Naratriptan oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of naratriptan.
Drugs List
Therapeutic Indications
Uses
Acute treatment of migraine attacks with or without aura
Unlicensed Uses
Menstrual migraine: Prophylaxis
Dosage
Naratriptan tablets should be taken as early as possible after migraine headache but they are effective if taken at a later stage.
Naratriptan tablets are recommended as monotherapy for the acute treatment of a migraine attack.
Adults
Treatment of acute migraine:
2.5mg as single dose, repeated after at least 4 hours if migraine recurs. If patient does not respond to first dose of naratriptan, a second dose should not be taken for the same attack, as it is unlikely to be of any benefit. However, naratriptan may be used for subsequent migraine attacks. Maximum dose should not exceed 5mg naratriptan in any 24 hour period.
Menstrual migraine prophylaxis (unlicensed):
2.5mg twice daily, to be taken from 2 days before until 3 days after bleeding starts.
Additional Dosage Information
If a patient does not respond to the first dose of naratriptan, a second dose should not be taken for the same attack, as it is unlikely to be of any benefit. However, naratriptan may be used for subsequent migraine attacks.
Contraindications
Children under 18 years
Patients over 65 years
Suspected ischaemic heart disease
Coronary vasospasm
Galactosaemia
History of cerebrovascular accident
History of myocardial infarction
History of transient ischaemic attack
Ischaemic heart disease
Moderate hypertension
Peripheral vascular disease
Pregnancy
Prinzmetal's angina
Renal impairment - creatinine clearance below 15ml/minute
Severe hepatic impairment - Child-Pugh score greater than or equal to 10
Uncontrolled hypertension
Precautions and Warnings
Predisposition to ischaemic heart disease
Breastfeeding
Glucose-galactose malabsorption syndrome
Lactose intolerance
Mild hepatic impairment
Renal impairment
Not for prophylactic use
Not indicated in hemiplegic, ophthalmoplegic or basilar migraine
Advise ability to drive/operate machinery may be affected by side effects
Evaluate patients for cardiovascular disease prior to treatment
Exclude other potentially serious neurological conditions
Contains lactose
Only for use where a clear diagnosis of migraine has been established
Risk of cerebrovascular events
When used with SSRIs, risk of Serotonin syndrome
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
Patients should not exceed recommended dose
The safety and efficacy of naratriptan when administered during the aura phase, prior to the onset of migraine headache, has yet to be established.
As with other 5-HT1 receptor agonists, naratriptan should not be given to patients who have risk factors for ischaemic heart disease, including those patients who are heavy smokers or users of nicotine substitution therapy without prior cardiovascular evaluation. Special consideration should be given to post menopausal women and males over 40 years old, naratriptan should not be used without a cardiovascular evaluation.
Serotonin syndrome (including altered mental status, autonomic instability and neuromuscular abnormalities) has been reported following concomitant treatment with triptans and SSRIs/SNRIs. If concomitant treatment with naratriptan and an SSRI/SNRI is clinically warranted, appropriate observation of the patient is advised.
Pregnancy and Lactation
Pregnancy
Naratriptan is contraindicated during pregnancy.
The manufacturer does not recommend using naratriptan during pregnancy.
At the time of writing there is limited published information regarding the use of naratriptan in pregnancy. Potential risks are unknown, however the molecular weight (about 336 for the free base) suggests that the drug will cross the placenta.
Animal studies have not indicated any teratogenic effects or harmful effect on peri- and postnatal development. However, delays in foetal ossification and possible effects on embryo viability have been observed in the rabbit.
Lactation
Use naratriptan with caution during breastfeeding.
The manufacturer states that breastfeeding should be avoided during and for 24 hours after naratriptan treatment.
There is insufficient data regarding the use of naratriptan during human lactation. The molecular weight (about 336 for the free base) is low enough that excretion into breast milk should be expected. Animal data reports naratriptan and/or drug related metabolites are secreted into the milk of lactating rats.
The effect of this exposure, if any, on a nursing infant is unknown. According to LactMed, if naratriptan is required by the mother of an older infant during breastfeeding , it is not a reason to discontinue breastfeeding; however, an alternate drug may be preferred, especially while breastfeeding a newborn or preterm infant.
Side Effects
Anaphylaxis
Angina
Bradycardia
Coronary vasospasm
Dizziness
Drowsiness
Facial oedema
Fatigue
Flushing
Hypersensitivity reactions including anaphylaxis
Increased blood pressure (transient)
Ischaemic colitis
Malaise
Myocardial infarction
Nausea
Pain
Palpitations
Peripheral ischaemia
Pruritus
Rash
Sensation of heat
Sensation of heaviness
Sensation of pressure
Sensation of tightness
Sensation of tingling
Tachycardia
Tightness of chest and/or throat
Transient ischaemic ECG changes
Urticaria
Visual disturbances
Vomiting
Weakness
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: July 2022
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Naramig Tablets 2.5mg. GlaxoSmithKline. Revised November 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 21 July 2022
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Naratriptan Last revised: 17 May 2021
Last accessed: 21 July 2022
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.