Drugs List

Therapeutic Indications

Uses

Acute treatment of migraine attacks with or without aura

Contraindications

Children under 18 years
Patients over 65 years
Suspected ischaemic heart disease
Angina
Cardiac failure
Galactosaemia
History of cerebrovascular accident
History of myocardial infarction
History of transient ischaemic attack
Ischaemic heart disease
Moderate hypertension
Peripheral vascular disease
Prinzmetal's angina
Serious cardiac arrhythmias
Severe hepatic impairment
Severe renal impairment
Uncontrolled hypertension

Precautions and Warnings

Predisposition to ischaemic heart disease
Risk factors for cardiovascular disorder
Breastfeeding
Glucose-galactose malabsorption syndrome
Lactose intolerance
Mild hypertension
Mild renal impairment
Pregnancy

Not for prophylactic use
Not for use in atypical headache
Not indicated in hemiplegic, ophthalmoplegic or basilar migraine
Reduce dose in patients with renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Avoid ergotamine-type medication for 24 hrs before/after treatment
Evaluate patients for cardiovascular disease prior to treatment
Exclude other potentially serious neurological conditions
Contains lactose
Contains sunset yellow (E110) - may cause allergic reaction
Only for use where a clear diagnosis of migraine has been established
Advise patient to report any chest pain
Excessive use may increase frequency of headache, may require withdrawal
If angina-like symptoms occur, discontinue treatment and investigate.
Advise patient not to take St John's wort concurrently
Advise patient grapefruit products may increase plasma level
Breastfeeding: Do not breastfeed & discard milk for 24 hours after therapy

Eletriptan should not be given without prior evaluation, to patients in whom unrecognised cardiac disease is likely, or to patients at risk of coronary artery disease, for example, patients with hypertension, diabetes, smokers or users of nicotine substitution therapy, men over 40 years of age, postmenopausal women and those with a strong family history of coronary artery disease. Cardiac evaluations may not identify every patient who has cardiac disease and, in very rare cases, serious cardiac events have occurred in patients without underlying cardiovascular disease when 5-HT1 agonists have been administered.

Pregnancy and Lactation

Pregnancy

Use with caution in pregnancy.

No clinical data on exposed pregnancies are available. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal or foetal development, parturition or postnatal development. Eletriptan should be used during pregnancy only if clearly needed.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution in breastfeeding.

Eletriptan is excreted in human breast milk. In a study of eight women given a single dose of 80 mg, the mean total amount of eletriptan in the breast milk over 24 hours was 0.02% of the dose. This would not be expected to cause any adverse effects in breastfed infants, especially in infants older than 2 months. Caution should be exercised when considering the administration of eletriptan to women who are breastfeeding. Infant exposure can be minimised by avoiding breastfeeding for 24 hours after treatment.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Abnormal thinking
Abnormal vision
Agitation
Allergic reaction
Angioedema
Anorexia
Arthralgia
Arthritis
Arthrosis
Asthenia
Asthma
Ataxia
Back pain
Bone pain
Bradycardia
Breast pain
Chest pain
Chest tightness
Chills
Confusion
Conjunctivitis
Constipation
Depersonalisation
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyspepsia
Dyspnoea
Ear pain
Emotional lability
Eructation
Euphoria
Eye pain
Facial oedema
Flushing
Glossitis
Headache
Hyperaesthesia
Hyperbilirubinaemia
Hypertension
Hypertonia
Hypoaesthesia
Hypokinesia
Increase in AST level
Insomnia
Ischaemic colitis
Lacrimation disorder
Lymphadenopathy
Malaise
Menorrhagia
Myalgia
Myasthenia
Myopathy
Nausea
Oedema
Oesophagitis
Palpitations
Peripheral oedema
Peripheral vascular disorders
Pharyngitis
Photophobia
Polyuria
Pruritus
Rash
Respiratory disorders
Respiratory tract infection
Rhinitis
Sensation of pressure
Sensation of tingling
Sensation of warmth
Serotonin syndrome
Shock
Skin disorder
Somnolence
Speech disturbances
Stupor
Sweating
Syncope
Tachycardia
Taste disturbances
Thirst
Throat tightness
Tinnitus
Tongue oedema
Tremor
Twitching
Urinary frequency
Urinary tract disorders
Urticaria
Vertigo
Voice changes
Vomiting
Yawning

Presentation

Tablets containing eletriptan

Drugs List

Therapeutic Indications

Uses

Acute treatment of migraine attacks with or without aura

Dosage

Eletriptan tablets should be taken as early as possible after the onset of migraine headache but they are also effective if taken at a later stage during a migraine attack.

Eletriptan has not been demonstrated to prevent migraine headache if taken during the aura phase and therefore should only be taken during the headache phase of migraine.

