What is the recommended dosage and usage of Eletriptan (eletriptan) for treating migraine attacks?

Eletriptan Dosing and Administration for Acute Migraine

Recommended Dosage

For acute migraine treatment in adults, eletriptan should be administered as a single oral dose of 20 mg or 40 mg at migraine onset, with 40 mg demonstrating superior efficacy and representing the optimal balance between effectiveness and tolerability. 1

• The maximum recommended single dose is 40 mg 1
• If the migraine persists or returns after initial improvement, a second dose may be administered at least 2 hours after the first dose 1
• The maximum daily dose must not exceed 80 mg 1
• Clinical trials demonstrated that 40 mg doses produced greater response rates than 20 mg doses 1

Frequency Limitations

• The safety of treating more than 3 migraine attacks in a 30-day period has not been established 1
• Limit acute treatment use to no more than twice weekly to prevent medication-overuse headaches 2

Critical Contraindications

Eletriptan is absolutely contraindicated in patients with ischemic coronary artery disease, coronary vasospasm (including Prinzmetal's angina), uncontrolled hypertension, hemiplegic or basilar migraine, peripheral vascular disease, ischemic bowel disease, or history of stroke/TIA. 1

• Do not use within 24 hours of another triptan, ergotamine-containing medication, or ergot-type drugs (DHE, methysergide) 1
• Do not use within 72 hours of potent CYP3A4 inhibitors (ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir) 1
• Contraindicated in patients with Wolff-Parkinson-White syndrome or other cardiac accessory pathway disorders 1
• Contraindicated in patients with known hypersensitivity to eletriptan (angioedema and anaphylaxis have occurred) 1

Pre-Treatment Cardiovascular Screening

• Perform cardiovascular evaluation in triptan-naïve patients with multiple cardiovascular risk factors (increased age, diabetes, hypertension, smoking, obesity, strong family history of CAD) before prescribing eletriptan 1
• For high-risk patients with negative cardiovascular evaluation, consider administering the first dose in a medically-supervised setting with immediate post-dose ECG 1

Important Clinical Considerations

• Eletriptan should only be used when a clear diagnosis of migraine has been established 1
• If a patient has no response to the first migraine attack treated with eletriptan, reconsider the diagnosis before treating subsequent attacks 1
• Eletriptan is not intended for migraine prevention 1
• Safety and effectiveness have not been established for cluster headache 1

Comparative Efficacy

• Eletriptan 40 mg demonstrates superior efficacy compared to sumatriptan 50-100 mg for most endpoints 3, 4
• Eletriptan 40 mg is generally superior to naratriptan 2.5 mg and equivalent to almotriptan 12.5 mg, rizatriptan 10 mg, and zolmitriptan 2.5 mg 3, 4
• Onset of action occurs as early as 30 minutes after administration 3, 4

Tolerability Profile

• Eletriptan 20 mg has an adverse event profile similar to placebo 5
• Eletriptan 40 mg has a marginally higher adverse event profile than placebo but remains well tolerated 5
• No significant difference in major adverse effects compared to placebo at any dose 6
• Minor adverse effects are dose-dependent, with number-needed-to-harm of 7.0 for 40 mg 6

Managing Treatment Failure

• Patients should trial eletriptan for 2-3 migraine episodes before determining effectiveness 7
• If inadequate response after dose optimization, consider switching to another triptan (almotriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan) 7
• Different triptans work for different patients even when one fails 7