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Triptan (5-HT1B/1D agonist) Pregnancy: Avoid unless essential — limited data. Sumatriptan has the largest safety dataset in pregnancy and is preferred where a triptan is needed.

Almotriptan

Brand names: Almogran

Adult dose

Dose: 12.5 mg PO at first sign of migraine headache (NOT during aura). May repeat after 2 hours if symptoms recur. Maximum 25 mg/24 hours.
Route: Oral
Frequency: PRN (max 2 doses in 24 hours)
Max: 25 mg/24 hours; ≤2 days/week to avoid medication-overuse headache
Take at headache onset for best efficacy. Ineffective if taken during aura phase.

Dose adjustments

Renal

Severe (eGFR <30): max 12.5 mg/24 hours.

Hepatic

Severe: avoid.

Clinical pearls

  • Slightly better tolerability profile than sumatriptan in head-to-head trials — useful when other triptans poorly tolerated (chest tightness, drowsiness).
  • Effective in ~60% of migraines at 2 hours — comparable to sumatriptan.
  • Counsel against use >2 days/week (NICE) — medication-overuse headache risk.
  • Take a separate antiemetic (e.g., metoclopramide 10 mg) 15 min before almotriptan if nausea/vomiting limits oral absorption.
  • First-line triptan choice should be based on patient preference and response — try at least 3 attacks before switching.

Contraindications

  • Ischaemic heart disease, prior MI, vasospastic angina (Prinzmetal)
  • Uncontrolled hypertension
  • Cerebrovascular disease (stroke, TIA)
  • Peripheral vascular disease
  • Basilar or hemiplegic migraine
  • Ergotamine within 24 hours; another triptan within 24 hours
  • MAOI within 14 days
  • Severe hepatic or renal impairment

Side effects

  • Chest tightness/pressure (non-cardiac, transient — counsel patient)
  • Paraesthesia, tingling
  • Drowsiness, dizziness
  • Nausea (less than sumatriptan)
  • Fatigue, dry mouth
  • Rare but serious: coronary vasospasm, MI, stroke, serotonin syndrome

Interactions

  • Ergotamines / methysergide: avoid within 24 hours (coronary vasospasm)
  • Other triptans: avoid within 24 hours
  • SSRIs / SNRIs: small risk of serotonin syndrome — counsel; do not routinely avoid
  • MAOIs: contraindicated (within 14 days)
  • CYP3A4 inhibitors (ketoconazole, ritonavir): ↑ almotriptan levels — caution

Monitoring

  • Headache diary; days/month of triptan use

Reference: BNF 90; SmPC Almogran; NICE CG150 (Headaches in over 12s 2012, updated 2021); BASH Migraine Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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