5-HT1B/1D agonist (triptan) Pregnancy: Administration should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus. Animal studies do not indicate direct teratogenic effects, although delays in foetal ossification and possible effects on embryo viability were seen in the rabbit; post-marketing prospective registry data cover fewer than 60 exposed pregnancies, too few for a definitive conclusion. Breast-feeding: infant exposure should be minimised by avoiding breast-feeding for 24 hours after treatment.

Naratriptan

Brand names: Naramig

Naratriptan is a selective serotonin 5-HT1B/1D receptor agonist (a triptan) used for the acute treatment of migraine attacks.

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: 2.5 mg as a single dose, taken as early as possible after the onset of a migraine headache (adults 18 to 65 years)

Route: Oral — tablets should be swallowed whole with water

Frequency: Once per attack. If symptoms of migraine recur following an initial response, a second dose may be taken provided there is a minimum interval of four hours between the two doses.

Max: 5 mg in any 24-hour period

UK SPC (Naratriptan 2.5 mg film-coated tablets / Naramig, eMC product 102192), acute treatment of a migraine attack. Recommended as MONOTHERAPY; must NOT be used prophylactically. Tablets are effective if taken at a later stage of the attack, but should be taken as early as possible. If a patient does not respond to a first dose, a second dose should NOT be taken for the same attack as it is unlikely to be of benefit — however naratriptan may be used for subsequent migraine attacks. Adolescents 12 to 17 years: efficacy at single doses of 0.25, 1.0 and 2.5 mg was not demonstrated to be greater than placebo in a placebo-controlled study, so use under 18 years is not recommended. Children under 12 years: no data available; use not recommended. Elderly over 65 years: safety and effectiveness have not been evaluated and use cannot be recommended (there is a moderate decrease in clearance with age). Hepatic impairment: use with caution — the maximum dose in any 24-hour period is a single 2.5 mg tablet; contraindicated in severe hepatic impairment (Child-Pugh grade C). (US label, cross-check: recommended dose 1 mg or 2.5 mg; if the migraine returns or there is only a partial response, the dose may be repeated once after 4 hours to a maximum of 5 mg in 24 hours; in mild to moderate renal or hepatic impairment a 1 mg starting dose is recommended with a maximum of 2.5 mg in 24 hours. The safety of treating an average of more than 4 migraine attacks in a 30-day period has not been established.)

Dose adjustments

Renal

Use with caution in patients with renal impairment — the maximum dose in any 24-hour treatment period is a single 2.5 mg tablet. Contraindicated in severe renal impairment (creatinine clearance <15 ml/min). (US label: in mild to moderate renal impairment a 1 mg starting dose is recommended and the maximum daily dose should not exceed 2.5 mg over 24 hours.)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; 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

Hypersensitivity to naratriptan or to any of the excipients
Myocardial infarction, ischaemic heart disease, Prinzmetal's angina / coronary vasospasm, or symptoms or signs consistent with ischaemic heart disease
Peripheral vascular disease
History of cerebrovascular accident (CVA) or transient ischaemic attack (TIA)
Moderate or severe hypertension, and mild uncontrolled hypertension
Concomitant administration of ergotamine, ergotamine derivatives (including methysergide) and/or any other triptan / 5-HT1 receptor agonist
Severe renal impairment (creatinine clearance <15 ml/min)
Severe hepatic impairment (Child-Pugh grade C)

Side effects

Tingling/paraesthesia (common) — usually short-lived, may be severe and may affect any part of the body including the chest or throat
Dizziness and drowsiness (common)
Nausea and vomiting (common)
Sensations of heat, malaise/fatigue (common)
Bradycardia, tachycardia, palpitations (uncommon); increase in blood pressure of approximately 5 mmHg systolic and 3 mmHg diastolic for up to 12 hours after administration (uncommon)
Very rare but serious: coronary artery vasospasm, transient ischaemic ECG changes, angina and myocardial infarction; peripheral vascular ischaemia; ischaemic colitis (rare); hypersensitivity reactions up to anaphylaxis (rare)

Interactions

Ergot-containing or ergot-type medications (including dihydroergotamine and methysergide) — prolonged vasospastic reactions; use within 24 hours of each other is contraindicated (US label; also contraindicated in the UK SPC)
Other 5-HT1B/1D agonists (triptans) — concomitant use within 24 hours is contraindicated because the risk of vasospastic reactions may be additive (US label; also contraindicated in the UK SPC)
SSRIs, SNRIs, tricyclic antidepressants and MAO inhibitors — cases of serotonin syndrome have been reported during co-administration of triptans with these agents (US label)

Clinical monograph

How it works

It activates 5-HT1B/1D receptors, causing cranial vasoconstriction and inhibiting release of pro-inflammatory neuropeptides from trigeminal nerve endings, which relieves migraine.

Prescribing in practice

It is contraindicated in ischaemic heart disease, uncontrolled hypertension and other significant cardiovascular or cerebrovascular disease because of its vasoconstrictor action.
Avoid concurrent use with ergot-type medicines and other triptans owing to the risk of additive vasospasm.
Overuse can lead to medication-overuse headache, so limit frequency of use.

Monitoring

No routine laboratory monitoring is needed, but review cardiovascular risk and headache frequency at follow-up.

Counselling the patient

Take at the onset of migraine headache rather than during aura.
Seek urgent help if you develop chest tightness or pain after dosing.
Limit how often you use it to avoid rebound headaches.

Evidence & guidelines

Naratriptan is an established acute migraine therapy, with triptans recommended by NICE for moderate-to-severe attacks not responding to simple analgesia.

Reference: NICE CG150; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

MIDAS (Migraine Disability Assessment) · Headache

Drugs

Pathways