From the Guidelines
Naratriptan and sumatriptan are both effective triptans for treating migraine headaches, but the choice between them depends on the patient's migraine pattern, desired onset of action, and side effect tolerance. The main difference between naratriptan and sumatriptan is their onset of action and duration of relief.
- Sumatriptan works more quickly (within 30 minutes) but has a shorter duration (3-4 hours), making it ideal for rapid relief of acute migraines.
- Naratriptan acts more slowly (1-3 hours) but provides longer-lasting relief (up to 24 hours) with potentially fewer side effects and lower recurrence rates. Both medications work by binding to serotonin receptors to constrict blood vessels and reduce inflammation in the brain. Neither should be used by patients with cardiovascular disease, uncontrolled hypertension, or hemiplegic migraine. Common side effects include chest tightness, dizziness, and fatigue, though naratriptan typically causes fewer of these effects 1. It's essential to consider individual patient preferences, such as route of administration and cost, when choosing between naratriptan and sumatriptan 1. Additionally, patients should be aware of the potential for medication overuse headache and the importance of lifestyle modifications, such as staying well hydrated and maintaining regular meals, to help manage migraine symptoms 1. The most recent and highest quality study recommends considering the use of a nonoral triptan and an antiemetic in people having severe nausea or vomiting, and counseling patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy 1.
From the Research
Comparison of Naratriptan and Sumatriptan
- Naratriptan and sumatriptan are both triptans used for the treatment of migraine headaches 2
- Sumatriptan is a serotonin1 (5-HT1) receptor agonist, which is effective in the acute treatment of migraine headache 3
- Naratriptan has a longer time to onset but is associated with a lower rate of migraine recurrence than other triptans, including sumatriptan 2
- Sumatriptan has a shorter half-life (approximately 2 hours) compared to naratriptan, which may contribute to a higher rate of migraine recurrence 3, 4
Efficacy and Safety
- Sumatriptan has been shown to be effective in reducing migraine headache from 'moderate or severe' to 'mild or none' within 2 hours in 50 to 73% of patients following oral administration of 100 or 200 mg 3
- Naratriptan has a lower therapeutic gain compared to sumatriptan, with a mean therapeutic gain of 22% compared to 32% for oral sumatriptan 100mg 4
- Both naratriptan and sumatriptan are generally well tolerated, with common adverse events including nausea, vomiting, and dizziness 3, 5
Pharmacokinetics
- Sumatriptan has a low oral bioavailability (14%) and a short half-life (approximately 2 hours) 3, 4
- Naratriptan has a longer half-life compared to sumatriptan, which may contribute to its lower rate of migraine recurrence 4
- The newer triptans, including naratriptan, have improved oral bioavailability and longer half-lives compared to sumatriptan 4