Acute Migraine Treatment with Eletriptan
Migraine is multi factorial, neurological and disabling disorder also characterized by several autonomic symptoms. Triptans, selective serotonin 5-HT1B/1D agonists are the first-line treatment option for moderate-to-severe headache attacks. The researchers reviewed the recent data on eletriptan clinical efficacy, safety and tolerability and potential clinically efficacy.
It has a good tolerability profile in the treatment of migraine, especially for patients with cardiovascular risk factors without coronary artery disease. It shows the most favorable clinical response, together with sumatriptan injections, zolmitriptan and rizatriptan. Additionally, eletriptan shows the most complex pharmacokinetic/dynamic profile compared with the other triptans.
Eletriptan is a relatively new drug approved by the US FDA for acute migraine with or without aura in adults. It has consistent and significant clinical efficacy and a good tolerability profile. The clinical efficacy of eletriptan at suggested dosages has been compared in several trials for the treatment of moderate-to-severe acute migraine attacks. Among various triptans, eletriptan exhibits a higher frequency of central side effects, including dose-related somnolence, dizziness, asthenia and nausea. It may interact with substrates, inhibitors and inducers of the CYP3A4 enzyme. Eletriptan metabolism by the prostaglandin G/H synthase 1 (or cyclooxigenase-1) has been also reported. Notably, frovatriptan and eletriptan are the only triptans not metabolized by monoamino-oxydase 1, thus have no risk of interaction with drugs acting on these enzymes.
Triptan selection for each patient is a complex process involving several clinical, pharmacological and individual variables. Eletriptan is a selective 5-HT1 vaso-constrictive drug for intracranial blood vessels than extracranial vessels, with a very low vaso-constrictive action on coronary arteries. Pharmacokinetic parameters are linear over the clinical-dose range and eletriptan is primarily metabolized by hepatic cytochrome P450, accounting for higher chances of interactions. It showed that most favorable clinical responses among all triptans Co-prescription of eletriptan with drugs such as potent CYP3A4 inhibitors and other serotoninergic medications should be carefully considered.