Naratriptan

A to Z Drug Facts

 Action Binds to serotonin 1_B and 1_D receptors in intracranial arteries leading to vasoconstriction and subsequent relief of migraine headache.

 Indications Treatment of acute migraine attacks with or without aura.

 Contraindications Patients with history, signs, or symptoms of ischemic heart disease (eg, angina, including Prinzmetal’s variant, MI, silent myocardial ischemia), cerebrovascular or peripheral vascular syndromes, uncontrolled hypertension, severe renal or hepatic insufficiency and patients with hemiplegic or basilar migraine. Naratriptan is contraindicated within 24 hr of use with other serotonin agonists, ergotamine compounds, or methysergide.

 Route/Dosage

ADULTS: PO 1 mg or 2.5 mg with onset of migraine headache. Dose is individualized based on response and side effects. The dose may be repeated once at 4 hr if partial response or if the headache returns. The maximum daily dose is 5 mg in 24 hr.

 Interactions

Ergot-Containing Drugs: May cause additive, prolonged vasospasm.

Selective Serotonin Reuptake Inhibitors (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline)

Weakness, hyperreflexia, and incoordination have been rarely reported.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Palpitations; ECG abnormalities; hypertension. CNS: Dizziness; drowsiness; malaise; fatigue; vertigo. EENT: Neck and throat pressure or pain; hyposalivation; phonophobia; photophobia; tinnitus. GI: Nausea; vomiting; dyspepsia; diarrhea; discomfort or pain; gastroenteritis; constipation. OTHER: Warm or cold sensations; paresthesia; pressure; tightness; heaviness sensations; thirst; polydypsia; dehydration; fluid retention.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children < 18 yr not established. Elderly: Not recommended. Cardiac: May cause coronary vasospasm in patients with coronary artery disease.

 Administration/Storage

• Store at controlled room temperature, protect from light and moisture.

 Assessment/Interventions

• Obtain patient history, including drug history.
• Assess symptoms of migraine attacks, including pain location, intensity, duration, photophobia, and phonophobia.
• Assess for presence of risk factors such as hypertension, hypercholesterolemia, smoking, obesity, diabetes, and strong family history of coronary artery disease.
• Review history and laboratory tests for signs of decreased hepatic and renal function (ie, increased liver enzymes and serum creatinine, Ccr). Dosage will need to be adjusted with mild or moderate hepatic or renal impairment and contraindicated with severe impairment.
• If risk factors are present, administer first dose in a medically staffed and equipped facility as ischemia can occur in the absence of clinical symptoms.
• Hold medication and notify health care provider if during the cardiovascular evaluation, electrocardiogram, or laboratory results reveal findings of coronary artery vasospasm or myocardial ischemia.
• If ergot-containing medications have been used, wait 24 hr following their discontinuation before administration of naratriptan.
• Monitor BP prior to and after initial dose. If angina occurs, monitor for ischemic changes and take appropriate actions if present.
• Provide a quiet, dark environment.
• Assess for relief or lowering of symptoms such as migraine-associated nausea, photophobia, and phonophobia.
• If overdose occurs, monitoring of patients should continue for ³ 24 hr or while symptoms or signs persist.

 Patient/Family Education

• Provide patient information pamphlet.
• Explain that the drug is to be used during migraine attack and does not reduce or prevent the number of attacks.
• If overdose is taken, contact the hospital emergency department or nearest poison control center immediately.
• Instruct patients to notify health care provider immediately if sudden or severe abdominal pain, shortness of breath, wheeziness, heart throbbing, swelling of eyelids, face, or lips, skin rash, skin lumps, or hives occur.
• Instruct patient to report symptoms of tingling, heat, flushing (redness of face lasting a short time), heaviness or pressure, or if they are drowsy, dizzy, tired, or sick.
• Instruct the patient to notify teir health care provider if feeling unwell or having any unusual symptoms.
• Instruct the patient concerning storage of medication.
• Inform patient that the drug or migraines may cause drowsiness or dizziness and to use caution while driving or performing tasks that require mental alertness.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts