What are triptans?

From the Guidelines

Triptans are a class of medications primarily used to treat migraine headaches, working by stimulating serotonin receptors in the brain to constrict blood vessels and reduce inflammation, and should be taken at the first sign of a migraine for maximum effectiveness, as recommended by the most recent guidelines 1.

Key Characteristics of Triptans

• They are available in various forms including tablets, nasal sprays, and injections, with typical dosages ranging from 2.5mg to 100mg depending on the specific triptan.
• Common triptans include sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), naratriptan (Amerge), almotriptan (Axert), frovatriptan (Frova), and eletriptan (Relpax).
• They should not be used by people with certain cardiovascular conditions or within 24 hours of taking ergotamine medications or other triptans, and they should not be combined with MAO inhibitors or SSRIs due to risk of serotonin syndrome.

Usage and Side Effects

• Triptans are not recommended for daily use due to the risk of medication overuse headaches; they should generally be limited to 2-3 days per week.
• Side effects may include dizziness, fatigue, chest tightness, and tingling sensations.
• Consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting, as suggested by recent guidelines 1.

Treatment Approach

• Counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy (such as a triptan with an NSAID or acetaminophen) to improve efficacy.
• If the episodic migraine occurs frequently or treatment does not provide an adequate response, the addition of preventive medications may be warranted.
• Patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and should be managed accordingly, as recommended by recent studies 1.

From the FDA Drug Label

Sumatriptan tablets, USP are a serotonin (5-HT1B/1D) receptor agonist (triptan) indicated for acute treatment of migraine with or without aura in adults. Eletriptan hydrobromide is a serotonin (5-HT1B/1D) receptor agonist (triptan) indicated for the acute treatment of migraine with or without aura in adults

Triptans are a class of medications that are serotonin (5-HT1B/1D) receptor agonists, used for the acute treatment of migraine with or without aura in adults 2, 3. They are not indicated for the prophylactic therapy of migraine or the treatment of cluster headache. Key points about triptans include:

• They are used to treat migraine attacks
• They are not used to prevent migraine attacks
• They are not used to treat cluster headaches
• Examples of triptans include sumatriptan and eletriptan 2, 3, 3

From the Research

Definition and Mechanism of Triptans

• Triptans are a class of compounds developed for the treatment of migraine attacks, acting as serotonin 5-HT1B and 5-HT1D receptor agonists 4.
• They work by decreasing neurogenic inflammation peripherally in the meninges, vasoconstriction of meningeal vessels, and modulating secondary-order neurons in the brain stem 5.
• Triptans are not pain medications, but rather abortive migraine medications that cannot prevent migraines 6.

Types and Efficacy of Triptans

• There are seven triptans available worldwide, including sumatriptan, zolmitriptan, naratriptan, rizatriptan, eletriptan, almotriptan, and frovatriptan 4, 6.
• Each triptan has its own distinctive pharmacokinetic properties, resulting in different profiles of efficacy and tolerability 5.
• Standard dose triptans relieve headaches within 2 hours in 42 to 76% of patients, and 2-hour sustained freedom from pain is achieved for 18 to 50% of patients 7.

Clinical Use and Safety of Triptans

• Triptans are effective and well-tolerated drugs in the acute treatment of migraine attacks, and are the most cost-effective migraine therapy in patients with severe symptoms 8.
• Triptans should be considered as first-line therapy in a stratified strategy, ensuring 'right treatment first time' for patients with severe migraine 8.
• Clinical experience shows that a non-responder to one triptan may well benefit from another triptan, or even the same compound via a different route of administration 8.

Comparison with Other Treatments

• Triptans are associated with better outcomes than ergots, and most triptans are associated with equal or better outcomes compared with NSAIDs, ASA, and acetaminophen 7.
• Use of triptans in combination with ASA or acetaminophen, or using alternative modes of administration such as injectables, may be associated with slightly better outcomes than standard dose triptan tablets 7.