Naratriptan (Oral)

Overview

Naratriptan belongs to a group of medicines known as triptans. It works on the brain to relieve the pain and other symptoms (such as vomiting, nausea, and sensitivity to sound and light) caused by chronic migraine headaches.

Many patients notice that their migraines retreat completely after taking Naratriptan. Others find that their migraines are less painful and they are able to function normally, even though their migraine remains. Naratriptan also works on the peripheral symptoms of a chronic migraine, including hypersensitivity to light and sound, nausea and vomiting. It differs from other pain relievers, and should not be used to treat other types of pain other than migraine headaches.

Otherwise known under the US brand name Amerge, Naratriptan is typically prescribed for patients whose migraines have not been relieved by other pain medications, aspirin or acetaminophen.

It is not, however, without the risk of causing side effects. Some patients who have blood vessel or heart disease may experience difficulties. Patients should ensure their physician knows about their history of other illnesses, as well as any other medications they are taking.

Patients who are receiving other medical treatment should ensure they tell all healthcare providers that they are being treated with Naratriptan for migraine headaches, including dentists, pharmacists, nurses and other doctors.

Naratriptan has been known to cause severe, harmful side effects. Patients should ensure they understand the benefits against the risks associated with taking Naratriptan before starting treatment. Naratriptan can decrease alertness in some patients. Patients should wait to see how Naratriptan affects them before attempting to drive, operate machinery, or do anything else that could pose a risk if they were not fully alert.

Naratriptan is designed to treat and relieve the active symptoms of a migraine. It does not prevent or lower the number of migraines a patient suffers. Patients who are concerned about this should discuss other treatment options with their physician.

Particular care should be taken by patients who are at a higher risk of heart disease (such as those who have high cholesterol, high blood pressure, are overweight, have diabetes, smoke cigarettes, are over the age of 40, or who have a family history of early heart disease).

Patients should be advised that taking more Naratriptan than they have been directed to by their physician could actually increase the severity of their headaches. A physician should regularly review the patient's condition, including regular blood pressure checks, while they are taking Naratriptan.

Patients who are pregnant or planning on becoming pregnant should discuss their treatment options with their physician. Any prescription for Naratriptan will need to be decided based on an assessment of the benefits against the risks of use in pregnancy. Similarly, patients who are breastfeeding should talk to their physician to understand the potential risks to their baby.

Conditions Treated

  • Acute migraine.

Type Of Medicine

  • Triptan.

Side Effects

Every medicine carries the risk of causing unwanted side effects alongside their desired functions. Not all of the following side effects may appear, but if they do they may require some medical attention.

Patients who notice any of the following side effects should contact their physician immediately:

  • Pressure, heaviness or tightness in the throat, neck or chest

Other side effects may appear that will not typically require medical assistance. These side effects may disappear as the patient's body adjusts to the medicine over the course of treatment. Patients who are concerned about their side effects should discuss ways to prevent or reduce them with their physician or pharmacist.

  • Bone pain

Some patients may also experience other side effects, not listed in this guide. Patients who notice other side effects should check with their physician. New side effects can also be reported to the FDA by calling 1-800-FDA-1088.

Dosage

Doses of Naratriptan will vary from patient to patient. Patients should always carefully follow their physician's advice or the instructions on the label. The information below covers typical dosing instructions, but it may not include all potential dosages of this medicine. Patients should not change their dose if it does not appear in this guide, unless their physician tells them to do so.

The amount of Naratriptan a patient will be directed to take will depend on the strength of the specific formulation. The time allocated between doses, the total length of treatment, and the number of doses per day will also depend on the severity of the patient's condition, and a range of factors including their wider medical history.

In the treatment of chronic migraine, Naratriptan oral tablets are typically prescribed in doses of between 1 to 2.5mg, to be taken when the symptoms of migraine appear. If the migraine persists or returns, the patient may then take a second dose four hours after their first dose, up to 5mg in any 24 hour period. Naratriptan is not typically prescribed for use with children (in pediatric care), but any use will be decided by a physician.

