Comparative aspects of triptans in treating migraine.
Triptans, beginning with sumatriptan, have revolutionized the treatment of migraine. New triptans in several formulations will soon become available in the United States. Although the similarities of these 5-hydroxytryptamine (5-HT) 1B/1D receptor agonists outweigh their differences, important differences in pharmacokinetics and clinical responses do exist. Subcutaneous sumatriptan has the most rapid onset of action and greatest efficacy but the most adverse effects. Intranasal sumatriptan also has rapid onset of action, but at 2 hours its efficacy is comparable to that of oral zolmitriptan. Of the oral triptans, rizatriptan seems to have the greatest early efficacy. Both rizatriptan and zolmitriptan are now available as rapidly dissolving wafers. Almotriptan, the newest of the triptans, has a response rate similar to that of oral sumatriptan and may produce fewer adverse effects. Naratriptan and frovatriptan, with their slow onset, high tolerability, and long half-lives, may have a role in aborting prolonged migraine attacks and in headache prevention. Eletriptan at higher doses (80 mg) has a response rate approaching that of rizatriptan but may be limited by potential side effects. The many triptans available offer the opportunity to individualize migraine treatment, depending on the patient's attack characteristics, tolerance, and preferences.
Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA. jadelman@triad.rr.com
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Adelman
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Lewit
D002227:Carbazoles / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008881:Migraine Disorders / Q000188:drug therapy*; D023303:Oxazolidinones / Q000627:therapeutic use; D017060:Patient Satisfaction; D010880:Piperidines / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D018170:Sumatriptan / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D014363:Tryptamines
D002227:Carbazoles; D007211:Indoles; D023303:Oxazolidinones; D010880:Piperidines; D011759:Pyrrolidines; D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C409045:almotriptan; C115647:eletriptan; C089750:zolmitriptan; C093622:rizatriptan; D018170:Sumatriptan; C108128:frovatriptan; C106783:naratriptan