Almotriptan is a selective
serotonin 5-HT(1B/1D) receptor agonist ('
triptan'). Its efficacy and tolerability have been assessed in a number of randomised, controlled trials in over 4800 adults with moderate or severe attacks of
migraine. Oral
almotriptan has a rapid onset of action (significant
headache relief is observed 0.5 hours after administration of a 12.5mg dose) and efficacy is sustained in most patients who respond by 2 hours. The
drug is significantly more effective than placebo as measured by a number of parameters including 2-hour
headache response and
pain-free response rates. Other symptoms of
migraine, including
nausea,
photophobia and
phonophobia, are also alleviated by
almotriptan. The efficacy of oral
almotriptan appears to be maintained over repeated doses for multiple attacks of
migraine treated over a long period (up to 1 year). High
headache response rates were reported over all attacks without tachyphylaxis. For the relief of single attacks of
migraine, oral
almotriptan 12.5mg had similar efficacy to oral
sumatriptan 50mg. Patients given
almotriptan report less concern with adverse effects than patients given
sumatriptan. The lower incidence of
chest pain following treatment with
almotriptan than with
sumatriptan may lead to a reduction in direct costs, with fewer patients requiring management of
chest pain.
Almotriptan is well tolerated. Most adverse events were of mild or moderate intensity, transient and generally resolved without intervention or the need for treatment withdrawal. The most common adverse events associated with oral
almotriptan 12.5mg treatment were
dizziness, paraesthesia,
nausea,
fatigue,
headache,
somnolence, skeletal
pain,
vomiting and chest symptoms. The incidence of adverse events did not differ from placebo and decreased in the longer term.
Almotriptan can be coadministered with drugs that share a common hepatic metabolic path; in addition, dosage reduction is required only in the presence of severe renal or hepatic impairment.
CONCLUSIONS:
Almotriptan is an effective
drug for the acute treatment of moderate or severe attacks of
migraine in adults. An oral dose of
almotriptan 12.5mg has shown greater efficacy than placebo; current data indicate that efficacy is similar to that of oral
sumatriptan 50mg, and is maintained in the long term (< or = 1 year).
Almotriptan has a good adverse event profile and a generally similar overall tolerability profile to
sumatriptan; of note,
almotriptan is associated with a significantly lower incidence of
chest pain than
sumatriptan. However, further clinical experience is required to clearly define the place of
almotriptan among the other currently available
triptans. Nevertheless, because
triptans have an important place in various management regimens, and because the nature of individual patient response to
triptans is idiosyncratic,
almotriptan is likely to become a useful treatment option in the management of adults with moderate or severe
migraine headaches.