Adults

Patients with Renal Impairment

Contraindications

Children under 18 years
Patients over 65 years
Suspected ischaemic heart disease
Angina
Cardiac failure
Galactosaemia
History of cerebrovascular accident
History of myocardial infarction
History of transient ischaemic attack
Ischaemic heart disease
Moderate hypertension
Peripheral vascular disease
Prinzmetal's angina
Serious cardiac arrhythmias
Severe hepatic impairment
Severe renal impairment
Uncontrolled hypertension

Precautions and Warnings

Predisposition to ischaemic heart disease
Risk factors for cardiovascular disorder
Breastfeeding
Glucose-galactose malabsorption syndrome
Lactose intolerance
Mild hypertension
Mild renal impairment
Pregnancy

Not for prophylactic use
Not for use in atypical headache
Not indicated in hemiplegic, ophthalmoplegic or basilar migraine
Reduce dose in patients with renal impairment
Advise ability to drive/operate machinery may be affected by side effects
Avoid ergotamine-type medication for 24 hrs before/after treatment
Evaluate patients for cardiovascular disease prior to treatment
Exclude other potentially serious neurological conditions
Contains lactose
Contains sunset yellow (E110) - may cause allergic reaction
Only for use where a clear diagnosis of migraine has been established
Advise patient to report any chest pain
Excessive use may increase frequency of headache, may require withdrawal
If angina-like symptoms occur, discontinue treatment and investigate.
Advise patient not to take St John's wort concurrently
Advise patient grapefruit products may increase plasma level
Breastfeeding: Do not breastfeed & discard milk for 24 hours after therapy

Eletriptan should not be given without prior evaluation, to patients in whom unrecognised cardiac disease is likely, or to patients at risk of coronary artery disease, for example, patients with hypertension, diabetes, smokers or users of nicotine substitution therapy, men over 40 years of age, postmenopausal women and those with a strong family history of coronary artery disease. Cardiac evaluations may not identify every patient who has cardiac disease and, in very rare cases, serious cardiac events have occurred in patients without underlying cardiovascular disease when 5-HT1 agonists have been administered.

Pregnancy and Lactation

Pregnancy

Use with caution in pregnancy.

No clinical data on exposed pregnancies are available. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal or foetal development, parturition or postnatal development. Eletriptan should be used during pregnancy only if clearly needed.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution in breastfeeding.

Eletriptan is excreted in human breast milk. In a study of eight women given a single dose of 80 mg, the mean total amount of eletriptan in the breast milk over 24 hours was 0.02% of the dose. This would not be expected to cause any adverse effects in breastfed infants, especially in infants older than 2 months. Caution should be exercised when considering the administration of eletriptan to women who are breastfeeding. Infant exposure can be minimised by avoiding breastfeeding for 24 hours after treatment.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

The tablets should be swallowed whole with water.

Advise patients to avoid taking herbal preparations containing St. John's wort (Hypericum perforatum).

Advise patient to avoid grapefruit products.

Advise patients to report chest pain and tightness, which may be intense and involve the throat. No further doses should be taken until appropriate evaluation has been carried out.

Migraine or treatment with eletriptan may cause drowsiness or dizziness in some patients. Patients should be advised to evaluate their ability to perform complex tasks such as driving during migraine attacks and following administration of eletriptan.

Side Effects

Abdominal pain
Abnormal thinking
Abnormal vision
Agitation
Allergic reaction
Angioedema
Anorexia
Arthralgia
Arthritis
Arthrosis
Asthenia
Asthma
Ataxia
Back pain
Bone pain
Bradycardia
Breast pain
Chest pain
Chest tightness
Chills
Confusion
Conjunctivitis
Constipation
Depersonalisation
Depression
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Dyspepsia
Dyspnoea
Ear pain
Emotional lability
Eructation
Euphoria
Eye pain
Facial oedema
Flushing
Glossitis
Headache
Hyperaesthesia
Hyperbilirubinaemia
Hypertension
Hypertonia
Hypoaesthesia
Hypokinesia
Increase in AST level
Insomnia
Ischaemic colitis
Lacrimation disorder
Lymphadenopathy
Malaise
Menorrhagia
Myalgia
Myasthenia
Myopathy
Nausea
Oedema
Oesophagitis
Palpitations
Peripheral oedema
Peripheral vascular disorders
Pharyngitis
Photophobia
Polyuria
Pruritus
Rash
Respiratory disorders
Respiratory tract infection
Rhinitis
Sensation of pressure
Sensation of tingling
Sensation of warmth
Serotonin syndrome
Shock
Skin disorder
Somnolence
Speech disturbances
Stupor
Sweating
Syncope
Tachycardia
Taste disturbances
Thirst
Throat tightness
Tinnitus
Tongue oedema
Tremor
Twitching
Urinary frequency
Urinary tract disorders
Urticaria
Vertigo
Voice changes
Vomiting
Yawning

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2013

Reference Sources

British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Relpax 20mg and 40 mg Tablets. Pfizer Ltd. Revised August 2012.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Eletriptan tablets. Last revised: December 27, 2007
Last accessed: May 8, 2013