Available Triptans in the Philippines
While the provided evidence does not specify which triptans are currently available in the Philippines, international guidelines acknowledge that triptan availability varies significantly between countries, and you should verify local formulary access before prescribing. 1
Understanding Triptan Availability Limitations
The Nature Reviews Neurology consensus statement explicitly notes that "all triptans have well-documented effectiveness, but availability of and access to each vary between countries." 1 This is a critical consideration when treating migraine patients in the Philippines, as not all seven internationally available triptans may be accessible in your local market.
The Seven Triptans Available Globally
Worldwide, seven triptans exist with multiple formulation options: 2
- Sumatriptan - available as oral tablets, subcutaneous injection, intranasal spray, and rectal suppositories 2, 3
- Rizatriptan - available as oral tablets and orally disintegrating tablets 2
- Zolmitriptan - available as oral tablets, orally disintegrating tablets, and intranasal spray 2
- Naratriptan - available as oral tablets 2
- Almotriptan - available as oral tablets 2
- Frovatriptan - available as oral tablets 2
- Eletriptan - available as oral tablets 2
Practical Approach for Philippine Prescribers
Start by confirming which specific triptans and formulations are registered with the Philippine FDA and available through local pharmacies, as this will determine your actual prescribing options. 1
Most Likely Available Option
Sumatriptan is typically the most widely available triptan internationally due to its status as the first-in-class medication and availability of generic formulations. 4, 3 If choosing sumatriptan for your patient:
- Oral dosing: 25 mg, 50 mg, or 100 mg tablets, with 50-100 mg providing optimal efficacy 5
- Subcutaneous injection: 6 mg for patients who rapidly reach peak intensity, experience severe vomiting, or have failed all oral triptans 1, 6
- Maximum daily dose: 200 mg in 24 hours, with at least 2 hours between doses 5
When to Use Triptans
Triptans serve as second-line therapy after NSAIDs (aspirin, ibuprofen, diclofenac) fail to provide adequate relief. 1, 7, 6 Take early in the attack when headache is still mild for maximum effectiveness, but not during the aura phase. 1, 6
Critical Contraindications to Screen
Before prescribing any triptan, exclude: 5
- Ischemic heart disease or coronary vasospasm
- Previous myocardial infarction
- Uncontrolled hypertension
- Basilar or hemiplegic migraine
- History of stroke or TIA
- Peripheral vascular disease
- Concurrent use with ergotamines or MAO inhibitors
If One Triptan Fails
Try a different triptan, as failure of one does not predict failure of others - allow an adequate trial of at least 3 consecutive attacks before abandoning. 1, 6 This strategy requires having access to multiple triptan options in your local market.
Common Pitfall: Medication Overuse Headache
Limit triptan use to no more than 2 days per week, as using acute medications more frequently can lead to medication overuse headache and daily headaches. 6, 5 If treatment is needed more than twice weekly, initiate preventive therapy instead. 6