No

Serotonin 5-HT_1D Receptor Agonist

Treatment of acute migraine headache with or without aura

C

Hypersensitivity to naratriptan or any component; cerebrovascular, peripheral vascular disease (ischemic bowel disease), ischemic heart disease (angina pectoris, history of myocardial infarction, or proven silent ischemia); or in patients with symptoms consistent with ischemic heart disease, coronary artery vasospasm, or Prinzmetal's variant angina; uncontrolled hypertension or patients who have received within 24 hours another 5-HT agonist (sumatriptan, zolmitriptan) or ergotamine-containing product; patients with known risk factors associated with coronary artery disease; patients with severe hepatic or renal disease (Cl_cr <15 mL/minute); do not administer naratriptan to patients with hemiplegic or basilar migraine

Use only if there is a clear diagnosis of migraine. Patients who are at risk of CAD but have had a satisfactory cardiovascular evaluation may receive naratriptan but with extreme caution (ie, in a physician's office where there are adequate precautions in place to protect the patient). Blood pressure may increase with the administration of naratriptan. Monitor closely, especially with the first administration of the drug. If the patient does not respond to the first dose, re-evaluate the diagnosis of migraine before trying a second dose.

1% to 10%:

Central nervous system: Dizziness, drowsiness, malaise/fatigue

Gastrointestinal: Nausea, vomiting

Neuromuscular & skeletal: Paresthesias

Miscellaneous: Pain or pressure in throat or neck

<1% (Limited to important or life-threatening symptoms): Coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, ventricular fibrillation, palpitations, hypertension, EKG changes (PR prolongation, QT_c prolongation, premature ventricular contractions, atrial flutter, or atrial fibrillation) hypotension, heart murmurs, bradycardia, hyperlipidemia, hypercholesterolemia, hypothyroidism, hyperglycemia, glycosuria, ketonuria, eye hemorrhage, abnormal liver function tests, abnormal bilirubin tests, convulsions, allergic reaction, panic, hallucinations

Decreased effect: Smoking increases the clearance of naratriptan

Increased effect/toxicity: Ergot-containing drugs (dihydroergotamine or methysergide) may cause vasospastic reactions when taken with naratriptan. Avoid concomitant use with ergots; separate dose of naratriptan and ergots by at least 24 hours. Oral contraceptives taken with naratriptan reduced the clearance of naratriptan ~30% which may contribute to adverse effects. Selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) may cause lack of coordination, hyper-reflexia, or weakness and should be avoided when taking naratriptan.

The therapeutic effect for migraine is due to serotonin agonist activity

Onset of effect: 30 minutes

Protein binding, plasma: 28% to 31%

Metabolism: Liver, cytochrome P-450 isoenzymes

Bioavailability: 70%

Time to peak: 2-3 hours

Elimination: Urine

Adults: Oral: 1-2.5 mg at the onset of headache; it is recommended to use the lowest possible dose to minimize adverse effects. If headache returns or does not fully resolve, the dose may be repeated after 4 hours; do not exceed 5 mg in 24 hours.

Elderly: Not recommended for use in the elderly

Dosing in renal impairment:

Cl_cr: 18-39 mL/minute: Initial: 1 mg; do not exceed 2.5 mg in 24 hours

Cl_cr: <15 mL/minute: Do not use

Dosing in hepatic impairment: Contraindicated in patients with severe liver failure; maximum dose: 2.5 mg in 24 hours for patients with mild or moderate liver failure; recommended starting dose: 1 mg

No information available to require special precautions

No effects or complications reported

This drug is to be used to reduce your migraine, not to prevent or reduce the number of attacks. If headache returns or is not fully resolved, the dose may be repeated after 4 hours. If you have no relief with first dose, do not take a second dose without consulting prescriber. Do not exceed 5 mg in 24 hours. Do not take within 24 hours of any other migraine medication without first consulting prescriber. You may experience some dizziness, fatigue, or drowsiness; use caution when driving or engaging in tasks that require alertness until response to drug is known. Frequent mouth care and sucking on lozenges may relieve dry mouth. Report immediately any chest pain, heart throbbing, tightness in throat, skin rash or hives, hallucinations, anxiety, or panic. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Breast-feeding is not recommended.

Tablet: 1 mg, 2.5 mg