title: Optimal balance of efficacy and tolerability of oral triptans and telcagepant: a review and a clinical comment.
abstract: Dose-response curves for headaches relief and adverse events (AEs) are presented for five triptans: sumatriptan, zolmitriptan, naratriptan, almotriptan, and frovatriptan, and the CGRP antagonist telcagepant. The upper part of the efficacy curve of the triptans is generally flat, the so-called ceiling effect; and none of the oral triptans, even in high doses, are as effective as subcutaneous sumatriptan, In contrast, AEs increases with increasing dose without a ceiling effect. The optimal dose for the triptans is mainly determined by tolerability. Telcagepant has an excellent tolerability and can be used in migraine patients with cardiovascular co-morbidity. Based on the literature the triptans and telcagepant are rated in a table for efficacy and tolerability.
authors.affiliation: Department of Neurology, Danish Headache Center, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark. ptha@glo.regionh.dk
authors.forename: Peer
authors.initials: P
authors.lastname: Tfelt-Hansen
mesh_terms: D001381:Azepines / Q000627:therapeutic use*; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008881:Migraine Disorders / Q000188:drug therapy*; D058825:Serotonin 5-HT1 Receptor Agonists / Q000627:therapeutic use*; D014363:Tryptamines / Q000627:therapeutic use*
chemical_list: D001381:Azepines; D000077221:Calcitonin Gene-Related Peptide Receptor Antagonists; D007093:Imidazoles; D058825:Serotonin 5-HT1 Receptor Agonists; D014363:Tryptamines; C525458:telcagepant