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Triptan (5-HT1B/1D agonist) Pregnancy: US Pregnancy Category C. In animal studies almotriptan produced developmental toxicity (increased embryolethality, foetal skeletal variations, decreased offspring body weight) at doses greater than those used clinically. There are no adequate and well-controlled studies in pregnant women; use during pregnancy only if the potential benefit justifies the potential risk to the foetus.

Almotriptan

Brand names: Almogran

A serotonin 5-HT1B/1D receptor agonist (triptan) used for the acute treatment of migraine attacks with or without aura.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 6.25 mg to 12.5 mg as a single dose (the 12.5 mg dose tends to be the more effective dose in adults)
Route: Oral
Frequency: Single dose for an acute migraine attack; if the headache is relieved but returns, the dose may be repeated after 2 hours
Max: 25 mg in 24 hours
Acute treatment of migraine attacks. Individuals vary in their response to different doses, so the choice of dose should be made on an individual basis. The effectiveness of a second dose has not been established in placebo-controlled trials, and the benefit of a second dose in patients who failed to respond to the first dose has not been established. The safety of treating an average of more than four migraines in a 30-day period has not been established. Adolescents aged 12 to 17 years: the label gives the same fixed 6.25 mg to 12.5 mg dose as adults (not weight-based); efficacy on migraine-associated symptoms (nausea, photophobia, phonophobia) was not established in adolescents, and safety and efficacy under 12 years have not been established. Elderly with normal renal function for their age: same dose as younger adults, but dose selection should be cautious. With ketoconazole: use a single 6.25 mg dose, maximum 12.5 mg daily. NOTE: no UK SPC was fetched — this is US labelling (Mylan, label date 2017-05-09) and must be checked against the UK SPC before publication.

Dose adjustments

Renal

Severe renal impairment: recommended starting dose 6.25 mg, maximum daily dose 12.5 mg in 24 hours. Hepatic impairment: recommended starting dose 6.25 mg, maximum daily dose 12.5 mg in 24 hours.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Ischaemic heart disease (angina, previous myocardial infarction, documented silent ischaemia), coronary artery vasospasm including Prinzmetal's variant angina, or other significant underlying cardiovascular disease
  • Cerebrovascular syndromes, including stroke of any type and transient ischaemic attack
  • Peripheral vascular disease (including ischaemic bowel disease)
  • Uncontrolled hypertension
  • Use within 24 hours of an ergotamine-containing or ergot-type medication, or of another 5-HT1 agonist (e.g. another triptan)
  • Hemiplegic or basilar migraine
  • Known hypersensitivity to almotriptan

Side effects

  • Dizziness, somnolence, headache, paraesthesia, nausea and vomiting (most common, ≥1%; reported in the adolescent study, where the safety and tolerability profile was similar to that seen in adults)
  • Sensations of pain, tightness, pressure and heaviness in the chest, throat, neck and jaw — generally not associated with myocardial ischaemia, but evaluate for coronary artery disease if suggestive of angina
  • Serious cardiac reactions including myocardial infarction, coronary artery vasospasm, transient myocardial ischaemia, ventricular tachycardia and ventricular fibrillation (extremely rare, mostly in patients with risk factors for coronary artery disease)
  • Cerebrovascular events, some fatal
  • Other vasospasm-related events including peripheral vascular ischaemia, colonic/gastrointestinal ischaemic events and Raynaud's syndrome
  • Serotonin syndrome; increases in blood pressure

Interactions

  • Ergotamine-containing or ergot-type medicines (dihydroergotamine, ergotamine tartrate, methysergide) — do not use within 24 hours of each other; vasospastic effects may be additive
  • Other 5-HT1 agonists (triptans) — concomitant use within 24 hours is contraindicated
  • SSRIs and SNRIs — cases of life-threatening serotonin syndrome reported with combined use; monitor for neurologic changes and gastrointestinal symptoms
  • Ketoconazole — use a single almotriptan dose of 6.25 mg; maximum daily dose 12.5 mg

Clinical monograph

How it works

It stimulates 5-HT1B/1D receptors causing cranial vasoconstriction and inhibition of pro-inflammatory neuropeptide release from trigeminal nerve terminals, relieving migraine.

Prescribing in practice

  • As a vasoconstrictor it is contraindicated in ischaemic heart disease, coronary spasm, uncontrolled hypertension and cerebrovascular or peripheral vascular disease.
  • It should be taken to treat an established migraine attack rather than during aura, and overuse can lead to medication-overuse headache.
  • Combination with ergot alkaloids or other triptans must be avoided, and caution is needed with serotonergic drugs because of serotonin syndrome risk.

Monitoring

No routine laboratory monitoring is required; review cardiovascular risk before use and monitor headache frequency to detect medication-overuse headache.

Counselling the patient

  • Take it as soon as the headache phase of a migraine starts, not during warning aura.
  • Limit the number of treatment days each month to avoid rebound headaches.
  • Seek urgent advice if you develop chest tightness or pain after a dose.

Evidence & guidelines

Use is supported by NICE guidance on the management of headaches and migraine, which positions triptans for acute attacks.

Reference: SmPC Almogran; NICE CG150 (Headaches in over 12s 2012, updated 2021); BASH Migraine Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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