Migraine and headache:
Indications for RELPAX:
Acute treatment of migraine. Limitations of use: not for migraine prophylaxis or treatment of cluster headache.
≥18yrs: 20mg or 40mg once. Reevaluate if no response. May repeat once after 2 hours; max 80mg/day. The safety of treating an average of more than 3 headaches in a 30-day period has not been established.
<18yrs: not established.
Ischemic coronary artery disease or vasospasm, including Prinzmetal's angina. Wolff-Parkinson-White syndrome. Arrhythmias associated with other cardiac accessory conduction pathway disorders. History of stroke, TIA, or hemiplegic or basilar migraine. Peripheral vascular disease. Ischemic bowel disease. Uncontrolled hypertension. Within 24hrs of other 5-HT1 agonists, ergotamines, or ergot-type drugs (eg, methysergide, dihydroergotamine). Within 72hrs of potent CYP3A4 inhibitors (eg, ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir).
Confirm diagnosis. Exclude underlying cardiovascular disease, supervise 1st dose, and consider monitoring ECG in patients with likelihood of unrecognized coronary disease (eg, increased age, hypertension, obesity, diabetes, smokers, strong family history). Monitor cardiovascular function in long-term intermittent use. Discontinue if arrhythmias or serotonin syndrome occurs. Possible cerebrovascular events, peripheral or GI vascular ischemia and infarction, Raynaud's syndrome following use of 5-HT1 agonists. Monitor BP during treatment. Severe hepatic impairment: not recommended. Elderly. Pregnancy. Nursing mothers: avoid breastfeeding for 24hrs after treatment.
Selective 5-HT1B/1D receptor agonist.
Methysergide, other ergotamines, other 5-HT1 agonists, or potent CYP3A4 inhibitors: see Contraindications. Serotonin syndrome with SSRIs, SNRIs, TCAs, or MAOIs.
Asthenia, nausea, dizziness, somnolence, dry mouth, paresthesia, chest/throat/neck/jaw symptoms (pain, pressure, tightness), drug overuse headache (detox may be needed), dyspepsia, abdominal pain; rare: serious cardiovascular events, anaphylactoid reactions.
Half-life: ~4 hours.
Tabs 20mg—6; 40mg—6, 12