Migraine during breastfeeding
Second line
Migraine in nursing mothers. Dose 2.5 mg orally, repeat at 4 h. Max 5 mg/day. Slower than other triptans, longer effect.
Triptan, selective 5HT1B/1D receptor agonist
ATC code: N02CC02 (Naratriptan)
Brand names
Amerge
Activates 5HT1B/1D receptors on meningeal vessels and the trigeminal system. Acts more gently and slowly than sumatriptan, with onset in 1–2 hours and lower recurrence rate thanks to a ~6-hour half-life. Mostly renal excretion, minimal CYP metabolism.
Second line
Migraine in nursing mothers. Dose 2.5 mg orally, repeat at 4 h. Max 5 mg/day. Slower than other triptans, longer effect.
1 pair found. Sorted from critical to minor.
Mechanism
Naratriptan is a serotonin agonist. With phenelzine – fatal serotonin syndrome.
Symptoms
Agitation, tachycardia, hyperthermia, myoclonus, hyperreflexia within hours.
Management
Combination contraindicated. 14 days after MAOI withdrawal before starting triptan.
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AEMPS Category C. Post-marketing registries have not detected a clear excess of major malformations, with limited exposure samples. Half-life of 6 hours is intermediate within the triptan class. SEN recommends paracetamol as first-line for acute migraine in pregnancy; sumatriptan remains the best-studied triptan. Naratriptan is used only when better-studied alternatives have failed.
Compatible with caution. Hale L3. T½ 6 h – longer than sumatriptan. Milk accumulation possible with repeated dosing. Prefer shorter-acting triptans.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Naratriptan is evaluated for the following indications with varying evidence strength: Migraine during breastfeeding (evidence tier C). See the full indication matrix with dosing and citations above on this page.
Common side effects of Naratriptan (≥ 1 in 100): Dizziness, Somnolence, Hot flushes, Paraesthesia, Chest or throat tightness (non-ischaemic), Nausea. See the Safety section for uncommon and serious reactions.
FDA category C. AEMPS Category C. Post-marketing registries have not detected a clear excess of major malformations, with limited exposure samples. Half-life of 6 hours is intermediate within the triptan class. SEN recommends paracetamol as first-line for acute migraine in pregnancy; sumatriptan remains the best-studied triptan. Naratriptan is used only when better-studied alternatives have failed.
Compatible with caution. Hale L3. T½ 6 h – longer than sumatriptan. Milk accumulation possible with repeated dosing. Prefer shorter-acting triptans.
Naratriptan is contraindicated in: Hypersensitivity to triptans or sulfonamides; Ischaemic heart disease, prior myocardial infarction, Prinzmetal angina; Uncontrolled hypertension; Cerebrovascular disease and prior transient ischaemic attack; Peripheral arterial disease. Full list in the Safety section.