Naratriptan belongs to the group of triptans. The drug is effective against migraine and cluster headaches.
What is naratriptan?
Naratriptan belongs to the group of triptans. The drug is effective against migraine and cluster headaches. Naratriptan is an active substance from the triptan group. Several different triptans are available in Germany. The selective serotonin agonist naratriptan was manufactured in the 1990s by the British pharmaceutical company GlaxoSmithKline. Naratriptan, which entered the market in 1997, was the weakest triptan because it was supposed to cause fewer side effects than other triptans. For some time, naratriptan represented the only triptan in Europe that was no longer subject to prescription at a suitably low dosage of 2.5 milligrams per tablet. Thus, naratriptan in the form of the preparation Formigran can be purchased over the counter in pharmacies since 2006. In 2012, bioequivalent generics were also launched on the market. Naratriptan is used in migraine for the treatment of acute headache during an attack.
Pharmacologic action
In the case of migraine, affected individuals suffer periodically from typical headache attacks, which occur hemiplegically. About the exact processes during a migraine attack in the body exist until today only assumptions. During an attack, vasoactive messenger substances are released within the blood vessels of the brain. The messenger substances cause the blood vessels to dilate and activate adjacent nerve fibers. This causes inflammation, which results in the irritation of sensitive nerve endings on the blood vessels. This results in the emission of painful signals to important brain switching centers. Affected individuals experience severe headaches, nausea, and nausea. Naratriptan is considered a selective agonist at serotonin receptors such as 5-HT1B and 5-HT1D. These receptors are found presynaptically on neurons (nerve cells) and cerebral blood vessels. When a migraine attack occurs, naratriptan has the ability to activate the receptors. This allows the blood vessels within the brain to constrict to their normal size, which in turn results in the attenuation of the transmission of pain. In this process, the messenger substance serotonin is influenced. Furthermore, fewer inflammatory mediators are released. Since naratriptan is considered to be very well tolerated, it is well suited for the therapy of patients who are coming into contact with a triptan for the first time. It is also recommended for young and sensitive patients. The onset of action and the subsiding of the headache occurs in a period of about one hour. The maximum effect occurs after about four hours, so naratriptan should be taken as early as possible. Another advantage of naratriptan is that recurrent headaches occur in only 19 percent of all patients. In addition, the duration of action of the serotonin agonist turns out to be longer than with other triptans.
Medical application and use
The most important indication for naratriptan is migraine-related headaches. In this context, the active substance is suitable for the treatment of migraine attacks with or without aura. An aura is when the migraine attack is accompanied by visual disturbances, speech disorders or paralysis. However, naratriptan is not suitable for the permanent treatment of migraine, so its use should be limited to the duration of the attack. Naratriptan should also only be used if there is a confirmed diagnosis of migraine. Furthermore, no other brain diseases should be present. Furthermore, naratriptan is used to prevent cluster headaches.
Risks and side effects
In general, naratriptan can be classified as well tolerated. Therefore, side effects show up relatively rarely. The most common adverse effects include malaise, nausea, vomiting, drowsiness, feeling hot, tingling, and dizziness. In some cases, there may also be palpitations, slower heartbeat, an increase in blood pressure, visual disturbances, feelings of pressure, pain, angina attacks, itching, hives, edema, as well as allergic shock. In the worst case, even a heart attack is within the realm of possibility. It is suspected that some side effects are the result of the migraine attack.If naratriptan is taken for too long, there is a risk of aggravation of the symptoms, which may be manifested by regular headaches. The use of naratriptan is considered unsuitable if the patient suffers from forms of migraine such as basilar migraine caused by blood flow, hemiplegic migraine or paralysis of the eye muscles. Other contraindications include previously suffered heart attacks, heart disease due to decreased blood flow, circulatory disorders of the limbs, strokes, renal dysfunction, hepatic dysfunction, and hypersensitivity to the active ingredient. In addition, patients should not be older than 65 years. There is little evidence to date that the drug is suitable for use during pregnancy. In principle, the migraine drug should only be used in pregnant women with the consent of the physician. Since it is also not known whether naratriptan can pass into breast milk, it is recommended that the child not be breastfed until 24 hours after administration of the drug. Naratriptan should not be administered at the same time as ergot alkaloids. Thus, there is a risk of spasm of the coronary arteries. Furthermore, concomitant use of naratriptan and selective serotonin reuptake inhibitors should be done only under strict supervision of a physician. There may otherwise be a risk of dangerous serotonin syndrome.