Major drug interactions:

Some specific medicines should never be used together due to the severity of the effects of their interaction. Other medicines may be used together, even if there is a known risk of interactions. In that case, a physician will typically look to adjust the dose, frequency or timing of doses of one or more of a patient's medications to reduce the risks of interaction. Patients should make sure they fully inform their physician about all medicines they are taking, including prescription and over the counter medications, vitamins and herbal remedies. Patients should make their physician particularly aware if they are taking any of the following substances, which have been published here based on their known significance. This list should not be seen as necessarily all-inclusive.

The following medicines are not recommended for use at the same time as Naratriptan. A physician may choose to change a patient's other medications, or not to prescribe Naratriptan altogether if they are taking any of the following:

  • Sumatriptan

The following list of medicines are not recommended for use alongside Naratriptan. In some cases, a physician may still decide to prescribe them together, but may alter the dosages or frequency of use of one or more of the medicines.

  • Fentanyl

Some medicines will also interact with certain types of food or drink, or should not be used around the time of eating. Using tobacco or alcohol can also have an effect on how medicines work or whether side effects appear. Patients who are concerned about food, drink or other lifestyle factors should discuss these thoroughly with their physician before starting treatment.

Patients who also suffer from other medical issues may experience problems while they take Naratriptan for their chronic migraines. Patients should ensure they tell their physician about all previous and current medical problems, particularly:

  • Any history of basilar migraine (migraine with hearing and vision problems)

Warnings

When deciding whether to prescribe any medicine, a physician should weigh up the potential benefits against the risks of taking it with the patient. It should be a joint, well-informed decision. The following factors should be considered when deciding whether to take Naratriptan:

Allergies

Patients should always tell their physician about any allergic reactions they have suffered to other medications, Naratriptan, or other foods or substances, preservatives, dyes or animals. Patients should always carefully read the label on any medications, including over the counter medicines.

Use in pediatric care

There have been no appropriate studies carried out into the relationship between young age and the effects of Naratriptan. Efficacy and safety have not been established for use with patients under the age of 18.

Use in geriatric care

There have been no appropriate studies carried out into the relationship between older age and the effects of Naratriptan. However, elderly patients are more likely to experience liver and kidney problems, blood vessel and heart disease, and high blood pressure. Patients who have any of those conditions are unlikely to be prescribed Naratriptan, as the medicine may make these issues worse.

Use in treating pregnant female patients

Officially, Naratriptan has been given a category C for all pregnancy trimesters. This either indicates that appropriate animal studies have proved an adverse effect on pregnant patients and there have been no relevant human studies, or that no animal or human studies have been conducted into the effects on pregnancy.

Use in treating breastfeeding patients

There have been no appropriate studies in human patients showing a relationship between Naratriptan and a risk to infants while breastfeeding. Patients and physicians should always carefully weigh the benefits of taking Naratriptan against the risks when determining whether to take it while breastfeeding.

A patient's physician should regularly review the patient's condition through frequent appointments throughout their treatment period. The physician should continually assess whether Naratriptan is working, and whether the patient should carry on with their treatment.

Patients should not take Naratriptan if they have used ergot-type migraine medicines or other triptan medications within the last 24 hours. Triptan medicines include eletriptan (known as Relpax®), zolmitriptan (known as Zomig®), frovatriptan (known as Frova®), almotriptan (known as Axert®), sumatriptan (known as Imitrex® and Treximet®), and rizatriptan (known as Maxalt®). Ergot-type migraine medications include ergotamine (known under the US brand names Bellergal®, Cafergot®, Ergomar® and Wigraine®) and dihydroergotamine (also known as D.H.E. 45® and Migranal®).

Naratriptan has also been known to trigger severe allergic reactions and anaphylactic shock, which can be potentially life-threatening. Patients who notice itching, a rash, breathing difficulties, trouble swallowing, or swelling of their mouth, hands or face while taking Naratriptan should seek medical attention immediately.

Patients should check with their physician if they have been using Naratriptan but the symptoms of their migraine do not retreat, or their migraines become more severe or happen more often.

