Selective serotonin 5HT1B/1D agonists (triptans)
ATC code: N02CC05 (Almotriptan)
Brand names
Almotriptan Cinfa, Axert, Almotriptan Normon
Selective serotonin 5HT1B/1D receptor agonist. Constricts dilated intracranial arteries, suppresses peripheral and central neuronal pain transmission in the trigeminovascular system. Developed by Spanish company Almirall and registered in Spain as Almogran. Compared with sumatriptan, almotriptan has fewer side effects (chest and neck tightness) and higher bioavailability (70% vs 14%).
Second line
Second-line for acute moderate-to-severe migraine attack per EHF 2024 and Spanish SEN 2022 – after NSAID failure (ibuprofen 800 mg, 500 mg, ). Dose 12.5 mg at the first signs of attack; if symptoms persist at 2 hours, may repeat, maximum 25 mg/day. Efficacy – pain relief at 2 hours in 60-70% of patients. Not used for prophylaxis – , beta-blockers, , or CGRP monoclonal antibodies are used instead.
Second line
Migraine in nursing mothers. Dose 12.5 mg orally, repeat at 2 h. Max 25 mg/day. Popular in Spain as Almogran.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Almotriptan is a triptan (a serotonin 5-HT1B/1D receptor agonist). It is prescribed for migraine ( NG150 2021, AHS 2021, and AEMPS Ficha Técnica). For severe headaches without confirmed migraine, especially in adolescents, almotriptan is not used: regular use provokes medication-overuse headache. Triptans are contraindicated in cardiovascular disease and uncontrolled hypertension. If almotriptan was prescribed for any severe headache without confirmed migraine, consider seeking a second opinion; a neurological workup to clarify the headache diagnosis may be needed.
2 pairs found. Sorted from critical to minor.
Mechanism
Almotriptan is CYP3A4 + CYP2D6 substrate. With phenelzine – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Mechanism
MAO-A inhibition + triptan – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Direct links to regulator labels. Open in a new tab.
Limited pregnancy data. First-line for migraine in pregnancy is paracetamol; if insufficient – sumatriptan (the triptan with most pregnancy safety data).
Compatible. Hale L3. Limited RID data during breastfeeding. T½ 3.5 h.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Almotriptan is evaluated for the following indications with varying evidence strength: Acute migraine attack (evidence tier A), Migraine during breastfeeding (evidence tier C), Memory and concentration enhancement (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Almotriptan (≥ 1 in 100): Nausea, Somnolence, Dizziness, Dry mouth, Chest and neck tightness (less than sumatriptan). See the Safety section for uncommon and serious reactions.
FDA category C. Limited pregnancy data. First-line for migraine in pregnancy is paracetamol; if insufficient – sumatriptan (the triptan with most pregnancy safety data).
Compatible. Hale L3. Limited RID data during breastfeeding. T½ 3.5 h.
Almotriptan is contraindicated in: Almotriptan hypersensitivity; Ischemic heart disease, prior myocardial infarction; Uncontrolled hypertension; Prior stroke or TIA; Peripheral arterial disease. Full list in the Safety section.