Eletriptan Hydrobromide

Class and Category

Pharmacologic Class: Triptan

Therapeutic Class: Antimigraine agent

Indications and Dosages

To relieve acute migraine attacks with or without aura

TABLETS

Adults

Initial: 20 or 40 mg as a single dose. Repeated in 2 hr, as needed and ordered. Maximum: 40 mg as a single dose, 80 mg daily.

Mechanism of Action

May stimulate 5-HT1 receptors, causing selective vasoconstriction of dilated and inflamed cranial blood vessels in carotid circulation, which decreases carotid arterial blood flow and relieves acute migraines.

Contraindications

Bibasilar or hemiplegic migraine, cardiovascular disease (significant), cerebrovascular syndromes (stroke, transient ischemic attack), hepatic impairment (severe), hypersensitivity to eletriptan or components, ischemic bowel disease, ischemic or vasospastic coronary artery disease (CAD), peripheral vascular disease, uncontrolled hypertension, use within 24 hours of another serotonin 5-HT1 receptor agonist or ergot-type drug, use within 72 hours of a potent CYP3A4 inhibitor (clarithromycin, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin), Wolff–Parkinson–White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders

Interactions

DRUGS

1. Clarithromycin, ketoconazole, itraconazole, nefazodone, nelfinavir, ritonavir, troleandomycin, and other potent CYP3A4 inhibitors: Increased blood eletriptan level significantly
2. Ergot-containing drugs, 5-HT1receptor agonists: Possibly additive or prolonged vasoconstrictive effects
3. MAO inhibitors, selective serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, tricyclic antidepressants: Increased risk of serotonin syndrome

Adverse Reactions

1. CNS: Asthenia, chills, dizziness, headache, hypertonia, hypesthesia, paresthesia, seizures, somnolence, tiredness, weakness, vertigo
2. CV: Chest tightness, pain, or pressure; coronary artery vasospasm; hypertension, MI, or myocardial ischemia (transient); palpitations; shock; ventricular fibrillation or tachycardia
3. EENT: Dry mouth, pharyngitis, throat tightness
4. GI: Abdominal pain, cramps, discomfort, or pressure; dysphagia; indigestion; nausea, vomiting
5. MS: Back pain
6. SKIN: Diaphoresis, flushing
7. Other: Allergic reaction; angioedema; feeling of warmth, pain, or pressure

Childbearing Considerations

PREGNANCY

• It is not known if the drug causes fetal harm.
• Use with caution only if benefit to mother outweighs potential risk to fetus.

LACTATION

• The drug is present in breast milk.
• Patient should check with prescriber before breastfeeding.

Nursing Considerations

• Ensure that patients who are at risk for CAD undergo a satisfactory CV evaluation before administering the first dose of eletriptan and that they have a periodic reevaluation of their cardiac status during intermittent long-term therapy.
• Obtain an ECG immediately after the first dose of the drug in patients who have CV risk factors but who have had a satisfactory CV evaluation because of the drug’s potential to cause coronary vasospasm.
• Evaluate patient for CV signs and symptoms after administration of eletriptan and notify prescriber if they occur. Expect the drug to be withheld, as ordered, while the patient undergoes an extensive CV workup, and discontinued if abnormalities are detected.
• Monitor patient’s blood pressure during therapy because of the drug’s potential to increase blood pressure.

PATIENT TEACHING

• Advise patient to take eletriptan as soon as possible after the onset of migraine symptoms.
• Urge patient to contact prescriber and avoid taking drug if headache symptoms aren’t typical.
• Advise against exceeding the prescribed dose.
• Instruct patient to seek emergency care for chest, jaw, or neck tightness after taking drug because these may indicate adverse CV reactions; subsequent doses may require ECG monitoring.
• Urge patient to report palpitations.
• Advise patient to avoid hazardous activities until drug’s CNS effects are known.
• Advise yearly ophthalmic examinations during prolonged eletriptan therapy.
• Instruct patient to inform prescriber of all drugs he’s taking, including OTC products and herbal remedies.