Naratriptan may also present problems for patients who have heart or vascular disease. A physician who suspects a patient may experience heart-related problems from taking Naratriptan may decide to administer the first dose under supervision in their office or clinic.

Naratriptan also raises the risk of developing angina, stroke, an abnormal heart rhythm or suffering a heart attack. This is particularly relevant for patients who have a family history of heart disease, or who already have heart disease themselves. The risks are also raised for patients who have diabetes, high cholesterol, high blood pressure, are a smoker, are male and over the age of 40, or if they are female and past the menopause. Patients who recognise any of the symptoms of heart issues, including chest pain, nausea and vomiting, pain in the arms, shoulders, back, jaw or neck, an uneven heartbeat, sweating or shortness of breath should call their physician immediately.

Patients who notice any of the symptoms of a stroke (including confusion, speaking difficulties, headaches, double vision, speech difficulties, slurred speech, or an inability to move their legs, arms or facial muscles) should seek medical attention immediately.

Patients who notice discomfort in their chest or neck or jaw tightness should also check with their physician immediately. Patients who experience sudden severe stomach or abdominal pain, or bloody diarrhea should also consult their physician as soon as possible.

Taking Naratriptan for more than 10 days in any given month may worsen headaches. Patients may be asked to keep a headache journal to record their frequency and how many times they take Naratriptan.

Patients should fully inform their physician about all other medications and substances they are taking at the same time as Naratriptan. When taken with some medicines, Naratriptan can trigger a serious condition known as serotonin syndrome. These medicines include antidepressants, such as duloxetine (known as Cymbalta®), fluvoxamine (known as Luvox®), paroxetine (known as Paxil®), citalopram (known as Celexa®), fluoxetine (known as Prozac®, Sarafem® and Symbyax®), venlafaxine (known as Effexor®), escitalopram (known as Lexapro®), olanzapine (known as Zyprexa®), and sertraline (known as Zoloft®). Patients who notice confusion, agitation, unusual excitement, overactive reflexes, fever, diarrhea, restlessness, sweating, shaking, poor coordination, shivering or trembling should seek medical attention immediately. These could be signs that a patient is suffering from serotonin syndrome.

Drinking alcohol can exacerbate the effects of headaches, or trigger new ones. Patients who suffer from migraines and severe headaches should avoid alcohol, especially while they are experiencing symptoms.

Some patients may feel lightheaded or dizzy during or after a migraine, or after they have taken Naratriptan to relieve it. While they are feeling drowsy or dizzy, patients should avoid driving, operating machinery, or doing anything else that could be dangerous if they are not fully alert.

Patients should not take any other medicines while they are using Naratriptan, unless checked and approved by their physician. These include prescription and over the counter medications, herbal remedies and vitamin supplements.

Storage

As with most medicines, Naratriptan should be stored in its original packaging, firmly closed at room temperature and away from direct sunlight, heat and moisture. Do not allow it to freeze.

All medicines should be kept out of the reach of children. Patients should also avoid keeping old, unwanted or out of date medicines. Patients with surplus medications should ask their local pharmacist or physician for details of take-back programs where medicines will be safely disposed.

Summary

Naratriptan is a medicine that is used to treat chronic migraines in adults over the age of 18. It is only available on prescription from a qualified physician, and helps to relieve headache pain as well as a variety of peripheral migraine symptoms (such as light and sound sensitivity, vomiting and nausea). Patients should take a dose of Naratriptan when they start to feel the symptoms of a migraine begin, up to a total dose of 5mg in any 24 period. Prompt treatment can stop the symptoms from progressing, allowing the patient to continue with their everyday activities. Naratriptan does not stop future migraines, and it cannot reduce the frequency of headaches.

Naratriptan belongs to a subsection of medications known as triptans. It works by altering the action of serotonin (a natural brain chemical) that constricts blood vessels. It can also block other pain pathways across the brain.

As with all medicines, the decision to take Naratriptan should be based on a thorough assessment of the benefits and risks as a joint decision between the physician and the patient. Patients who have heart problems are at particular risk of severe side effects. All patients who take Naratriptan to relieve their chronic migraines should be closely supervised by a qualified physician.