain and discomfort and bleeding and bruising than the needle injections do. I can’t really find any advantages for Sumavel over the Imitrex injectionable, though individual responses do tend to vary. Additionally, I would not expect Sumavel to be less expensive than the Imitrex injectable.
Imitrex injectable (by needle), though it has a slightly faster onset than some of the fastest-acting orals, also brings with it a significant increase in side effects. Pain at the injection site was reported in 59% of patients in trials, tingling in 14%, dizziness in 12%, warm/hot sensations in 11%, chest discomfort in 5%, flushing in 7%, neck discomfort in 5%, and jaw discomfort in 2%.
Contraindications of Triptans
Triptan migraine treatments should not be given to patients with hemiplegic or basilar migraines. A hemiplegic migraine is a type of migraine that comes with an aura and muscle weakness and paralysis. Basilar migraines are due to a problem with an artery in the base of the brain. In addition to auras, basilar migraines may cause poor coordination, vertigo, and double vision.
Triptans fall into pregnancy category C. Drugs in category C have had studies with reports of dangers to the fetuses of animals, but have had no conclusive studies in humans. They should be given to pregnant women only if the benefits might outweigh the risk.
All of the triptans are contraindicated in the presence of cardiovascular disease that includes (but is not limited to) strokes, angina, myocardial infarction and in high blood pressure that is not controlled.
Monoamine oxidase inhibitor (MAOI) drugs such as Nardil are sometimes prescribed for depression. Amerge, Axert, Relpax, and Frova are not specifically contraindicated to be taken with MAOIs. None of the other triptans should be taken with MAOIs. None of them should be taken with other triptans or with a class of drugs that is derived from ergot (such as Cafergot).
Patients should be sure their doctors are aware of any organ system problems, including liver, kidney, cardiovascular, or other disease states when getting treatment for migraine headaches. Doctors and pharmacists should be told about any medications to which there has been an allergic reaction.
You can help your doctor determine which is the best migraine treatment for you by learning the difference in the triptans. If your migraines cause you to vomit, you may choose an injectable or nasal triptan. If you cannot bear the sight of needles but you want fast relief, you may try the new migraine treatment named Sumavel. If you want an extended relief in an oral remedy for migraines, Treximet is a good choice. If you have had dizziness when taking triptans, Axert or Imitrex may be the best of the triptan migraine remedies for you.
DISCLAIMER: This article comparing the triptans is provided for information only. This information is not a substitute for professional medical care by a qualified doctor or other health care professional. I am not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information. This information is in no way intended as a recommendation of any of the triptans or any other drug therapy and is not intended as a diagnosis of any problem you may have.
Comparison of available triptans. Pharmacist’s Letter/Prescriber’s Letter 2009;25(5):250509
No author given. Hemiplegic Migraine Headaches: Symptoms, Causes, Treatments. Webmd.com
No author given. Basilar Artery Migraines: Causes, Symptoms, Tests, and Treatments. Webmd.com
No author given. GSK Prescribing Imation: Amerge. GSK.com
No author given. Sumavel DosePro. Drugs.com
No author given. Prescribing Information: Axert. Axert360.com
No author given. Prescribing Information: Maxalt. Merck.com
No author given. Prescribing Information: Relpax. Pfizer.com
No author given. Prescribing Information: Frova. Endo.com
No author given. Sumavel DosePro. Zogenix.com
No author given. Sumavel DosePro. RxList.com
Labels: A Pharmacist Compares Triptan Migraine Medications